Percutaneous Native Renal Biopsy Adequacy: A Successful Interdepartmental Quality Improvement Activity

• Published in: Canadian journal of kidney health and disease Vol. 2; no. 1; p. 8
• Main Authors: Geldenhuys, Laurette, Nicholson, Peter, Sinha, Namita, Dini, Angela, Doucette, Steve, Alfaadhel, Talal, Keough, Valerie, West, Michael
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 13.03.2015; Sage Publications Ltd; BioMed Central Ltd; BioMed Central; SAGE Publishing
• Subjects: Biopsy; Initiatives; Original; Quality control; Quality improvement; Native and allograft renal biopsy adequacy
• ISSN: 2054-3581; 2054-3581
• DOI: 10.1186/s40697-015-0043-z

Background: An adequate renal biopsy is essential for diagnosis and treatment of medical renal disease. Objective: We evaluated two initiatives to improve adequacy of renal biopsy samples at our centre. Design: Retrospective determination of renal biopsy adequacy. Setting: Queen Elizabeth II Health Sciences Centre. Patients: Patients undergoing medical renal biopsies. Measurements: Renal biopsy adequacy. Methods: The first initiative was to restrict the performance of biopsies to a smaller group of radiologists and to include a comment on biopsy adequacy in every pathology report. The second initiative was to introduce on-site adequacy assessment by a medical laboratory technologist. Native renal and allograft biopsy adequacies were calculated for three periods: 1) baseline, October 2005 to September 2006; 2) after implementation of the first initiative, January 2007 to September 2011; and 3) after implementation of the second initiative, October 2011 to September 2012. A subset of native renal biopsies was examined to determine if there was a relationship between adequacy and number of passes. Results: The percentages of adequate native renal biopsies during the first, second, and third periods were 31%, 72% and 90%, respectively. This represents a significant increase (40%, p < 0.0001) in adequacy following the first initiative, and another significant increase (18%, p = 0.0003) following the second initiative. The percentages of adequate renal allograft biopsies during the first, second, and third periods were 75%, 56% and 69%, respectively. These changes in adequacy were not statistically significant. In the subset of native renal biopsies examined, a biopsy comprising more than three cores was not associated with increase in adequacy. Limitations: The most important limitation is the lack of generally accepted and applied adequacy criteria limiting generalizability of our findings. Conclusions: Restricting the performance of biopsies to subspecialist operators, including an adequacy statement in the renal biopsy report and on-site adequacy assessment were effective in significantly improving native renal biopsy adequacy. This improvement appeared unrelated to an increase in the number of passes taken with a biopsy needle. Neither initiative improved the low adequacy of allograft biopsies.