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Arteriovenöz Fistül ve Psodoanevrizma: Böbrek Biyopsinin Nadir Fakat Önemli İki Komplikasyonu ve 16 G Otomatik Biyopsi İğnesinin Güvenilirliği

Arteriovenous Fistula and Pseudoaneurysm: Two Important But Rare Complications of Percutaneous Renal Biopsy and Safety of the 16 G Automated Biopsy Needle

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DOI: 
10.5262/tndt.2013.1003.08
Abstract (2. Language): 
OBJECTIVE: The aim of this study was to evaluate the safety of 16 G automated biopsy needles, and the incidence of AVF and pseudoaneurysm in patients undergoing renal biopsy. MATERIAL and METHODS: Patients who underwent renal biopsy from January 2010 to December 2012 were prospectively evaluated. Color Doppler USG, hemoglobin and platelet counts, spot urine analysis were performed perormed before and after the biopsy procedure, AVF and pseudoaneurysm that developed secondary to percutaneous renal biopsy were evaluated by Doppler USG at 12 h, and 24 h, and 6 and 12 months after biopsy. RESULTS: Postbiopsy small perirenal, subcapsular, or parenchymal bleeding without clinical relevance were detected in 59 patients (89.2 %) 12 and 24 hours after procedure. RBC counts per high power fi eld increased signifi cantly after the procedure in all subjects (p<0.05). Signifi cant retroperitoneal bleeding, macroscopic hematuria, arteriovenous malformation, and pseudoaneurysm were not detected in our cohort. Glomeruli counts were acceptable in all subjects. CONCLUSION: To optimize safety, patient comfort, and diagnostic yield, a 16 G automated biopsy needle with real-time U/S guidance may be prefered as the standard approach.
Abstract (Original Language): 
AMAÇ: Bu çalışmanın amacı, nefrotik sendrom nedeni ile böbrek biyopsisi yapılan hastalarda, psödoanevrizma ve A-V fi stül sıklığını, 16 G otomatik biopsi iğnesinin güvenilirliğini değerlendirmektir. GEREÇ ve YÖNTEMLER: Çalışmaya Ocak 2010 ile Aralık 2012 yılları arasında nefrotik sendrom tanısı nedeni ile böbrek biyopsisi yapılan hastalar alındı. Biyopsi işleminden sonra psödoanevrizma ve A-V fi stül gelişip gelişmediğini değerlendirmek için işlem sonrası 12. saat, 24. saat, 6. ay ve 12. ayda hastalar renkli Doppler USG, hemogram, trombosit değerleri ve spot idrar tahlil sonuçları ile değerlendirildi. BULGULAR: Biyopsi işlemi sonrasında 12. Saat ve 24. saatlerde 59 hastada (% 89.2) klinik önem taşımayan perirenal, subkapsüler ve parenkimal kanama saptandı. 12. ve 24. saatlerde gözlenen mikroskobik hematüri oranı 6. ay ve 12. aylarda görülen mikroskobik hematüri oranına göre istatistiksel olarak anlamlı oranda yüksek saptandı (p<0.05). Ancak klinik olarak anlamlı kanama, hemogramda anlamlı düşme, makroskobik hematüri saptanmadı. Hastaların işlem sonrası takibi sırasında psödoanevrizma ve de A-V fi stül saptanmadı. SONUÇ: Böbrek biyopsi işlemi sonrasında A-v fi stül görülme oranı nadir olmamakla birlikte genellikle sessiz seyretmektedir. Klinisyenler yeterli doku elde etmek için ideal iğne kalınlığı ve görüntüleme yöntemi konusunda dikkatli olmalıdırlar. Güvenli işlem, hasta rahatlığı ve yeterli tanı materyali için USG eşliğinde 16-G otomatize böbrek biyopsi iğnesi kullanmalıdırlar.
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