1. Renal biopsy training and sample adequacy –Audit and Re-audit at a single UK centre
Azharuddin Mohammed1 , Sarah Edwards1, Andrew Short1
1University Hospital of Coventry and Warwickshire, Clifford bridge Road, Coventry, CV2 2DX
OBJECTIVES
METHODS
Renal biopsy is an essential competency of the nephrology curriculum in UK.
In our unit majority of biopsies are performed by the radiologists.
Sample adequacy is well recognised to be operator dependent. Following a series of inadequate biopsies a retrospective audit was undertaken in 2011 of all the biopsies in the preceding 6 months.
Recommendations re-audited in 2012 to identify and compare results of biopsies performed by each operator, their technique and sample adequacy rate.
Standard: Local renal histopathologist report for sample adequacy.
Data : All renal biopsies between January -June 2012 and compared with similar data of results of audit between November April 2011.
CRRS (IT system) : To identify operator, number of cores received and sample adequacy.
Excluded : Surgical on-table transplant kidney biopsies and biopsies for renal tumours.
Included :Only ultrasound guided kidney biopsies .
2 operator groups: Radiologist(Rad) and Nephrologist (Nep).
Number of cores : Grouped into 1 core or >2 cores.
Adequacy compared for each sample as inadequate, marginal or adequate.
RESULTS
Who does kidney biopsies?
Total of 84(n=) biopsies were performed- 45 native and 39 transplant biopsies.(2011,n=90; 47N & 43T).
As recommended more biopsies (25% Vs 18%) were performed by nephrologists in Fig. 1
Number of times >2 cores taken was higher at 76.6%(61.45%).
Adequacy was better when >2 cores obtained at 97.8%(R) and 85.7%.(N) as compared to 1 core 87.5%(R) vs 66.6%(N). Fig .2
Combined inadequacy rate was non significantly better at 9.5% (11.5%) but remained high for nephrologists at 24%(19%).Radiologist were better at 5%(11%). Fig 3
Fig.1
Fig. 2
RESULTS
CONCLUSIONS
There is an on-going gap in the renal biopsy training of nephrologists in our unit . This is likely a result of 1) Far less and infrequent number of procedures done due to other clinical commitments and 2) Lack of formal education and training in the use of various available ultrasound machines.
Fig. 3
RECOMMENDATIONS
Formal education and training in the use of available ultrasound machine along with ‘nephrologist first’ policy for most renal biopsies may help improve renal biopsy training and sample adequacy if renal biopsy is to remain an essential competency for renal trainees in UK.
Peer review of renal biopsy practices may help.
Poster number: BTS/RA Congress, Bournemouth, UK, 13th – 15th March 