metricas
covid
Buscar en
Actas Urológicas Españolas (English Edition)
Toda la web
Inicio Actas Urológicas Españolas (English Edition) Renal biopsy with 16G needle: A safety study
Journal Information

Statistics

Follow this link to access the full text of the article

Original article
Renal biopsy with 16G needle: A safety study
Estudio de seguridad de la biopsia renal percutánea con aguja de caliber 16G
F. Guerrero-Ramos
Corresponding author
felixguerrero@gmail.com

Corresponding author.
, F. Villacampa-Aubá, E. Jiménez-Alcaide, L. García-González, I.A. Ospina-Galeano, F. de la Rosa-Kehrmann, A. Rodríguez-Antolín, J. Passas-Martínez, R. Díaz-González
Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, Spain
Read
265
Times
was read the article
71
Total PDF
194
Total HTML
Share statistics
 array:24 [
  "pii" => "S217357861400050X"
  "issn" => "21735786"
  "doi" => "10.1016/j.acuroe.2014.03.007"
  "estado" => "S300"
  "fechaPublicacion" => "2014-11-01"
  "aid" => "610"
  "copyright" => "AEU"
  "copyrightAnyo" => "2013"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "fla"
  "cita" => "Actas Urol Esp. 2014;38:584-8"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 277
    "formatos" => array:3 [
      "EPUB" => 12
      "HTML" => 194
      "PDF" => 71
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0210480613003896"
      "issn" => "02104806"
      "doi" => "10.1016/j.acuro.2013.12.001"
      "estado" => "S300"
      "fechaPublicacion" => "2014-11-01"
      "aid" => "610"
      "copyright" => "AEU"
      "documento" => "article"
      "crossmark" => 0
      "subdocumento" => "fla"
      "cita" => "Actas Urol Esp. 2014;38:584-8"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 569
        "formatos" => array:3 [
          "EPUB" => 9
          "HTML" => 319
          "PDF" => 241
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Art&#237;culo original</span>"
        "titulo" => "Estudio de seguridad de la biopsia renal percut&#225;nea con aguja de calibre 16<span class="elsevierStyleHsp" style=""></span>G"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "584"
            "paginaFinal" => "588"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Renal biopsy with 16<span class="elsevierStyleHsp" style=""></span>G needle&#58; A safety study"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 923
                "Ancho" => 1661
                "Tamanyo" => 72761
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Relaci&#243;n de complicaciones&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "F&#46; Guerrero-Ramos, F&#46; Villacampa-Aub&#225;, E&#46; Jim&#233;nez-Alcaide, L&#46; Garc&#237;a-Gonz&#225;lez, I&#46;A&#46; Ospina-Galeano, F&#46; de la Rosa-Kehrmann, A&#46; Rodr&#237;guez-Antol&#237;n, J&#46; Passas-Mart&#237;nez, R&#46; D&#237;az-Gonz&#225;lez"
            "autores" => array:9 [
              0 => array:2 [
                "nombre" => "F&#46;"
                "apellidos" => "Guerrero-Ramos"
              ]
              1 => array:2 [
                "nombre" => "F&#46;"
                "apellidos" => "Villacampa-Aub&#225;"
              ]
              2 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Jim&#233;nez-Alcaide"
              ]
              3 => array:2 [
                "nombre" => "L&#46;"
                "apellidos" => "Garc&#237;a-Gonz&#225;lez"
              ]
              4 => array:2 [
                "nombre" => "I&#46;A&#46;"
                "apellidos" => "Ospina-Galeano"
              ]
              5 => array:2 [
                "nombre" => "F&#46;"
                "apellidos" => "de la Rosa-Kehrmann"
              ]
              6 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Rodr&#237;guez-Antol&#237;n"
              ]
              7 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Passas-Mart&#237;nez"
              ]
              8 => array:2 [
                "nombre" => "R&#46;"
                "apellidos" => "D&#237;az-Gonz&#225;lez"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S217357861400050X"
          "doi" => "10.1016/j.acuroe.2014.03.007"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357861400050X?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480613003896?idApp=UINPBA00004N"
      "url" => "/02104806/0000003800000009/v1_201410280110/S0210480613003896/v1_201410280110/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173578614000511"
    "issn" => "21735786"
    "doi" => "10.1016/j.acuroe.2014.03.008"
    "estado" => "S300"
    "fechaPublicacion" => "2014-11-01"
    "aid" => "618"
    "copyright" => "AEU"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Actas Urol Esp. 2014;38:589-93"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 255
      "formatos" => array:3 [
        "EPUB" => 10
        "HTML" => 162
        "PDF" => 83
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Home-based treadmill training improved seminal quality in adults with type 2 diabetes"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "589"
          "paginaFinal" => "593"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "El entrenamiento en tapiz rodante a domicilio mejora la calidad seminal en adultos con diabetes de tipo 2"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46; Rosety-Rodriguez, J&#46;M&#46; Rosety, G&#46; Fornieles, M&#46;A&#46; Rosety, A&#46;J&#46; Diaz, I&#46; Rosety, A&#46; Rodr&#237;guez-Pareja, F&#46;J&#46; Ordonez, S&#46; Elosegui"
          "autores" => array:10 [
            0 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Rosety-Rodriguez"
            ]
            1 => array:2 [
              "nombre" => "J&#46;M&#46;"
              "apellidos" => "Rosety"
            ]
            2 => array:2 [
              "nombre" => "G&#46;"
              "apellidos" => "Fornieles"
            ]
            3 => array:2 [
              "nombre" => "M&#46;A&#46;"
              "apellidos" => "Rosety"
            ]
            4 => array:2 [
              "nombre" => "A&#46;J&#46;"
              "apellidos" => "Diaz"
            ]
            5 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "Rosety"
            ]
            6 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Rodr&#237;guez-Pareja"
            ]
            7 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Rosety"
            ]
            8 => array:2 [
              "nombre" => "F&#46;J&#46;"
              "apellidos" => "Ordonez"
            ]
            9 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Elosegui"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0210480614000217"
