Complication rates of 16- and 18-gauge needles for native kidney biopsies: a systematic review and proportional meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not statistically significant (specific p-value not reported)

• Effect Size: Difference of 0.54 percentage points (not statistically significant)

• Primary Outcome: Major complication rates: 16G needles 1.83% vs 18G needles 1.29%

• Nnt Or Sensitivity: Mean glomerular yield: 18.8 with 16G vs 17.5 with 18G needles

• Confidence Interval: 16G: 95% CI 1.20-2.79%; 18G: 95% CI 0.78-2.13%

Clinical Application

Both needle sizes appear safe with low complication rates, supporting current practice flexibility Relevant to Australian nephrology practice; findings support TGA-approved biopsy devices and align with RACGP referral guidelines for specialist nephrology assessment Adult patients requiring native kidney biopsy for diagnostic evaluation of medical kidney diseases

Abstract

This systematic review and meta-analysis evaluated complication rates and diagnostic yield reported in studies of adult native kidney biopsy using 16-gauge (16 G) or 18-gauge (18 G) needles. We included randomized trials and cohort studies of real-time ultrasound-guided biopsies, including case series. MEDLINE, Embase, and CENTRAL were searched through October 2024. Two reviewers independently performed study selection, data extraction, and risk of bias assessment using Joanna Briggs Institute tools. Random-effects meta-analyses estimated pooled proportions with 95% confidence intervals (CI), and univariable random-effects meta-regression explored study-level associations with major complications, transfusion, or gross hematuria. We screened 4,499 titles and abstracts and reviewed 319 full-text articles; 62 studies comprising 68 biopsy series were included. The pooled major complication rate in studies using 16 G needles was 1.83% (95% CI: 1.20-2.79) and 1.29% (95% CI: 0.78-2.13) in studies using 18 G needles, with no statistically significant difference. Mean glomerular yield was 18.8 with 16 G and 17.5 with 18 G needles. In study-level meta-regression, studies with higher prevalence of acute kidney injury, lower mean estimated glomerular filtration rate, or lower mean hemoglobin reported higher pooled complication rates. Most studies were single-arm cohorts; between-needle differences therefore reflect indirect study-level contrasts. Interpretation is limited by retrospective design and heterogeneity across studies. Overall, studies using both needle sizes reported low complication rates and similar diagnostic yield, although definitions and reporting varied. Direct comparative studies are needed to determine whether meaningful differences exist. What was knownKidney biopsy is essential for diagnosing many medical kidney diseases and guiding treatment, requiring adequate tissue samples for subsequent analyses.Modern biopsy techniques use spring-loaded, ultrasound-guided devices with smaller gauge needles, but optimal needle size remains uncertain.While 14G needles are associated with higher complication risk, evidence on whether 16G or 18G needles differ in safety or diagnostic yield is conflicting.This study addsIn this systematic review and meta-analysis of 62 studies involving 22,208 adult native kidney biopsies, we found no statistically significant difference in major complication rates between studies using 16G and 18G needles.In study-level meta-regression analyses, studies with a higher prevalence of acute kidney injury, lower mean estimated glomerular filtration rate, and lower mean hemoglobin reported higher pooled major complication rates.Potential impactStudies using both 16G and 18G needles reported similarly low major complication rates, although comparisons are based on indirect evidence with substantial heterogeneity.Findings support the ethical feasibility and clinical relevance of a large, randomized controlled trial to definitively guide needle size selection in native kidney biopsies.

References

1. 1.Møller, M., Andersen, T. H., Borg, R., Christensen, R., Bressendorff, I., Hansen, E. K., Rønnemoes, R., Jakobsen, S. K., Haar, K., Persson, F., Rossing, P., & Hansen, D. (2026). Complication rates of 16- and 18-gauge needles for native kidney biopsies: a systematic review and proportional meta-analysis. Renal Failure. https://doi.org/10.1080/0886022X.2026.2665032