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Original ArticlesClinical Nephrology
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Survey of Kidney Biopsy Clinical Practice and Training in the United States

Christina M. Yuan, Robert Nee, Dustin J. Little, Rajeev Narayan, John M. Childs, Lisa K. Prince, Rajeev Raghavan and James D. Oliver; for the Nephrology Education Research and Development Consortium (NERDC)
CJASN May 2018, 13 (5) 718-725; DOI: https://doi.org/10.2215/CJN.13471217
Christina M. Yuan
Nephrology Service, and
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Robert Nee
Nephrology Service, and
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Dustin J. Little
Nephrology Service, and
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Rajeev Narayan
San Antonio Kidney Disease Center, San Antonio, Texas; and
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John M. Childs
Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland;
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Lisa K. Prince
Nephrology Service, and
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Rajeev Raghavan
Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas
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James D. Oliver
Nephrology Service, and
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Abstract

Background and Objectives Practicing clinical nephrologists are performing fewer diagnostic kidney biopsies. Requiring biopsy procedural competence for graduating nephrology fellows is controversial.

Design, Setting, Participants, & Measurements An anonymous, on-line survey of all Walter Reed training program graduates (n=82; 1985–2017) and all United States nephrology program directors (n=149; August to October of 2017), regarding kidney biopsy practice and training, was undertaken.

Results Walter Reed graduates’ response and completion rates were 71% and 98%, respectively. The majority felt adequately trained in native kidney biopsy (83%), transplant biopsy (82%), and tissue interpretation (78%), with no difference for ≤10 versus >10 practice years. Thirty-five percent continued to perform biopsies (13% did ≥10 native biopsies/year); 93% referred at least some biopsies. The most common barriers to performing biopsy were logistics (81%) and time (74%). Program director response and completion rates were 60% and 77%. Seventy-two percent cited ≥1 barrier to fellow competence. The most common barriers were logistics (45%), time (45%), and likelihood that biopsy would not be performed postgraduation (41%). Fifty-one percent indicated that fellows should not be required to demonstrate minimal procedural competence in biopsy, although 97% agreed that fellows should demonstrate competence in knowing/managing indications, contraindications, and complications. Program directors citing ≥1 barrier or whose fellows did <50 native biopsies/year in total were more likely to think that procedural competence should not be required versus those citing no barriers (P=0.02), or whose fellows performed ≥50 biopsies (P<0.01).

Conclusions Almost two-thirds of graduate respondents from a single military training program no longer perform biopsy, and 51% of responding nephrology program directors indicated that biopsy procedural competence should not be required. These findings should inform discussion of kidney biopsy curriculum requirements.

  • Biopsy
  • Contraindications
  • Curriculum
  • Fellowships and Scholarships
  • Interventional Radiology
  • kidney biopsy
  • Military Personnel
  • Nephrologists
  • nephrology
  • Nephrology Education
  • Nephrology Fellowship
  • Program Directors
  • Surveys and Questionnaires
  • Thinking
  • Transplants
  • United States
  • Received December 4, 2017.
  • Accepted February 13, 2018.
  • Copyright © 2018 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 13 (5)
Clinical Journal of the American Society of Nephrology
Vol. 13, Issue 5
May 07, 2018
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Survey of Kidney Biopsy Clinical Practice and Training in the United States
Christina M. Yuan, Robert Nee, Dustin J. Little, Rajeev Narayan, John M. Childs, Lisa K. Prince, Rajeev Raghavan, James D. Oliver
CJASN May 2018, 13 (5) 718-725; DOI: 10.2215/CJN.13471217

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Survey of Kidney Biopsy Clinical Practice and Training in the United States
Christina M. Yuan, Robert Nee, Dustin J. Little, Rajeev Narayan, John M. Childs, Lisa K. Prince, Rajeev Raghavan, James D. Oliver
CJASN May 2018, 13 (5) 718-725; DOI: 10.2215/CJN.13471217
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Keywords

  • biopsy
  • contraindications
  • Curriculum
  • Fellowships and Scholarships
  • Interventional Radiology
  • kidney biopsy
  • Military Personnel
  • nephrologists
  • nephrology
  • nephrology education
  • nephrology fellowship
  • Program Directors
  • surveys and questionnaires
  • Thinking
  • transplants
  • United States

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