        "doi" => "10.1016/j.acuro.2013.10.013"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480614000217?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578614000511?idApp=UINPBA00004N"
    "url" => "/21735786/0000003800000009/v1_201410250047/S2173578614000511/v1_201410250047/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173578614001383"
    "issn" => "21735786"
    "doi" => "10.1016/j.acuroe.2014.09.007"
    "estado" => "S300"
    "fechaPublicacion" => "2014-11-01"
    "aid" => "667"
    "copyright" => "AEU"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Actas Urol Esp. 2014;38:576-83"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 547
      "formatos" => array:3 [
        "EPUB" => 13
        "HTML" => 351
        "PDF" => 183
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Comparative study of retrograde intrarenal surgery and micropercutaneous nephrolithotomy in the treatment of intermediate-sized kidney stones"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "576"
          "paginaFinal" => "583"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Estudio comparativo entre cirug&#237;a retr&#243;grada intrarrenal y micro-nefrolitotom&#237;a percut&#225;nea en el tratamiento de la litiasis renal de tama&#241;o intermedio"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0020"
          "etiqueta" => "Figure 4"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr4.jpeg"
              "Alto" => 664
              "Ancho" => 996
              "Tamanyo" => 99701
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Almost imperceptible 8<span class="elsevierStyleHsp" style=""></span>Ch microperc incision after the surgery&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "F&#46; Ram&#243;n de Fata, A&#46; Garc&#237;a-Tello, G&#46; Andr&#233;s, C&#46; Redondo, E&#46; Meil&#225;n, H&#46; Gimbernat, J&#46;C&#46; Angulo"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Ram&#243;n de Fata"
            ]
            1 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Garc&#237;a-Tello"
            ]
            2 => array:2 [
              "nombre" => "G&#46;"
              "apellidos" => "Andr&#233;s"
            ]
            3 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Redondo"
            ]
            4 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Meil&#225;n"
            ]
            5 => array:2 [
              "nombre" => "H&#46;"
              "apellidos" => "Gimbernat"
            ]
            6 => array:2 [
              "nombre" => "J&#46;C&#46;"
              "apellidos" => "Angulo"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0210480614001478"
        "doi" => "10.1016/j.acuro.2014.04.004"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480614001478?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578614001383?idApp=UINPBA00004N"
    "url" => "/21735786/0000003800000009/v1_201410250047/S2173578614001383/v1_201410250047/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "Renal biopsy with 16<span class="elsevierStyleHsp" style=""></span>G needle&#58; A safety study"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "584"
        "paginaFinal" => "588"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "F&#46; Guerrero-Ramos, F&#46; Villacampa-Aub&#225;, E&#46; Jim&#233;nez-Alcaide, L&#46; Garc&#237;a-Gonz&#225;lez, I&#46;A&#46; Ospina-Galeano, F&#46; de la Rosa-Kehrmann, A&#46; Rodr&#237;guez-Antol&#237;n, J&#46; Passas-Mart&#237;nez, R&#46; D&#237;az-Gonz&#225;lez"
        "autores" => array:9 [
          0 => array:4 [
            "nombre" => "F&#46;"
            "apellidos" => "Guerrero-Ramos"
            "email" => array:1 [
              0 => "felixguerrero&#64;gmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "F&#46;"
            "apellidos" => "Villacampa-Aub&#225;"
          ]
          2 => array:2 [
            "nombre" => "E&#46;"
            "apellidos" => "Jim&#233;nez-Alcaide"
          ]
          3 => array:2 [
            "nombre" => "L&#46;"
            "apellidos" => "Garc&#237;a-Gonz&#225;lez"
          ]
          4 => array:2 [
            "nombre" => "I&#46;A&#46;"
            "apellidos" => "Ospina-Galeano"
          ]
          5 => array:2 [
            "nombre" => "F&#46;"
            "apellidos" => "de la Rosa-Kehrmann"
          ]
          6 => array:2 [
            "nombre" => "A&#46;"
            "apellidos" => "Rodr&#237;guez-Antol&#237;n"
          ]
          7 => array:2 [
            "nombre" => "J&#46;"
            "apellidos" => "Passas-Mart&#237;nez"
          ]
          8 => array:2 [
            "nombre" => "R&#46;"
            "apellidos" => "D&#237;az-Gonz&#225;lez"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servicio de Urolog&#237;a&#44; Hospital Universitario 12 de Octubre&#44; Madrid&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Estudio de seguridad de la biopsia renal percut&#225;nea con aguja de caliber 16<span class="elsevierStyleHsp" style=""></span>G"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 923
            "Ancho" => 1661
            "Tamanyo" => 75976
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Relationship of complications&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background and objectives</span><p id="par0005" class="elsevierStylePara elsevierViewall">The percutaneous biopsy of native kidneys is a technique that has been employed for several decades for the diagnosis of medical renal diseases&#46; The technique was first described in 1951&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> although its variant in the prone position &#40;similar to the method we know today&#41; was described in 1955 by Muehrcke et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Since then&#44; this technique has been simplified and continuously improved&#46; However&#44; in the last three decades&#44; the technique has undergone its two more significant changes&#58; the use of ultrasound and the automatic biopsy gun&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Percutaneous renal biopsy has traditionally been rejected in the diagnostic regimen of renal masses for 3 main reasons&#58; the risk of disseminating tumor cells through a puncture trajectory&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> the technique&#39;s questionable diagnostic yield and the complications resulting from the procedure&#46; These issues have brought into question the appropriateness &#40;in terms of risk-benefit&#41; of the percutaneous renal biopsy of renal masses&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">However&#44; percutaneous renal biopsy is a well-established technique for ascertaining renal disease in standard clinical