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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

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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.

REFERENCES

References: 

1. Vogler C, Wang Y, Brink DS, Wood E, Belsha C, Walker PD: Renal
pathology in the pediatric transplant patient. Adv Anat Pathol 2007;
14: 202-216
2. Furness PN, Philpott CM, Chorbadjian MT, Nicholson ML,
Bosmans JL, Corthouts BL, Bogers JJ, Schwarz A, Gwinner W,
Haller H, Mengel M, Seron D, Moreso F, Cañas C: Protocol biopsy
of the stable renal transplant: A multicenter study of methods and
complication rates. Transplantation 2003;76: 969-973
3. Feneberg R, Schaefer F, Zieger B, Waldherr R, Mehls O, Schärer
K: Percutaneous renal biopsy in children: A 27-year experience.
Nephron 1998; 79: 438-446
4. Matsell DG, Jones DP, Boulden TF, Burton EM, Baum SL, Tonkin
IL: Arteriovenos fi stula after biopsy of renal transplant kidney:
Diagnosis and treatment. Pediatr Nephrol 1992; 6: 562-5645. Brandenburg VM, Frank RD, Riehl J: Color-coded duplex
sonography study of arteriovenous fi stulae and pseudoaneurysms
complicating percutaneous renal allograft biopsy. Clin Nephrol
2002; 58: 398-404
6. Tarif N, Dunne PM, Parachuru PR, Bakır AA: Life-threatening
hematuria from an arteriovenous fi stula complicating an open renal
biopsy. Nephron 1998; 80: 66-70
7. Riccabona M, Schwinger W, Ring E: Arteriovenous fi stula after
renal biopsy in children. J Ultrasound Med 1998; 17: 505-508
8. Riehl J, Maigatter S, Kierdorf H, Schmitt H, Maurin N, Sieberth HG:
Percutaneous renal biopsy: Comparison of manual and automated
puncture techniques with native and transplanted kidneys. Nephrol
Dial Transplant 1994; 9: 1568-1574
9. Rüth EM, Dittrich K, Jüngert J, Uder M, Rascher W, Dötsch J:
Successful interventional treatment of arteriovenous fi stula after
kidney biopsy in paediatric patients-a report of three cases. Nephrol
Dial Transplant 2008; 23: 3215-3218
10. Omoloja AA, Racadio JM, McEnery PT: McEnery: Post-biopsy
renal arteriovenous fi stula. Pediatr Transplantation 2002; 6: 82-85
11. Alcázar R, de la Torre M, Peces R: Symptomatic intrarenal
arteriovenous fi stula detected 25 years after percutaneous renal
biopsy. Nephrol Dial Transplant 1996; 11: 1346-1348
12. Racusen LC, Solez K, Colvin RB, Bonsib SM, Castro MC, Cavallo
T, Croker BP, Demetris AJ, Drachenberg CB, Fogo AB, Furness P,
Gaber LW, Gibson IW, Glotz D, Goldberg JC, Grande J, Halloran
PF, Hansen HE, Hartley B, Hayry PJ, Hill CM, Hoffman EO,
Hunsicker LG, Lindblad ES, Marcussen N, Mihatsch MJ, Nadasdy
T, Nickerson P, Olsen TS, Papadimitriou JC, Randhawa PS, Rayner
DC, Roberts I, Rose S, Rush D, Madrigal LS, Salomon DR, Sund
S, Taskinen E, Trpkov K, Yamaguchi Y: The Banff 97 working
classifi cation of renal allograft pathology. Kidney Int 1999;55:713
13. Friedewald WT, Levy RI, Fredrickson DS: Estimation of the
concentration of low-density lipoprotein cholesterol in plasma,
without use of the preparative ultracentrifuge. Clin Chem 1972; 18:
499-502
14. Levey AS, Coresh J,Greene T, Marsh J, Stevens LA, Kusek JW,
Van Lente F; Chronic Kidney Disease Epidemiology Collaboration:
Expressing the Modifi cation of Diet in Renal Disease Study
equation for estimating glomerular fi ltration rate with standardized
serum creatinine values. Clin Chem 2007; 53: 766-772
15. Korbet SM: Percutaneous renal biopsy. Semin Nephrol 2002; 22:
254-267
16. Kim D, Kim H, Shin G, Ku S, Ma K, Shin S, Gi H, Lee E, Yim
H: A randomized, prospective, comparative study of manual and
automated renal biopsies. Am J Kidney Dis 1998; 32: 426-431
17. Nyman RS, Cappelen-Smith J, al Suhaibani H, Alfurayh O,
Shakweer W, Akhtar M: Yield and complications in percutaneous
renal biopsy. A comparison between ultrasound-guided gun-biopsy
and manual techniques in native and transplant kidneys. Acta Radiol
1997; 38:431-436
18. Burstein DM, Korbet SM, Schwartz MM: The use of the automatic
core biopsy system in percutaneous renal biopsies: A comparative
study. Am J Kidney Dis 1993; 22: 545-55219. Manno C, Strippoli GF, Arnesano L, Bonifati C, Campobasso N,
Gesualdo L, Schena FP: Predictors of bleeding complications in
percutaneous ultrasound-guided renal biopsy. Kidney Int 2004;
66:1570-1577
20. Arora K, Punia RS, D’Cruz S: Comparison of diagnostic quality of
kidney biopsy obtained using 16g and 18g needles in patients with
diffuse renal disease. Saudi J Kidney Dis Transpl 2012;23:88-92
21. Nicholson ML, Wheatley TJ, Doughman TM, White SA, Morgan
