Effectiveness and Safety of Image-Guided Renal Biopsies: Insights from 5,235 Procedures in the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) Registry

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PURPOSE: This study evaluates the technical success, diagnostic yield, and complication rates of image-guided percutaneous renal biopsies based on multicenter registry data from the German Society for Interventional Radiology and Minimally Invasive Therapy. MATERIALS AND METHODS: This retrospective analysis included 5,235 renal biopsies at 176 centers in Germany, Austria, and Switzerland between 2018 and 2024. Technical success was defined as image-guided confirmed needle placement within the target lesion. Diagnostic yield is defined as proportion of procedures providing adequate samples for clinical diagnosis. RESULTS: CT was used for image guidance in 78.53% followed by ultrasound in 12.32%. Technical success was 98.38% and diagnostic yield 94.92%. Technical success was high in both inpatients (98.33%) and outpatients (99.26%; OR = 0.44, 95%CI 0.11-1,80; p = 0.241). The overall complication rate was 5.04%, with major complications in 0.74%. Complications were more frequent with pathological platelet counts and INR values, but none of these coagulation parameters remained independently associated in multivariable analysis. CT-guided biopsies showed higher complication rates than ultrasound-guided procedures, and this association remained after adjustment (adjusted OR 8.57, 95%CI 3.40-21.58; p < 0.001). No fatal complications occurred within 24 h; however, three delayed deaths were documented among hospitalized patients. CONCLUSION: Percutaneous image-guided renal biopsies are effective and safe, with low complication rates and high diagnostic yield. Ultrasound guidance remained independently associated with a lower complication risk, likely reflecting selection bias.

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