Renal Biopsy Training Using a Simulator

Nephrology Dialysis Transplantation, 2008

2000

BMC nephrology, 2015

Percutaneous renal biopsy (PRB) is an important diagnostic procedure. Despite advances in its safety profile there remains a small but significant risk of bleeding complications. Traditionally, operators train to perform PRB through tutor instruction and directly supervised PRB attempts on real patients. We describe an approach to teaching operators to perform PRB using cadaveric simulation. We devised a full day course hosted in the Clinical Anatomy Skills Centre, with places for nine candidates. Course faculty consisted of two Consultant Nephrologists, two Nephrology trainees experienced in PRB, and one Radiologist. Classroom instruction included discussion of PRB indications, risk minimisation, and management of complications. Two faculty members acted as models for the demonstration of kidney localisation using real-time ultrasound scanning. PRB was demonstrated using a cadaveric model, and candidates then practised PRB using each cadaver model. Written candidate feedback was un...

JSLS : Journal of the Society of Laparoendoscopic Surgeons, 2014

Introduction: Percutaneous nephrolithotomy is the most complicated stone surgery technique to learn. The steep learning curve is related mainly to obtaining precise renal access by puncturing the targeted calyx. A minimally misaligned puncture may lead to torrential bleeding, failure of the surgery, and complications. Renal puncture can take a long time, and the increased fluoroscopic time is a hazard for the patient and surgeon.

Pediatric Nephrology, 1993

The technique of renal biopsy includes the preparation of the patient, the localization of the kidneys, the biopsy itself and the postbiopsy care of the patient. A review of the literature and a survey of pediatric nephrologists practicing in the New York metropolitan area and in Philadelphia was used to determine what those techniques were. In preparation for biopsy, bleeding disorders are excluded and corrected if present. In units that localize the kidney by anatomical landmarks, a sonogram is performed at some earlier time to determine that the patient has two kidneys in the usual location. After sedation, patients are placed in the prone position, with a bolster under the abdomen. Sonography is the most commonly used localization method. This is followed by probing to confirm localization and depth. The Tru-Cut needle and the Franklin Vim Silverman needles are the two most commonly used. All nephrologists in the New York area then have the specimen examined to ensure adequacy of sampling. Postbiopsy care includes observation of vital signs, bed rest overnight and some limitation of activity for 2 days to 2 weeks subsequently. In the biopsy of renal allografts, palpation achieves adequate localization. The technique is otherwise the same as for the biopsy of native kidneys.

Nephrology, 2013

This paper demonstrated the better diagnostic yield of a renal biopsy sample using a caudal as opposed to a cranial biopsy needle trajectory in an ex vivo study. Given the potentially better yield and less risk of bleeding this approach now awaits clinical confirmation.

Renal Diseases [Working Title]

Renal biopsy is an invasive specialized test aimed at obtaining renal tissue for histologic diagnosis of a variety of kidney diseases. Common indications for renal biopsy in practice include adult nephrotic syndrome, steroid resistant or clinically atypical nephrotic syndrome in children, glomerulonephritis, acute kidney injury (AKI) of unknown aetiology, systemic diseases with renal involvement, and persistent proteinuria or haematuria with reduced renal function. Over the years there has been continuous refinement of renal biopsy techniques. It is now mostly performed percutaneously using imaging guidance and more sophisticated spring-loaded needles of varying sizes. Other non-percutaneous techniques such as transjugular, laparoscopic and open renal biopsy are also being performed especially in patients with contraindications to the percutaneous approach. Percutaneous ultrasound guided approach is standard care for biopsy of non-focal lesions. The CT-guided method can be used in obese patients and other patients who are unable to lay prone, patients with complex anatomy, and when the kidneys are not sufficiently visualised by ultrasound scan. The transjugular technique is most popular for combined liver and kidney biopsy. The major advantages of the laparoscopic and open biopsy techniques are the opportunity for direct visualization of the kidney and good intra-operative haemostasis.

Dialysis & Transplantation, 2011

American Journal of Kidney Diseases, 2019

The kidney biopsy is an invaluable tool that has become the gold standard for the diagnosis of pathologic kidney diseases since the early 1950s. Throughout the years, immunohistologic and ultrastructural microscopy techniques have improved and provide more information on the cause and classification of kidney diseases than that available from simple light microscopy alone. Kidney biopsy has become a preferred method to obtain critical information that can be used in conjunction with serologic, urinary, and genetic testing to diagnose a variety of kidney diseases, both acute and chronic. The kidney biopsy procedure carries relatively low risk and yields substantial information. Potential complications include bleeding requiring transfusion, gross hematuria, arteriovenous fistula formation, and perinephric hematoma, among others. Percutaneous kidney biopsies are typically performed using real-time ultrasound or computed tomographic imaging. This Core Curriculum briefly outlines the history of the kidney biopsy, then discusses indications, complications, and specific procedural aspects. Additional Readings ► Berns JS. A survey-based evaluation of selfperceived competency after nephrology fellowship training. Clin J Am Soc Nephrol. 2010;5(3):490-496. + ESSENTIAL READING ► Berns JS, O'Neill WC. Performance of procedures by nephrologists and nephrology fellows at U.S. nephrology training programs.

British Journal of Radiology, 1992

Two techniques for percutaneous renal biopsy were retrospectively reviewed to assess their relative safety and efficacy. Ultrasound localization of the kidney by a radiologists, with subsequent biopsy performed by a renal physician using a hand-held 15 G cutting needle (Tru-Cut), was compared with biopsy performed by a radiologist using an 18 G cutting needle with a springloaded biopsy device (Biopty) and real-time ultrasound guidance. The smaller needle with real-time ultrasound is more reliable at retrieving an adequate specimen for histological examination (93%) than the "conventional" technique (79%). Fewer complications occurred in the Biopty group although the difference did not reach statistical significance. The average length of stay in hospital was significantly shorter for elective biopsies with the Biopty device (1.80 compared with 2.93 nights, p < 0.01). We recommend the use of the Biopty device with an 18 G needle and real-time ultrasound guidance as the method of choice for percutaneous renal biopsy. The British Journal of Radiology, July 1992 Percutaneous renal biopsy techniques 1987. A new technique for renal allograft biopsy.