Original Article: Clinical Investigation
Clinical complications in renal biopsy using two different needle
gauges: The impact of large hematomas, a random clinical trial
Paulo Ramos Botelho Antunes,
Fabiano Franco Monteiro Prado,
oco Alvim de Souza,
Elisa Carvalho de Siqueira,
Alvares de Campos,
Maria Carolina Barbosa
Rene Berindoague Neto
Research Group on Diagnostic and Therapeutic Radiology, Santa Casa Hospital, and
Institute of Education and Research of Santa
Casa de Belo Horizonte, Santa Casa Hospital, Belo Horizonte, Minas Gerais, Brazil
Abbreviations & Acronyms
AVF = arteriovenous ﬁstula
CI = conﬁdence interval
NTRP = non-transplanted
OR = odds ratio
RCD = renal chronic disease
TRP = transplanted renal
oco Alvim de Souza Ph.D.,
Research Group on Diagnostic
and Therapeutic Radiology,
Avenida Francisco Sales,
umero 1111, Bairro Santa
enia, 30150-221 Belo
Horizonte, Minas Gerais, Brazil.
Received 6 December 2017;
accepted 20 February 2018.
Online publication 24 April
Objective: To compare complications of ultrasound-guided percutaneous renal biopsy
using two needle gauges (16-G and 18-G).
Methods: A total of 238 individuals with renal biopsy indication were included and
randomly separated into two groups: ultrasound-guided percutaneous renal biopsy
procedure carried out with a 16-G or 18-G needle. The adequacy of biopsy samples and
post-procedure complications were compared between the two groups.
Results: The procedures carried out with a 16-G needle collected fragments with a
mean of 22.1 Æ 10.8 glomeruli, and those carried out with an 18-G needle had a mean
of 17.5 Æ 9.4 glomeruli. Patients submitted to renal biopsies with a 16-G needle had a
higher likelihood of having a complication (OR 5.1, 95% CI 1.7–15.4, P = 0.001). The
overall mean volume of post-biopsy hematoma in patients with complications was
signiﬁcantly larger than those without complications (44 Æ 56.1 mL vs 5.9 Æ 6.6 mL;
P < 0.001).
Conclusions: Renal biopsies carried out by ultrasonography using an 18-G needle
provide adequate histological analysis, showing a lower amount of glomeruli but with
similar clinical quality as a 16-G needle. Furthermore, it is associated with a lower risk of
clinical complications, hematoma, needle gauges, renal biopsy,
Currently, RCD is a major public health problem worldwide. In Brazil, the prevalence of
patients maintained on a chronic dialysis program has grown in recent years. The estimated
total number of RCD patients in the country in 2014 was 112 004.
This number represents
an increase of 20 000 patients in the past 4 years (92 091 in 2010). There has been an aver-
age annual increase in the number of RCD patients of 5% in the past 4 years.
became an emerging tool for chronic renal failure screening in recent years for elucidation of
various renal diseases.
The renal biopsy is the gold standard that contributes to making a diagnosis, a treatment
selection and a prognostic evaluation of nephropathies by microscopic analysis, including
immunohistochemically and/or histopathological examinations.
However, as it is an invasive
method, biopsy of the kidney is not complication free. Among the postoperative complications,
the most frequent are macrohematuria with or without the need of blood transfusion.
The most current technique consists of the use of automatic systems of biopsy guns with
disposable needles or completely disposable systems of semi-automatic needles, associated
with an ultrasound imaging examination (ultrasound-guided percutaneous renal biopsy). The
use of ultrasonography makes biopsies of the kidney safer and easier,
such that it has
become the standard method.
To carry out this biopsy, one needle is necessary and it can
vary in gauge. In 2016, an American research group compared two different needle gauges
based on the number of tissues obtained in biopsy with two needles, complication rates, and
clinical and laboratory data. The potential for complications might be less using a 16-G
© 2018 The Japanese Urological Association
International Journal of Urology (2018) 25, 544--548 doi: 10.1111/iju.13559