Introduction. Adequate renal biopsies are essential for the diagnosis and treatment of medical renal disease. This process requires a sufficient number of glomeruli for light microscopy, immunofluorescence, and electron microscopy evaluation. On-site microscopic evaluation of kidney biopsy specimens significantly improves sample adequacy and the ability to render a diagnosis, with studies showing a much higher rate of inadequate samples when on-site evaluation is absent. Inadequate biopsies can have a significant negative impact on patient care including delay of adequate diagnoses, worsening of the patients’ condition and complications, and increasing costs due to the need for repeat biopsies. A real time on-site evaluation of kidney biopsies adequacy protocol was introduced in our institution on April 2019.
Methods. The goal was to document improved adequacy of non-targeted kidney biopsies after protocol implementation using a dissecting microscope and a protocol for on-site adequacy evaluation introduced on April 2019. Annual inadequacy rates were calculated, using a two-proportions calculation with α 0.15 and Fisher exact test to determine the statistical significance between data from 2017 and 2018, and 2023 and 2024.
Results and conclusion. The results showed a decrease in the inadequate biopsy rates from 23- 25% to 8.3-5% after implementation of the on-site quality improvement protocol, with return of investment after the first case, considering the cost of a repeat biopsy. In addition, we establish a more cohesive relationship between nephrology, interventional radiology and pathology with a significant increase in physician satisfaction that ultimately translates into more effective patient care.