JD, Veitch PS, Furness PN: A prospective randomized trial of three
different sizes of core-cutting needle for renal transplant biopsy.
Kidney Int 2000; 58: 390-395
22. Orons PD, Zajako AB: Angiography and interventional aspects of
renal transplantation. Radiol Clin North Am 1995; 33: 461-471
23. Boschiero LB, Saggin P, Galante O, Prati GF, Dean P, Longo M,
Ancona G: Renal needle biopsy of the transplant kidney: Vascular
and urologic complications. Urol Int 1992; 48(2): 130-133
24. Bilge I, Rozanes I, Acunas B, Minareci O, Nayir A, Oktem F, Tonguç
E, Kozok Y, Emre S, Ander H, Sirin A, Poyanli A: Endovascular
treat-ment of arteriovenous fi stulas complicating percutaneous renal
biopsy in three paediatric cases. Nephrol Dial Transplant 1999; 14:
2726-2730
25. Beaujeux R, Boudjema K, Ellero B, Rimmelin A, Roy C, Dietemann
JL, Wolf P, Cinqualbre J, Bourjat P: Endovascular treatment of renal
allograft post-biopsy arteriovenous fi stula with platinum microcoils.
Transplantation 1994; 57: 311-314
26. Rollino C, Garofalo G, Roccetello D, Sorrentino T, Sandrone M,
Basolo B, Quattrocchio G, Massara C, Ferro M, Picciotto G, Rendine
C, Piccoli G: Color coded Doppler sonography in monitoring native
kidney biopsies. Nephrol Dial Transplant 1994; 9: 1260-1263
27. Tung KT, Downes MO, O’Donnell PJ: Renal biopsy in diffuse renal
disease: Experience with a 14-gauge automatic biopsy gun. Clin
Radiol 1992; 46:111-113
28. Altebarmakian VK, Guthinger WP, Yakub YN, Guitierrez OH,
Linke CA: Percutaenous kidney biopsies: Complications and their
management. Urology 1981; 18:118-122
29. Ekelund L, Lindholm T: Arteriovenous fi stulae following
percutaneous renal biopsy. Acta Radiol Diagn (Stockh) 1971; 11(1):
38-48
30. Bennett AR, Wiener SN: Intrarenal arteriovenous fi stula and
aneurysm: A complication of percutaneous renal biopsy. Am J
Roentgenol Radium Ther Nucl Med 1965; 95:372-382
31. Hubsch PJS, Mostbeck G, Barton P, Gritzmann N, Fruehwald FXJ,
Schurawitzki H, Kovarik J: Evaluation of arteriovenous fi stulae and
pseudo aneurysm in renal allograft following percutaneous needle
biopsy. J Ultrasound 1990; 9: 95-100
32. Renowden SA, Blethyn J, Cochlin DL: Duplex and color fl ow
sonography in diagnosis of post biopsy arteriovenous fi stulae in the
transplant kidney. Clin Radiol 1992; 45:233-237
33. Pillay VK, Kurtzman NA: Percutaneous biopsy of the transplanted
kidney. JAMA 1973; 226:1561-156234. Buselmeier TJ, Schauer RM, Mauer SM, Goetz FC, Simmons
RL, Najarian JS, Kjellstrand CM, Najarian JS, Kjellstrand CM: A
simplifi ed method of percutaneous allograft biopsy. Nephron 1976;
16:318-321
35. Nagar D, Wathen RL: An improved method for renal allograft
biopsy. Kidney Int 1979; 16: 519-521
36. Bach AM, Merton DA, Burke JFJr, Halpern EJ: Sonographic
diagnosis of arteriovenous fi stula and pseudoaneurysm after biopsy
of a transplanted kidney. J Ultrasound Med 1993; 12: 545-547
37. Hubsch P, Schurawitzki H, Traindl O, Karnel F: Renal allograft
arteriovenous fi stula due to needle biopsy with late onset of
symptoms – diagnosis and treatment. Nephron 1991; 59: 482-485
38. Harrison KL, Nghiem HV, Coldwell DM, Davis CL: Renal
dysfunction due to an arteriovenous fi stula in a transplant patient. J
Am Soc Nephrol 1994; 5: 1300-1306
39. Pall AA, Reid AW, Allison ME: Renal artery aneurysm six years after
percutaneous renal biopsy: Successful treatment by embolization.
Nephrol Dial Transplant 1992; 7: 883
40. al Rasheed SA, al Mugeiren MM, Abdurrahman MB, Elidrissy AT:
The outcome of percutaneous renal biopsy in children: An analysis
of 120 consecutive cases. Pediatr Nephrol 1990; 4: 600-60341. Escolar G, Dı´az-Ricart M, Cases A: Uremic platelet dysfunction:
Past and present. Curr Hematol Rep 2005; 4: 359-367
42. De Beukelaer MM, Schreiber MH, Dodge WF, Travis LB: Intrarenal
arteriovenous fi stulas following needle biopsy of the kidney. J
Pediatr 1971; 78: 266
43. Jiang WX, Wang HF, Ma J, Han HJ.: Arteriovenous fi stula and
pseudoaneurysm as complications of renal biopsy treated with
percutaneous intervention. Chin Med J 2010; 123 (19):2736-2738
44. Wickre CG, Golper TA: Complications of percutaneous needle
biopsy of the kidney. Am J Nephrol 1982; 2: 173-178
45. Orons PD, Zajko AB: Angiography and interventional aspects of
renal transplantation. Radiol Clin North Am 1995; 33:461
46. Selim M, Goldstein MJ: Goldstein Case report: Parenchymal
pseudoaneurysm of a renal allograft after core needle biopsy: A
rare cause of allograft injury. Transplantation Proceedings 2011; 43:
2781-2783

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