Tangential biopsy angle and needle depth for adequacy and safety outcomes in ultrasound-guided native kidney biopsy-a single-center experience in a high-risk population.

Abstract

Background: Kidney biopsy is crucial for diagnosing kidney diseases but involves risks, notably bleeding, which must be balanced with diagnostic precision. This study examines the effect of the biopsy needle's cortical tangential angle and depth on specimen adequacy and safety outcomes.

Methods: This single-center, retrospective study reviewed electronic medical records from kidney biopsies performed between January 1, 2016 and December 31, 2020. Included were patients undergoing real-time ultrasound-guided percutaneous kidney biopsies. Exclusion criteria were pediatric patients, renal mass or transplant biopsies, and cases with incomplete records. Primary variables included biopsy needle cortical tangential angle and depth. Outcomes were tissue adequacy and safety, with complications assessed within 24 h.

Results: Out of 443 biopsies performed, 124 met the inclusion criteria. Our patient population had a mean BMI of 27.17 kg/m², which met the criteria for obesity based on BMI standards for Asians, and they also had relatively small kidneys (< 9 cm) with parenchymal thinning. Biopsies at angles of 30°-60° yielded more glomeruli (12 vs. 5, p < 0.001) and had a higher pathologist-reported adequacy (82.67% vs. 59.18%, p = 0.004). Needle depth did not significantly impact adequacy. Major complications occurred in 12.90% of cases, with blood transfusions required in 8.06% and embolizations in 3.23%. All technical factors lost statistical significance after adjusting for confounders, except for increased echogenicity, which remained significant.

Conclusions: The optimal needle angle for kidney biopsies is 30°-60° for the highest diagnostic yield compared to angles < 30° or > 60°. Our study did not reveal statistically significant differences in major complications between these angle ranges. This greater understanding of the relationship between biopsy angle, needle trajectory depth, and diagnostic and safety outcomes offers valuable insights for optimizing kidney biopsy procedures.