A variant of the classic technique of ultrasound guided percutaneous renal biopsy: the perpendicular entry by longitudinal viewing planes with a perforated probe.

Abstract

The percutaneous biopsy of native kidneys according to the classic methodology, takes place with the introduction of the needle and its guide with ultrasound sagittal viewing planes, with a 30-degree angle, up to the lower pole of the kidney.Since the longitudinal axis of the kidneys converges towards the spine with a sharp angle, we observed that starting from a longitudinal scan of the kidney (conducted along the posterior axillary line with the patient prone) you can drive the needle by a perforated probe through a shorter path perpendicular to the end section of the lower pole of the kidney where the front and rear rims of the cortex bearings without the renal sinus interposed so increasing the chance to obtain, even with a single pass, a good sample of cortical tissue while limiting the possibility to damage the lower chalices that may cause hematuria.We biopsied in that manner 26 patients and we compared the data with those reported in the literature performed with the same needle gauge and post-biopsy monitoring period.With a statistically lower number of needle passes, it is thus obtained the 100% of the sample validity for histological analysis, in absence of major complications and statistically hemoglobin variance when compared with a group of 44 patients biopsied with a significantly greater number of needle passes in the only work carried out with classical technique in the literature (Ori et al.) which is directly comparable to our for gauge of the needles and duration of monitoring.

Key words: longitudinal scan, percutaneous renal biopsy, perforated probe, perpendicular path

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Introduzione

La biopsia renale percutanea sin dalla sua introduzione è divenuta una tecnica diagnostica nefrologica di fondamentale importanza. La biopsia renale percutanea dei reni nativi è oggi solitamente eseguita con ago vincolato alla sonda per mezzo di adattatore od a mano libera ma sempre sotto guida ecografica (1) (2). L’ecografia consente infatti di localizzare il polo inferiore renale (laddove l’accessibilità è maggiore e minore invece il rischio di pungere un vaso di calibro maggiore come quelli situati all’ilo renale) (1, 2) e di guidare colà, con precisione, l’ago bioptico. (2). Se possibile si preferisce poi il rene di sinistra per la maggiore distanza dalla vena cava.(1

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