Percutaenous kidney biopsy

Caner Alparslan
Diyarbakır Gazi Yaşargil Training and Research Hospital, Turkey

The use of percutaneous kidney biopsy technique has become one of the most important tools in nephrology practice. In conjunction with the introduction of immunofluorescence and electron microscopy, the technique of percutaneous kidney biopsy has contributed to an improved understanding of kidney diseases. Nill Alwall performed the first percutaneous kidney biopsy in 1944. One year later, he presented preliminary results in Lund, Sweden. However, he stopped performing percutaneous kidney biopsies after one patient developed a hemorrhagic complication (1-2). Nonetheless, Antonio Perez-ara in Cuba (in 1948), and Paul Iverson and Claus Brun in Copenhagen (in 1949), unaware of each other’s work (3-4), began to perform percutaneous kidney biopsies. A liver biopsy aspiration needle was used by Iverson and Brun, whereas Perez-ara used a Vim-Silverman needle to perform the procedure. In following years, Robert M. Kark and Robert C. Muehrcke further developed the prone position percutaneous kidney biopsy technique which was subsequently adopted by many countries (5). In children, the first documented attempts were made in 1955 in Cuba and 1957 in Europe (1).

Localizing the kidney is an important component of obtaining a sample(s) and, in part, reducing biopsy related complications. Until 1961, fluoroscopy and intravenous pyelography were used to localize the kidney. G.M. Berlyne suggested the use of ultrasound to localize kidneys, which subsequently became the standard in percutaneous kidney biopsy technique (1).

Today, with advances in technology and tools, disposable automatic biopsy needles and higher resolution in imaging aid in the performance of safe and useful percutaneous kidney biopsies to yield tissue samples. This tissue remains the ultimate tool to aid in diagnosis, management, and identification of new therapeutic targets in both pediatric and adult nephrology practice.

References

  1. Cameron JS, Hicks J. The introduction of renal biopsy into nephrology from 1901 to 1961: a paradigm of the forming of nephrology by technology. Am J Nephrol 1997;17:347-358.
  2. Alwall N. Aspiration biopsy of the kidney, including report of a case of amyloidosis diagnosed in 1944 and investigated autopsy. Acta Med Scand 1952;143:430-435.
  3. Iversen P, Brun C. Aspiration biopsy of the kidney. Am J Med 1951;11:324-330.
  4. Perez-Ara A. La biopsia-punctural del rinon no megalico-consideraciones generales y aportacion de un nuevo metodo. Bol Liga Cubana Contra Cancer 1950;25:121-147.
  5. Muehrcke RC, Kark RM, Pirani CL. Biopsy of the kidney in the diagnosis and management of renal disease. NEJM 1955;253:537-546.

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