practice&#46; There is currently little discussion concerning its effectiveness in the diagnosis of renal diseases&#44; which according to the literature is above 90&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5&#44;10</span></a> Furthermore&#44; various studies have demonstrated the safety of the technique&#44; with a rate of major complications of approximately 5&#8211;7&#37; in virtually all of the studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5&#44;11&#44;12</span></a> In the last two decades&#44; there have been no reported complications requiring nephrectomy or surgery as a result of the use of the ultrasound-guided automated biopsy gun&#44; and there has been only 1 death related to the technique&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Since the widespread use of imaging techniques&#44; there has been a spectacular increase in the incidence of renal masses&#44; a large proportion of which are small &#40;smaller than 4<span class="elsevierStyleHsp" style=""></span>cm&#41;&#46; These masses create the most controversy in urological forums&#44; given that a rate of histological benignity of up to 20&#37; has been reported in those that are suspected of malignancy due to imaging techniques&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a> For this reason&#44; in recent years there has been a return to the discussion of implementing percutaneous renal biopsy as a routine procedure in the diagnosis of small renal masses&#46; Although problems are infrequent&#44; this technique is not without complications and morbidity&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The aim of this study was to perform a descriptive study of the complications and results of orthotopic renal biopsies indicated for medical reasons and conducted in our department&#46; We conduct these biopsies with 16<span class="elsevierStyleHsp" style=""></span>G needles&#44; one of the thickest used currently&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> which in theory entail a greater risk of morbidity&#46; Furthermore&#44; given the current controversial status of renal mass biopsy&#44; we performed a review to evaluate the role of percutaneous renal biopsy in the diagnosis of renal masses&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">We conducted a retrospective review of 180 consecutive cases of orthotopic ultrasound-guided renal biopsies performed by nephrological indication in our department between January 2008 and May 2010&#46; According to our renal biopsy protocol&#44; the patient is admitted the day before the procedure and undergoes laboratory tests &#40;blood count&#44; biochemistry and coagulation&#41;&#46; After the biopsy&#44; the patient remains for 24&#8211;48<span class="elsevierStyleHsp" style=""></span>h under observation&#44; with the first 24<span class="elsevierStyleHsp" style=""></span>hours in bed rest&#46; For patients with renal failure and to prevent the deleterious effects of associated uremic thrombopathy&#44; desmopressin acetate &#40;Minurin<span class="elsevierStyleSup">&#174;</span>&#41; is administered intravenously 1 hour before the operation at a dose of 0&#46;4<span class="elsevierStyleHsp" style=""></span>&#956;g per kg of body weight&#44; diluted in 50<span class="elsevierStyleHsp" style=""></span>cc of physiological saline at 0&#46;9&#37;&#44; to be passed in 30<span class="elsevierStyleHsp" style=""></span>min&#46; After administering local anesthesia with mepivacaine at a concentration of 1&#37;&#44; the technique is performed under ultrasound control and with a guide adapted to the transducer&#44; using a 16<span class="elsevierStyleHsp" style=""></span>G needle attached to a Bard<span class="elsevierStyleSup">&#174;</span> automated biopsy gun&#46; We collected a number of patient demographic variables &#40;age&#44; history&#44; serum creatinine readings&#44; coagulation parameters&#44; etc&#46;&#41;&#44; as well as the early complications resulting from the procedure and the approach adopted for each complication&#44; if applicable&#46; We studied the rate of complications and the relationship between risk factors and the onset of complications&#46; To assess the relationship among hypertension&#44; anticoagulation or antiplatelet therapy and complications&#44; we used the chi-squared test&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">The mean age of our patients was 55&#46;8 years &#40;range&#44; 18&#8211;88 years&#41;&#44; with a mean of 2&#46;49 cores per intervention &#40;range&#58; 1&#8211;7 cores&#41;&#46; The most common indications are listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The most common elements in the patients&#8217; history are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; In our series&#44; we found that 5&#46;6&#37; of the patients had undergone anticoagulation therapy&#44; and 10&#46;6&#37; had undergone antiplatelet therapy&#46; The overall rate of complications was 5&#46;6&#37; &#40;the complications are detailed in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Only 3 &#40;1&#46;67&#37;&#41; of the 180 patients required an interventional approach due to procedural complications&#58; 2 embolizations for retroperitoneal hematoma &#40;1&#46;1&#37;&#41; and 1 for anemia secondary to hematuria &#40;0&#46;6&#37;&#41;&#46; There was no need for surgery&#44; and there were no deaths resulting from the procedure&#46; There was no relationship &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41; between hypertension and complications &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;09&#41;&#44; prior anticoagulation therapy and complications &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;099&#41; or prior antiplatelet therapy and complications &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;603&#41;&#46; Only 2&#46;8&#37; of the biopsies presented insufficient material for the diagnosis&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Orthotopic ultrasound-guided renal biopsy with a 16<span class="elsevierStyleHsp" style=""></span>G needle is a safe technique in our center and has a low rate of complications&#44; even in patients with prior risk factors or coagulation disorders&#44; provided these are corrected appropriately prior to the procedure&#46; There are few publications that evaluate the results of renal biopsies with 16<span class="elsevierStyleHsp" style=""></span>G needles&#46; The results of our study therefore strengthen the available evidence&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a> With the rate of complications described&#44; there is no question about this technique&#39;s safety&#44; which