title: Percutaneous native renal biopsy adequacy: a successful interdepartmental quality improvement activity.
abstract: 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.
  
  
  METHODS
  Retrospective determination of renal biopsy adequacy.
  
  
  METHODS
  Queen Elizabeth II Health Sciences Centre.
  
  
  METHODS
  Patients undergoing medical renal biopsies.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, Nova Scotia Canada.
authors.forename: Laurette
authors.initials: L
authors.lastname: Geldenhuys
authors.affiliation: Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, Nova Scotia Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Nicholson
authors.affiliation: Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, Nova Scotia Canada.
authors.forename: Namita
authors.initials: N
authors.lastname: Sinha
authors.affiliation: Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, Nova Scotia Canada.
authors.forename: Angela
authors.initials: A
authors.lastname: Dini
authors.affiliation: Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia Canada.
authors.forename: Steve
authors.initials: S
authors.lastname: Doucette
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Nova Scotia Canada.
authors.forename: Talal
authors.initials: T
authors.lastname: Alfaadhel
authors.affiliation: Department of Diagnostic Imaging, Dalhousie University, Halifax, Nova Scotia Canada.
authors.forename: Valerie
authors.initials: V
authors.lastname: Keough
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Nova Scotia Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: West
keywords: Native and allograft renal biopsy adequacy