Audit of Ultrasound Guided Renal Biopsy

To audit diagnostic adequacy and complications of ultrasound guided renal biopsies.

Renal biopsies assess the histopathological diagnosis of native and transplant renal disease. Adequate samples are necessary for diagnosis and to enable prompt treatment of patients.

The standard: 

Renal transplant - Banff Criteria^(1,2)

Adequate sample: 10+ glomeruli and 2+ arteries

Marginal sample: 7 - 10 glomeruli and 1 artery

Unsatisfactory sample: < 7 glomeruli or no arteries

Native kidney – local pathology guideline, literature⁽³⁾

Adequate sample: 10+ glomeruli

Unsatisfactory sample: <10 glomeruli

Optimal Needle Gauge: 16G ^(4,5)

Target: 

Diagnostic adequacy:  >75% ^(3,5,6)

Re-biopsy rate: <5% ⁽⁶⁾

Major complications requiring further intervention: <1% ^(5,6)

Minor complications e.g. macroscopic haematuria, perirenal haematoma <5% ^(5,6)

Indicators: 

Number of glomeruli per sample

Presence of arteries

Complications

Data items to be collected: 

All departmental ultrasound guided renal biopsies from RIS

Operator (consultant, trainee)

Transplant and native: number of glomeruli

Transplant: number of arteries

Complications: from RIS/radiology software and discharge summaries/clinic letters

Suggested number: 

100, or all biopsies over 1 year

Present audit results at local & regional meetings

Seminar with operators concerning technique and importance of sample adequacy

Close supervision of trainees

Each operator to analyse their results

Trainees results reviewed at end of placement / appraisal

In room pathologist for ‘hot’ assessment

Appoint a lead consultant to supervise biopsies

Re-audit annually

1. Racusen LC, Solez K, Colvin RB et al. The Banff 97 working classification of renal allograft pathology. Kidney Int. 1999;55:713–23

2. Roufosse C, Simmonds N, Clahsen-van Groningen M et al.  2018 Reference Guide to the Banff Classification of Renal Allograft Pathology. 2018; 102:1795-1814

3. Geldenhuys L, Nicholson P, Sinha N et al. Percutaneous native renal biopsy adequacy: a successful interdepartmental quality improvement activity. Can J Kidney Health Dis. 2015; 2:8

4. Nicholson ML, Wheatley TJ, Doughman TM et al. A prospective randomized trial of three different sizes of core-cutting needle for renal transplant biopsy. 2000 ;58:390-5.

5. Schwarz A, Gwinner W, Hiss M et al. Safety and adequacy of renal transplant protocol biopsies. 2005; 5:1992-6.

6. H Ramotar, Smith J. Single operator/trainer renal biopsy complications in a tertiary centre: service provision audit. Leeds Teaching Hospitals audit.

Catriona Stoddart

Co-authors

Christopher Miller

Haripriya Ramotar

Hannah Lambie

Jonathan Smith