thereby allows us to broaden its indications&#44; even for renal mass biopsies&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">At present&#44; small renal masses &#40;smaller than 4<span class="elsevierStyleHsp" style=""></span>cm&#41; constitute 48&#8211;66&#37; of all newly diagnosed renal cancers&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;17</span></a> Of these&#44; up to 20&#37; present histological criteria of benignity and 60&#37; are low-grade renal cell carcinoma&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> However&#44; the percutaneous biopsy of small renal masses remains highly questioned among urologists&#44; only 5&#37; of whom indicate that they perform the procedure more or less routinely&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The three main reasons for rejecting the biopsy of small renal masses are the safety of the technique&#44; the diagnostic yield and the risk of tumor dissemination over the course of the puncture trajectory&#46; In terms of safety&#44; the data submitted in this study clearly support the view that the procedure presents an acceptable risk&#44; even when performed with a 16<span class="elsevierStyleHsp" style=""></span>G needle&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In terms of yield&#44; our series obtained a 97&#46;2&#37; diagnostic yield&#44; although our study is limited in that the yield was achieved with kidneys with medical nephropathies and not renal masses&#46; In the case of renal mass biopsies&#44; the diagnostic yield rates described in the literature are approximately 95&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> This yield is greater for the diagnosis of benignity than of malignancy&#44; with less precision in the assignment of tumor grade in cases of malignancy&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Occasionally&#44; the diagnostic reliability is limited by the presence of areas of central necrosis or inflammatory infiltrates associated with the tumor&#46; This problem could be minimized by obtaining &#40;in addition to the central cores&#41; at least 2 cores from the periphery of the mass&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Furthermore&#44; the incorporation of new techniques developed in molecular biology-based diagnosis&#44; if they can be applied to the material obtained from biopsies&#44; could contribute to increasing our ability to individually stratify the risk for each patient and&#44; consequently&#44; adopt the most appropriate management for each patient&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> A number of authors have reported the possibility of optimizing the yield of the biopsy using a repeat biopsy&#44; for cases that are initially negative&#44; with satisfactory diagnostic rates in the second biopsy of approximately 83&#46;3&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In terms of the dissemination of tumor cells over the course of the puncture trajectory&#44; there have been numerous studies that have estimated the dissemination in negligible percentages&#44; varying between 0&#46;009&#37; and 0&#46;01&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#44;25</span></a> Even in cases of transitional cell tumor histology and despite a number of reported cases&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> this risk is negligible&#46; Therefore&#44; the hypothetical possibility of dissemination as the result of the biopsy should not preclude performing the biopsy&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The current discussion focuses on the indications of renal mass biopsy&#44; whether this technique has the ability to change the approach to management when dealing with small renal masses and whether it should be included in diagnostic and therapeutic algorithms&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#8211;30</span></a> At present and depending on the available evidence&#44; the use of biopsies for renal masses smaller than 4<span class="elsevierStyleHsp" style=""></span>cm can be recommended for the following cases<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31&#44;32</span></a>&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0070" class="elsevierStylePara elsevierViewall">As support for imaging tests in the differential diagnosis of benignity versus malignancy&#44; adjusting the treatment to the result&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0075" class="elsevierStylePara elsevierViewall">In metastatic renal masses&#44; to determine the histological type and choose the ideal treatment&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0080" class="elsevierStylePara elsevierViewall">In the context of the emergence of new ablative techniques for the local treatment of small renal tumors&#44; directed to minimize the loss of nephron mass associated with surgical treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> In these cases&#44; renal mass biopsy is included in the diagnosis section of management protocols and plays an important role in the monitoring of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Lastly&#44; renal mass biopsy maintains its role in the diagnosis of potential renal metastases of other tumors&#46;</p></li></ul></p><p id="par0090" class="elsevierStylePara elsevierViewall">As in other solid tumors &#40;breast&#44; lung&#44; prostate&#44; etc&#46;&#41;&#44; biopsy is a standard procedure prior to treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> Its application in renal tumor disease remains a challenge among urologists&#46; In recent years&#44; there has been an enormous amount of interest in the subject and a considerable number of studies&#44; many of them of unquestionable quality&#46; The standardization of the technique and&#44; with it&#44; a paradigm shift in the management of renal tumors are therefore probably just a matter of time&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0095" class="elsevierStylePara elsevierViewall">Based on the results of our study and the available literature&#44; ultrasound-guided percutaneous renal biopsy is a safe technique with a high diagnostic yield&#44; even in patients with risk factors&#44; if these factors are properly corrected prior to the procedure&#46; This fact&#44; along with the change in scenario of renal cancer &#40;a considerable majority of small and incidentally diagnosed tumors&#41; we are experiencing&#44; leads us to a new concept in the management of this cancer&#44; in which renal mass biopsy plays a key role&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:2 [
          "identificador" => "xres378206"
