Kidney Biopsy Adequacy and Complications in Children – Does Technique Matter?

Abstract Background Kidney biopsy is part of the diagnostic workup of many children with renal disease. Traditionally a perpendicular approach to the biopsy has been used but more recently some proceduralists have favoured a tangential approach. It is not clear if one technique is superior with regards to tissue adequacy or complication rates. In our centre interventional radiologists (IR) use general anaesthetic and a tangential approach whereas paediatric nephrologists (PN) use sedation and a perpendicular approach. Methods We examined consecutive kidney biopsies performed between January 2008 and December 2017 for adequacy (sufficient tissue for light and electron microscopy and immunofluorescence) and examined the electronic medical records for data regarding technique and complications. Results IR performed 72 (29.4%) of the 245 native kidney biopsies, obtaining more total glomeruli (median 39 vs 16, p<0.001) and more glomeruli per tissue core (median 13.2 vs 8.0, p<0.001) than PN. No differences in specimen adequacy were observed between the two groups (79.2% IR vs 80.9% PN, p=0.75) and a diagnosis could be made in 98.6% and 93.6% respectively (p=0.1). A statistically lower rate of peri-nephric haematoma (27.8% vs 41.6%, p=0.04) was detected in the IR group, but there were no significant differences in other complications. One patient required a blood transfusion (PN) and another required surgical intervention for a perinephric haematoma (IR). Conclusion IR obtained larger samples and number of glomeruli, but the overall adequacy for native kidney biopsies was good using both perpendicular and tangential techniques, with similar low rates of significant complications.