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Iliac crest bone biopsy by interventional radiologists to improve access to bone biopsy in chronic kidney disease populations: technical note and a case series

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Abstract

Introduction

Chronic kidney disease-mineral and bone disorder (CKD-MBD) leads to increased fracture risk. Iliac crest biopsy remains the gold standard for diagnosing bone disease in CKD. Unfortunately, bone biopsy is rarely performed which is mainly due to the inability of clinicians to perform the procedure. In this paper, we propose a fluoroscopy-guided procedure performed by interventional radiologists as a novel approach to iliac crest biopsy in adult population. We describe the implementation of the procedure and present the first 11 cases of CKD patients who underwent iliac crest biopsy with this new approach.

Methods

A nephrologist already trained in performing iliac crest biopsy initiated the creation of a fluoroscopy-based iliac crest biopsy program. Two interventional radiologists underwent a short training. Patients’ demographical, clinical and biochemical data were collected on the day of the biopsy. Complications within the first three months after the procedure were collected from electronical records.

Results

IR rapidly mastered the procedure. The use of fluoroscopy allowed a precise localisation of the biopsy site and standardization of the intervention, which ensured specimen quality. The new approach allowed CKD patients to access iliac crest biopsy, which resulted in precise bone disease diagnosis (levels of bone turnover and mineralization) and targeted therapy for each case. There were no complications during, nor within 3 months after the intervention.

Conclusions

We believe this approach will increase the access to iliac crest biopsy for diagnosing bone disease in CKD population. Studies are now needed to evaluate whether CKD patients will benefit from anti-osteoporotic therapy based on the results of iliac crest biopsy.

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Fig. 1
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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

LC. Desbiens holds a master’s scholarship from Canadian Institutes of Health Research (CIHR), Fonds de Recherche du Québec Santé (FRQS) and Laval University Faculty of Medicine. F. Lavigne has received internship scholarship from Laval University Faculty of Medicine. Dr. Mac-Way holds a scholarship from FRQS and is supported by the Kidney Foundation of Canada, the Department of Medicine and the Fondation du CHU de Québec-Université Laval. He was a past awardee of the KRESCENT program from CIHR, Canadian Society of Nephrology and the Kidney Foundation of Canada.

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Authors and Affiliations

  1. Division of Nephrology, Faculty and Department of Medicine, CHU de Québec Research Center, L’Hôtel-Dieu de Québec Hospital, Université Laval, 11 Côte-du-Palais, Quebec City, QC, G1R2J6, Canada

    Félix Lavigne, Louis-Charles Desbiens & Fabrice Mac-Way

  2. Department of Radiology, Faculty of Medicine, CHU de Québec, L’Hôtel-Dieu de Québec Hospital, Université Laval, 11 Côte-du-Palais, Quebec City, QC, G1R 2J6, Canada

    Guillaume Garneau & François Côté

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  1. Félix Lavigne
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  2. Louis-Charles Desbiens
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  3. Guillaume Garneau
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  4. François Côté
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  5. Fabrice Mac-Way
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Contributions

FMW designed this study and trained GG and FC to perform iliac crest biopsy. FL, LCD and FMW collected and analysed data. FL and FMW have drafted the manuscript. FL, LCD, GG, FC and FMW have revised the final version of the manuscript.

Corresponding author

Correspondence to Fabrice Mac-Way.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The data used for this technical note paper are part of a larger study that was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of CHU de Québec (registration number: 2012-831).

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Informed consent was obtained for all participants.

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Lavigne, F., Desbiens, LC., Garneau, G. et al. Iliac crest bone biopsy by interventional radiologists to improve access to bone biopsy in chronic kidney disease populations: technical note and a case series. J Nephrol 34, 901–906 (2021). https://doi.org/10.1007/s40620-020-00798-x

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  • DOI: https://doi.org/10.1007/s40620-020-00798-x

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