Cranial versus Caudal Direction Technique of Native Percutaneous Kidney Biopsy: A Randomized Controlled Trial

Solos Jaturapisanukul; Chutima Chavanisakun; Nontawat Benjakul; Tanun Ngamvichchukorn; Punnawit Laungchuaychok; Sathit Kurathong; Wanjak Pongsittisak

doi:10.2147/IJNRD.S400639

Cranial versus Caudal Direction Technique of Native Percutaneous Kidney Biopsy: A Randomized Controlled Trial

Int J Nephrol Renovasc Dis. 2023 Mar 28:16:93-101. doi: 10.2147/IJNRD.S400639. eCollection 2023.

Authors

Solos Jaturapisanukul^{1

2}, Chutima Chavanisakun³, Nontawat Benjakul³, Tanun Ngamvichchukorn¹, Punnawit Laungchuaychok¹, Sathit Kurathong^{1

2}, Wanjak Pongsittisak^{1

2}

Affiliations

¹ Division of Nephrology and Renal Replacement Therapy, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
² Vajira Renal-Rheumatology-Autoimmune Disease Research Group, Bangkok, Thailand.
³ Department of Anatomical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.

Abstract

Background: Percutaneous kidney biopsy (PKB) is the gold standard for diagnosing various kidney diseases, but it can result in potential complications. This study aimed to compare kidney tissue adequacy and safety between the two biopsy techniques, including cranial direction (CN) and caudal direction (CD), of needle biopsy under real-time ultrasonogram guidance.

Methods: This single-center, prospective, single-blinded, randomized trial included patients undergoing native PKB from July 5, 2017, to June 30, 2019. Patients were randomized to the CN and CD groups. Adequacy and complications between the two groups were analyzed. All PKBs were performed under real-time ultrasonogram guidance with a 16-gauge kidney biopsy needle.

Results: A total of 107 participants were enrolled (53 in the CD group and 54 in the CN group). The CD group has more glomeruli than the CN group but with no statistical significance (16 versus 11, p = 0.0865). The CD group obtained more adequate kidney tissue samples than the CN group (69.8% versus 59.3%, p = 0.348). The number of inadequate glomeruli tissue sampling is similar in both groups (14 versus 15, respectively). Furthermore, the CN group had more adverse events, including Hb decline ≥10% after kidney biopsy, perinephric hematoma size ≥1 cm, hematuria, and the need for blood transfusion, than the CD group.

Conclusion: The CD technique of the percutaneous kidney biopsy in the native kidney has fewer complications and was possibly more effective than the CN technique.

Keywords: kidney biopsy; needle trajectory; post-biopsy complication.

Publication types

Case Reports
Clinical Trial

Grants and funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by Navamindradhiraj University Research Fund.