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Background: Percutaneous renal biopsy is an essential tool in the diagnosis and management of renal disease, however, there are variations in the techniques employed. A needle guide is a device which aids in needle tracking during ultrasound-guided biopsies. It is unclear what impact the needle guide has on procedure duration, complication rate, and tissue sample adequacy in a pediatric population.Methods: We conducted a retrospective review of all renal biopsy procedures performed at our institution from January 2016-November 2018. All biopsies were performed by a trainee and a nephrology attending trained in the specified technique. Biopsies occurring concurrently with other invasive procedures were excluded. Procedure duration, tissue sample adequacy, and complication rate were compared between biopsies performed with and without the use of a needle guide. Major complications were defined as those which resulted in the need for a blood transfusion or an invasive procedure, the development of serious infection, prolonged hospitalization, readmission, or patient death. Minor complications were defined as perinephric hematoma, parenchymal bleeding, site infection, or macroscopic hematuria or pain requiring additional imaging. Results: Of 160 renal biopsy procedures, 54 were performed with and 106 without the use of a needle guide. Minor complications were observed in 85 (53.1 %) biopsies. On post-biopsy Doppler ultrasound, 81 (50.6%) patients had perinephric hematoma (64% of which were 24h, one of which required an invasive procedure. Relative risk of developing a complication without a needle guide was 1.55 (p =0.02, CI 1.07-2.24). The mean number of passes to acquire adequate tissue was significantly less with the needle guide than without (2.2 vs. 2.6, p=0.01), although there was no difference in adequacy between the two groups. On multivariate logistic regression, kidney transplant biopsy (vs. native) and those performed with a needle guide were significantly associated with fewer complications. On multivariate linear regression, transplant kidney biopsy, needle guide, and age were associated with reduced procedure time. The mean procedure duration was 11.2 mins shorter when performed with a guide when controlling for covariates (p

The kidney transplant is the therapy of choice for the majority of the causes of chronic terminal kidney insufficiency, because it improves the quality of life and survival in comparison with dialysis. A kidney transplant from a live donor is an excellent alternative for the young patient in a state of pre-dialysis because it offers the best results. Immunosuppressive treatment must be individualised, seeking immunosuppressive synergy and the best safety profile, and must be adapted to the different stages of the kidney transplant. In the follow-up to the kidney transplant, cardiovascular risk factors and tumours must be especially taken into account, given that the death of the patient with a working graft is the second cause of loss of the graft following the first year of the transplant. The altered function of the graft is a factor of independent cardiovascular mortality that will require follow- up and the control of all its complications to postpone the entrance in dialysis.