          "titulo" => array:5 [
            0 => "Abstract"
            1 => "Introduction and objective"
            2 => "Material and methods"
            3 => "Results"
            4 => "Conclusions"
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec357260"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "xres378207"
          "titulo" => array:5 [
            0 => "Resumen"
            1 => "Introducci&#243;n y objetivo"
            2 => "Material y m&#233;todos"
            3 => "Resultados"
            4 => "Conclusiones"
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec357259"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Background and objectives"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Materials and methods"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conclusions"
        ]
        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conflicts of interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2013-10-26"
    "fechaAceptado" => "2013-12-01"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec357260"
          "palabras" => array:3 [
            0 => "Kidney"
            1 => "Biopsy"
            2 => "Safety"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec357259"
          "palabras" => array:3 [
            0 => "Ri&#241;&#243;n"
            1 => "Biopsia"
            2 => "Seguridad"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The development of percutaneous renal biopsy as a routine diagnostic procedure for renal masses has been the topic of discussion for the last few years&#46; However&#44; this technique has been associated with some complications&#44; although infrequent&#44; and morbidity&#46; Our objective was to carry out a descriptive study about the complications and outcomes of orthotopic kidney biopsies with 16<span class="elsevierStyleHsp" style=""></span>G needle&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective review of 180 orthotopic ultrasound-guided renal biopsies performed in our service from January 2008 to May 2010 was carried out&#46; The procedure was developed using an automated biopsy gun &#40;16<span class="elsevierStyleHsp" style=""></span>G needle&#41;&#46; Data on multiple clinical variables&#44; early post-procedure complications and renal biopsy management were collected&#46; Complication rates as well as the relationship between risk factors and occurrence of complications were studied&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Mean age of the subjects was 55&#46;8 years&#46; The average number of biopsy cylinders per intervention was 2&#46;49&#46; The overall complication rate was 5&#46;6&#37;&#46; An interventionist attitude derived from complication of the procedure was necessary in only 3 patients &#40;1&#46;67&#37;&#41;&#46; No surgical interventions were required and no death as consequence of procedure was registered&#46; No relationship between hypertension &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;09&#41;&#44; previous anticoagulation &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;099&#41; or previous antiaggregation &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;603&#41; and complications was demonstrated&#46; In 2&#46;8&#37; of biopsies the material obtained was insufficient for diagnosing&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Percutaneous ultrasound-guided renal biopsy with 16<span class="elsevierStyleHsp" style=""></span>G needle is a safe technique with high diagnostic performance&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Recientemente se vuelve a discutir sobre la implantaci&#243;n de la biopsia renal percut&#225;nea como procedimiento rutinario en el diagn&#243;stico de masas renales&#46; Sin embargo&#44; aunque infrecuentes&#44; esta t&#233;cnica no est&#225; exenta de complicaciones y morbilidad&#46; Nuestro objetivo es realizar un estudio descriptivo de las complicaciones y resultados de las biopsias renales ortot&#243;picas con aguja de 16<span class="elsevierStyleHsp" style=""></span>G&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Llevamos a cabo una revisi&#243;n retrospectiva de 180 biopsias renales ortot&#243;picas ecodirigidas realizadas en nuestro servicio entre enero de 2008 y mayo de 2010&#46; La t&#233;cnica se realiza utilizando una aguja de di&#225;metro 16<span class="elsevierStyleHsp" style=""></span>G acoplada a una pistola autom&#225;tica&#46; Se recogen m&#250;ltiples variables cl&#237;nicas&#44; as&#237; como las complicaciones tempranas derivadas del procedimiento y la actitud adoptada respecto a ellas&#46; Se estudi&#243; la tasa de complicaciones&#44; as&#237; como la relaci&#243;n entre factores de riesgo y aparici&#243;n de complicaciones&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La edad media fue de 55&#44;8 a&#241;os&#44; obteni&#233;ndose una media de 2&#44;49 cilindros por intervenci&#243;n&#46; La tasa global de complicaciones fue del 5&#44;6&#37;&#46; &#218;nicamente en 3 &#40;1&#44;67&#37;&#41; pacientes de los 180 fue necesaria una actitud intervencionista derivada de complicaci&#243;n del procedimiento&#46; No hubo necesidad de intervenciones quir&#250;rgicas ni se produjeron fallecimientos derivados del procedimiento&#46; No se demostr&#243; relaci&#243;n entre HTA &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;09&#41;&#44; anticoagulaci&#243;n previa &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;099&#41; o antiagregaci&#243;n previa &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;603&#41; y complicaciones&#46; El 2&#44;8&#37; de las biopsias presentaron material insuficiente para el diagn&#243;stico&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La biopsia renal percut&#225;nea ecodirigida con aguja de 16<span class="elsevierStyleHsp" style=""></span>G es una t&#233;cnica segura y con una rentabilidad diagn&#243;stica elevada&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Guerrero-Ramos F&#44; Villacampa-Aub&#225; F&#44; Jim&#233;nez-Alcaide E&#44; Garc&#237;a-Gonz&#225;lez L&#44; Ospina-Galeano IA&#44; de la Rosa-Kehrmann F&#44; et al&#46; Estudio de seguridad de la biopsia renal percut&#225;nea con aguja de caliber 16<span class="elsevierStyleHsp" style=""></span>G&#46; Actas Urol Esp&#46; 2014&#59;38&#58;584&#8211;588&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 923
            "Ancho" => 1661
            "Tamanyo" => 75976
