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Puncture approaches for ultrasound-guided kidney biopsy specimens: a pediatric model study using piglet kidneys

Pediatric Research volume 98, pages 507–511 (2025)Cite this article

Abstract

Background

The optimal puncture approach for real-time ultrasound-guided native kidney needle biopsy in children remains undetermined due to insufficient evidence. This study evaluated various puncture approaches for glomeruli count and arterial injury in the small kidneys of piglets.

Methods

A total of 144 kidneys sourced from a slaughterhouse were examined. On each kidney, three puncture approaches were performed on the lower pole using a 16-gauge needle: Caudocranial, Craniocaudal, and Vertical. Blinded pediatric nephrologists assessed core length, glomeruli count, and arterial injury.

Results

The kidneys had a mean vertical length of 9.31 ± 0.59 cm. Of 432 punctures, no punctures traversed the kidney. The Vertical approach yielded a significantly shorter core length than other methods (P < 0.001), but the glomeruli count was consistent across approaches (P = 0.41). Over 60% of the biopsies resulted in arterial injury, with the Caudocranial approach showing significantly higher injury rates (P < 0.03).

Conclusions

This study focused on puncture techniques in a pediatric model, suggesting that the Craniocaudal and Vertical approaches are advantageous for selective glomerular sampling without increasing the arterial injury risk. Although further research on smaller kidneys is necessary, these findings offer valuable guidance for biopsy approaches to small kidneys, particularly in pediatric patients.

Impact

  • Kidney biopsy is essential for establishing diagnosis and determining treatment strategies; however, there is no consensus on the puncture approach in children who have the additional risk factor of small-sized kidneys.

  • This study compared between biopsy specimens from piglet models of pediatric kidneys to clarify the best puncture approach based on pediatric characteristics.

  • Although the same number of glomeruli were sampled using all approaches, the Caudocranial approach exhibited a significantly higher incidence of arterial injury.

  • In kidney biopsy that considers the characteristics of children with small kidneys, the Craniocaudal or Vertical approaches may improve the safety and quality of biopsy specimens.

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Fig. 1: Assortment of specimens from study kidneys using the three different approaches.
Fig. 2: Each approach performed on the inferior pole of the kidney: photographs at the time of puncture and ultrasound images.
Fig. 3: Considerations for puncturing small kidneys to prevent traversing the kidney.

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Data availability

The data underlying this article are available within the article and in its online supplementary material. Further inquiries can be directed to the corresponding author.

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Acknowledgements

This work was supported by a Japan Society for the Promotion of Science Grant-in-Aid for Scientific Research (C Grant Number JP 22K07875).

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Authors and Affiliations

  1. Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan

    Tomohiko Nishino, Sakurako Hirano, Shin Takemura, Shinya Tomori, Sayaka Ono, Kazuhiro Takahashi & Masakazu Mimaki

Authors
  1. Tomohiko Nishino
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  2. Sakurako Hirano
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  3. Shin Takemura
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  4. Shinya Tomori
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  5. Sayaka Ono
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  6. Kazuhiro Takahashi
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  7. Masakazu Mimaki
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Contributions

All authors contributed to the conception and design of this study. Tomohiko Nishino: Drafted the manuscript and performed the data collection, statistical analysis, and material preparation. Sakurako Hirano, Shin Takemura, Shinya Tomori, Sayaka Ono, and Kazuhiro Takahashi collected the data and critically reviewed the manuscript. Masakazu Mimaki: Supervised this study. All the authors have read and approved the final manuscript.

Corresponding author

Correspondence to Tomohiko Nishino.

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Competing interests

The authors declare no competing interests.

Ethics approval

This study did not require ethical approval from the Teikyo University School of Medicine Animal Ethics Committee due to the uniqueness of the specimens handled. Nevertheless, all authors respected the piglets, and all procedures were conducted following the ethical standards of the Institutional and/or National Research Committee, the International Guiding Principles for Biomedical Research Involving Animals (1985), The Protection of Animals Used for Experimental and Other Scientific Purposes (1986), and their subsequent amendments or comparable ethical standards.

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Nishino, T., Hirano, S., Takemura, S. et al. Puncture approaches for ultrasound-guided kidney biopsy specimens: a pediatric model study using piglet kidneys. Pediatr Res 98, 507–511 (2025). https://doi.org/10.1038/s41390-025-03956-8

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