Nephrology and the Percutaneous Renal Biopsy: A Procedure in Jeopardy of Being Lost Along the Way

[摘要] The percutaneous renal biopsy (PRB) of native kidneys was introduced by Iversen and Brun (1) in 1951. Prior to this time, insight into clinicopathologic correlation was limited to information obtained through surgically obtained specimens or from evaluation at autopsy. The development of the PRB evolved from their experience with percutaneous liver biopsy using an aspiration-needle technique. Intravenous pyelography was used for localization of the right kidney (to avoid large vessels and the spleen), and the patient was biopsied in the sitting position. Unfortunately, the success of their technique was limited, with adequate tissue obtained in only 53% of biopsies (1). Concerned with the poor technical success using this technique, Drs. Robert Kark and Robert Muehrcke (2), my predecessors at Rush University Medical Center, made important modifications to the procedure (2–5). First, they performed the biopsy with the patient in the prone position and placed a sandbag under the abdomen, because they felt this would reduce the “mobility” of the kidney. Second, instead of an aspiration biopsy needle, they used a Franklin-modified Vim-Silverman needle, a precursor to the needle currently used today, which trapped the tissue in the needle and then sheared it off. In 1954, Kark and Muehrcke (2,3,5) published their experience with this “new technique,” reporting a success rate of 96% and no major complications.

[学科分类] 泌尿医学

[关键词] Bone marrow necrosis;Sickle cell disease;Hyperhemolysis syndrome