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Relationship of complications&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Renal failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nephrotic syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Systemic disease &#40;lupus&#44; vasculitis&#44; etc&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab575314.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Indications for orthotopic renal biopsy&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Type 2 diabetes mellitus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Antiplatelet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anticoagulation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vasculitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab575313.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Relationship of personal medical history&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Complications rate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Antiplatelet &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;603&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anticoagulation &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;099&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hypertension &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>119&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;090&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Overall &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>180&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab575312.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Relationship between risk factors and complications&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:35 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aspiration biopsy of the kidney"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46; Iversen"
                            1 => "C&#46; Brun"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med"
                        "fecha" => "1951"
                        "volumen" => "11"
                        "paginaInicial" => "324"
                        "paginaFinal" => "330"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14877837"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Technique of percutaneous renal biopsy in the prone position"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;C&#46; Muehrcke"
                            1 => "R&#46;M&#46; Kark"
                            2 => "C&#46;L&#46; Pirani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Urol"
                        "fecha" => "1955"
                        "volumen" => "74"
                        "paginaInicial" => "267"
                        "paginaFinal" => "277"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13252703"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Percutaneous renal biopsy with the use of real-time ultrasound"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;M&#46; Burstein"
                            1 => "M&#46;H&#46; Schwartz"
                            2 => "S&#46;M&#46; Korbet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Nephrol"
                        "fecha" => "1991"
                        "volumen" => "11"
                        "paginaInicial" => "195"
                        "paginaFinal" => "200"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1962666"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictors of bleeding complications in percutaneos ultrasound-guided renal biopsy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Manno"
                            1 => "G&#46;F&#46; Strippoli"
                            2 => "L&#46; Arnesano"
                            3 => "C&#46; Bonifati"
                            4 => "N&#46; Campobasso"
                            5 => "L&#46; Gesualdo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1523-1755.2004.00922.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Kidney Int"
                        "fecha" => "2004"
                        "volumen" => "66"
                        "paginaInicial" => "1570"
                        "paginaFinal" => "1577"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15458453"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Renal biopsy&#58; procedures&#44; contraindications&#44; complications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Lefaucheur"
                            1 => "D&#46; Nochy"
                            2 => "J&#46; Bariety"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.nephro.2009.02.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nephrol Ther"
                        "fecha" => "2009"
                        "volumen" => "5"
                        "paginaInicial" => "331"
                        "paginaFinal" => "339"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19345174"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Experience with a new method for percutaneous renal biopsy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "K&#46;L&#46; Donovan"
                            1 => "D&#46;M&#46; Thomas"
                            2 => "D&#46;C&#46; Wheeler"
                            3 => "I&#46;C&#46; Macdougall"
                            4 => "J&#46;D&#46; Williams"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Nephrol Dial Transplant"
                        "fecha" => "1991"
                        "volumen" => "6"
                        "paginaInicial" => "731"
                        "paginaFinal" => "733"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1754110"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adjustable automated biopsy device"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46; Jorulf"
                            1 => "L&#46;V&#46; Bennet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/radiology.185.3.1438781"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiology"
                        "fecha" => "1992"
                        "volumen" => "185"
                        "paginaInicial" => "897"
                        "paginaFinal" => "898"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1438781"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Needle tract seeding following aspiration of renal cell carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;P&#46; Gibbons"
                            1 => "W&#46;H&#46; Bush Jr&#46;"
                            2 => "L&#46;L&#46; Burnett"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Urol"
                        "fecha" => "1977"
                        "volumen" => "118"
                        "paginaInicial" => "865"
                        "paginaFinal" => "867"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/916121"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Needle tract seeding after percutaneous renal adenocarcinoma aspiration"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46;C&#46; Kiser"
