Renal biopsy procedure under CT guidance: procedural steps and technique

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Procedure explained step by step.

Renal biopsy is an established tool for the diagnosis of multiple renal diseases. Reasons to perform renal biopsy are various, from renal masses to sudden renal failure or transplant rejection. When possible, the use of ultrasound (US) guidance is preferable because kidney moves during ventilation and the real time control of the needle provider by US makes the procedure easier. Unfortunately sometimes lesions are not visible at US examination because too small or deep. In these cases CT guidance is required during renal biopsy to obtain tissue specimens for pathological analysis.

TECHNIQUE AND PROCEDURAL STEPS
Computed tomography is the modality of choice for lesions that are not clearly visible at US examination. Patient collaboration is essential because the kidney moves during the respiratory acts (inflation and deflation). The patient is positioned on the CT bed in a comfortable position because the procedure has a variable duration of about 20-60 minutes in which position should be invariate. Percutaneous posterior approach is usually adopted to avoid abdominal structures such as liver, spleen, bowel loops or pancreas. Local anesthesia is administered with a small needle in order to minimize procedural pain, usually described as poor by patients. The biopsy needle is inserted up to the renal parenchyma. Needle sampling system is activated once the tip is properly located in the nodule and the needle is extracted.
All the procedure is performed under imaging guidance and needle tip position can always be checked if necessary.

COMPLICATION AND MANAGEMENT
In a small number of cases, complications may occur during the renal biopsy procedure; among these, bleeding and urinary system injury are the most common.

Parenchymal bleeding occurs when the needle passes through renal vessels. This condition is usually more frequent when the lesion is close to the hilum. In the majority of cases, bleeding is self-limiting. In a very poor number of cases the bleeding persists and an endovascular management by embolization is required.

Urinary system injury causes an urinary leak with the formation of an urinoma (urine collection close to the kidney). The urinoma is usually asymptomatic but a superinfection can occur in these patients with subsequent percutaneous CT (   • Percutaneous CT-guided drainage of a ...  ) or US-guided drainage.

The video proposes a standard CT-guided renal biopsy procedure lingering on procedural steps and technical aspects. the patient is affected by a renal lesion located in the pelvis


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