Multislice Helical CT Assessment Of After Complications Percutaneous Renal Biopsy Of Chronic Kidney Disease

Objective:To evaluate the ability of multislice spiral CT(MSCT) in displaying the different types of hematoma and the associated kidney injury for the patients of chronic kidney disease, to explore the value of the triphasic dynamic contrast-enhanced MSCT in the assessment of complications after percutaneous renal biopsy(PRB), by comparing with the study of ultrasound(US).Materials and methods:Four thousand cases of chronic kidney disease after percutaneous renal biopsy patients, of whom ninety cases underwent CT scans who had more severe clinical symptoms, thirty-two patients simultaneously underwent triphasic dynamic contrast-enhanced CT scans, and hematoma size calculated by the software of the Volume. All patients were before PRB for biochemical tests, and record the data. In addition, patients underwent renal US before and after the renal biopsy. Then, the ability of showing the different types of hematoma and the associated kidney injury were evaluated between CT and US. The statistical ways were adppted according to corresponding data.Results:1、Forty-eight cases (53.3%,48/90) patients detected extrinsic hematoma of the renal. Basing on CT manifestations, the renal hematoma could be divided into three types; Subcapsular hematoma (SH) of the kidney39cases (81.3%,39/48), of whom complicating mild laceration of kidney in1cases (2.6%,1/39); Perinephric capsule hematoma (PCH) of the kidney6cases(12.5%,6/48), of whom complicating mild laceration of kidney in2cases(33.3%,2/6); Peritoneal-cavity hematoma(PH)3cases (6.3%,3/48), of whom complicating severe laceration of kidney in2cases(66.7%,2/3);1case PCH of the kidney and2cases PH complicated by renal pseudoaneurysm.2、Forty-eight cases of hematoma were found for US, which found1case of renal laceration and5cases of renal arteriovenous fistula.3、The bulk of three types hematoma were9.47±10.13ml for SH of the kidney,214.60±125.74ml for PCH and1645.80±283.62ml for PH, and there were significant differences among three types hematoma(P<0.01).4、There were51cases of IgA nephropathy (IgAN) patients in the90cases, of whom detected hematoma in27cases (52.9%,27/51); Thirty-nine cases of non-IgAN, of whom detected hematoma in21cases(53.8%,21/39). The frequencies of hematoma in IgAN and non-IgAN were no significant differences (X2=0.007, P>0.05). The activated partial thromboplastin time and Fibrinogen in non-hematoma group and hematoma group were significant differences(t=-2.259、-2.042, P<0.05).Conclusion:In this study, CT evaluation of percutaneous renal biopsy complications for the patients of chronic kidney disease, specific conclusions are as follows:1、Quantification of perinephric hematoma was feasible from CT data in all patients and was reproducible. Three kinds there are significant differences in hematoma size, hematoma size by the hematoma can accurately determine the type; hematoma greater the greater the risk of renal laceration.2、US has a low sensitivity for renal cortex and medulla injury, collecting system injury, vascular injury, and differentiate blood from extravasated urine or other body fluids, and often leads to underestimation of injury severity.3、The triphasic dynamic contrast-enhanced CT scans have the same evaluation value with US for minor complications (such as SH), but have a significant advantage over US for serious complications (such as PCH and PH with renal parenchyma, collecting system and vascular injury). They can accurately reveal the site and make the diagnosis of disease, to guide clinical treatment programs have a very important practical value.