                            1 => "M&#46; Totonchy"
                            2 => "J&#46;M&#46; Barry"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Urol"
                        "fecha" => "1986"
                        "volumen" => "136"
                        "paginaInicial" => "1292"
                        "paginaFinal" => "1293"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3773108"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Percutaneous renal biopsy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46;M&#46; Korbet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Nephrol"
                        "fecha" => "2002"
                        "volumen" => "22"
                        "paginaInicial" => "254"
                        "paginaFinal" => "267"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12012311"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complications of the percutaneous kidney biopsy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "W&#46;L&#46; Whittier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/j.ackd.2012.04.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Adv Chronic Kidney Dis"
                        "fecha" => "2012"
                        "volumen" => "19"
                        "paginaInicial" => "179"
                        "paginaFinal" => "187"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22578678"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complications of percutaneous renal biopsy&#58; a review of 37 years of experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46;E&#46; Parrish"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Nephrol"
                        "fecha" => "1992"
                        "volumen" => "38"
                        "paginaInicial" => "135"
                        "paginaFinal" => "141"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1395165"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Solid renal tumors&#58; an analysis of pathological features related to tumor size"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "I&#46; Frank"
                            1 => "M&#46;L&#46; Blute"
                            2 => "J&#46;C&#46; Cheville"
                            3 => "C&#46;M&#46; Lohse"
                            4 => "A&#46;L&#46; Weaver"
                            5 => "H&#46; Zincke"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.ju.0000095475.12515.5e"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Urol"
                        "fecha" => "2003"
                        "volumen" => "170"
                        "paginaInicial" => "2217"
                        "paginaFinal" => "2220"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14634382"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The natural history of incidentally detected small renal masses"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Volpe"
                            1 => "T&#46; Panzarella"
                            2 => "R&#46;A&#46; Rendon"
                            3 => "M&#46;A&#46; Haider"
                            4 => "F&#46;I&#46; Kondylis"
                            5 => "M&#46;A&#46; Jewett"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/cncr.20025"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer"
                        "fecha" => "2004"
                        "volumen" => "100"
                        "paginaInicial" => "738"
                        "paginaFinal" => "745"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14770429"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Safety and yield of percutaneous renal biopsy using an automatic 16<span class="elsevierStyleHsp" style=""></span>G needle in native kidneys"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;R&#46; Fortu&#241;o Andr&#233;s"
                            1 => "S&#46; de Lamo Mu&#241;oz"
                            2 => "E&#46; Garc&#237;a P&#233;rez"
                            3 => "A&#46; Mateos &#193;lvarez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rx.2009.11.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiologia"
                        "fecha" => "2010"
                        "volumen" => "52"
                        "paginaInicial" => "153"
                        "paginaFinal" => "156"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20097395"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Percutaneous renal biopsy&#44; a 26 years analysis&#58; complications rate and risk factors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "L&#46; Gonz&#225;lez-Michaca"
                            1 => "A&#46; Chew-Wong"
                            2 => "L&#46; Soltero"
                            3 => "G&#46; Gamba"
                            4 => "R&#46; Correa-Rotter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Invest Clin"
                        "fecha" => "2000"
                        "volumen" => "52"
                        "paginaInicial" => "125"
                        "paginaFinal" => "131"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10846435"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Decreasing size at diagnosis of stage 1 renal cell carcinoma&#58; analysis from the National Cancer Data Base&#44; 1993 to 2004"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;R&#46; Cooperberg"
                            1 => "K&#46; Mallin"
                            2 => "J&#46; Ritchey"
                            3 => "J&#46;D&#46; Villalta"
                            4 => "P&#46;R&#46; Carrol"
                            5 => "C&#46;J&#46; Kane"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.juro.2008.01.097"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Urol"
                        "fecha" => "2008"
                        "volumen" => "179"
                        "paginaInicial" => "2131"
                        "paginaFinal" => "2135"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18423754"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The penetration of renal mass biopsy in daily practice&#58; a survey among urologists"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46; Barwari"
                            1 => "J&#46;J&#46; de la Rosette"
                            2 => "M&#46;P&#46; Laguna"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1089/end.2011.0407"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Endourol"
                        "fecha" => "2012"
                        "volumen" => "26"
