Nephrology curriculum standards

Ultrasound guided percutaneous kidney biopsy

• Anatomy:
  • standard kidney anatomy as per KG1
  • relational anatomy of kidneys – adjacent structures and landmarks from posterior view for native kidneys and anterior lower abdomen for allografts
• Clinical pharmacology of antiplatelet agents, oral anticoagulants including novel oral anticoagulants (NOACS), and fractionated and unfractionated heparin

Cuffed and uncuffed catheter insertion and removal

• Relational anatomy of neck structures

• Complications and incidence of complications when performing the procedure
• Informed consent from the patient, family and/or carer
• Pre-biopsy medications

• Adapting to patient body size
• Air embolus
• High bleeding risk
• Inadvertent biopsy of other structures or cannulation of artery
• Management of patient anxiety and compliance
• Managing breathless patients
• Monitor and respond to the pain induced by procedure
• Peri-catheter bleeding/haematoma
• Peri-procedural haemodynamic instability differential diagnosis and management

• Imaging, needles and positioning
• Indications to abandon procedure

• Post-biopsy bleeding
• Indications and contraindications for kidney biopsy or dialysis catheter insertions

• Biopsy equipment requirements – types of biopsy devices, gauge and sample length, and throw
• Local context considerations – location, staffing, monitoring devices, all equipment required, and reporting and procedure documentation system

Cuffed and uncuffed catheter insertion and removal

• Clinical pharmacology as per kidney biopsy, plus agents for light sedation and catheter-locking solutions
• Ultrasound as per biopsy, plus appearance of veins and arteries using ultrasound

Ultrasound guided percutaneous kidney biopsy

• Ultrasound transducers and machine settings – normal versus pathologic kidney findings on ultrasound imaging