Percutaneous Renal Biopsy of Native Kidneys in Adults: A Single Center 40-Year Experience.

BACKGROUND: Percutaneous renal biopsy of native kidneys is essential in the diagnosis and management of renal disease. We report one of the largest single center experiences on the success and safety of the procedure. METHODS: From 6/1983 to 12/2022, 1384 adults underwent percutaneous renal biopsy using real-time ultrasound guidance using predominantly automated 14- and 16-gauge needles. A complication was defined by the need for an intervention (transfusion, radiologic or surgical procedure) or death. Multivariate analysis using logistic regression was performed to determine which features were predictive of attaining >20 total glomeruli and a complication or need for a transfusion post renal biopsy. RESULTS: Adequate tissue for diagnosis was obtained in 99% of biopsies. Significantly more glomeruli were obtained using the 14- vs 16-gauge automated needle (32±14 vs 27±12, P <0.001) with 81% vs 74% having >20 glomeruli (P 0.01). There was no difference in complication rate (7.0 vs 8.0%, P 0.6) or transfusion requirement (5.6 vs 5.7%, P 1.0) for the 14- vs 16-gauge automated needle. By multivariate analysis the features predictive of >20 total glomeruli per biopsy were the use of a 14- v. 16-gauge automated needle and obtaining >3 cores. By multivariate analysis, baseline features predictive of a complication were female gender (Adjusted Odds Ratio (OR) 2.1), systolic blood pressure >130 mmHg and >175 mmHg (OR 1.8 and 6.4, respectfully) and Hgb <10.5 g/dL OR 3.5). CONCLUSIONS: Percutaneous renal biopsy of native kidneys using real-time ultrasound remains a successful and safe procedure. The use of a 14-gauge automated needle not only provides a more glomeruli but is equally as safe as a 16-gauge automated needle.