                        "paginaInicial" => "737"
                        "paginaFinal" => "747"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22201614"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Imaging guided biopsy of renal masses&#58; indications&#44; accuracy and impact on clinical management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46;J&#46; Wood"
                            1 => "M&#46;A&#46; Khan"
                            2 => "F&#46; McGovern"
                            3 => "M&#46; Harisinghani"
                            4 => "P&#46;F&#46; Hahn"
                            5 => "P&#46;R&#46; Mueller"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Urol"
                        "fecha" => "1999"
                        "volumen" => "161"
                        "paginaInicial" => "1470"
                        "paginaFinal" => "1474"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10210375"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of percutaneous renal biopsy in the management of small renal masses"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Wang"
                            1 => "A&#46;Y&#46; Li"
                            2 => "D&#46;P&#46; Wood Jr&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11934-010-0149-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Urol Rep"
                        "fecha" => "2011"
                        "volumen" => "12"
                        "paginaInicial" => "18"
                        "paginaFinal" => "23"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20949338"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of location and number of cores on the diagnostic accuracy of renal mass biopsy&#58; an ex vivo study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46;J&#46; Hobbs"
                            1 => "M&#46; Zhou"
                            2 => "S&#46;C&#46; Campbell"
                            3 => "H&#46; Aydin"
                            4 => "C&#46;J&#46; Weight"
                            5 => "B&#46;R&#46; Lane"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00345-012-0868-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Urol"
                        "fecha" => "2013"
                        "volumen" => "31"
                        "paginaInicial" => "1159"
                        "paginaFinal" => "1164"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22527673"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Is there a contemporary role for percutaneous needle biopsy in the era of small renal masses&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "V&#46; Ph&#233;"
                            1 => "D&#46;R&#46; Yates"
                            2 => "R&#46; Renard-Penna"
                            3 => "O&#46; Cussenot"
                            4 => "M&#46; Roupr&#234;t"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1464-410X.2011.10544.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "BJU Int"
                        "fecha" => "2011"
                        "volumen" => "109"
                        "paginaInicial" => "867"
                        "paginaFinal" => "872"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21895938"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcomes of small renal mass needle core biopsy&#44; nondiagnostic percutaneous biopsy&#44; and the role of repeat biopsy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;J&#46; Leveridge"
                            1 => "A&#46; Finelli"
                            2 => "J&#46;R&#46; Kachura"
                            3 => "A&#46; Evans"
                            4 => "H&#46; Chung"
                            5 => "D&#46;A&#46; Shiff"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.eururo.2011.06.021"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Urol"
                        "fecha" => "2011"
                        "volumen" => "60"
                        "paginaInicial" => "578"
                        "paginaFinal" => "584"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21704449"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complications of percutaneous abdominal fine needle biopsy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "E&#46; Smith"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/radiology.178.1.1984314"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiology"
                        "fecha" => "1991"
                        "volumen" => "178"
                        "paginaInicial" => "253"
                        "paginaFinal" => "258"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1984314"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The current role of percutaneous biopsy in the evaluation of renal masses"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46; Herts"
                            1 => "M&#46; Baker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Urol"
                        "fecha" => "2000"
                        "volumen" => "10"
                        "paginaInicial" => "105"
                        "paginaFinal" => "109"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10785851"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Needle tract seeding of transitional cell carcinoma following fine needle aspiration of a renal mass"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46; Slywotzky"
                            1 => "M&#46; Maya"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Abdom Imaging"
                        "fecha" => "1994"
                        "volumen" => "19"
                        "paginaInicial" => "174"
                        "paginaFinal" => "176"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8199555"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tumour seeding following percutaneous needle biopsy&#58; the real story&#33;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46;G&#46; Robertson"
                            1 => "G&#46; Baxter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.crad.2011.05.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Radiol"
                        "fecha" => "2011"
                        "volumen" => "66"
                        "paginaInicial" => "1007"
                        "paginaFinal" => "1014"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21784421"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Renal mass biopsy &#8211; a renaissance&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46;R&#46; Lane"
                            1 => "M&#46;K&#46; Samplaski"
                            2 => "B&#46;R&#46; Herts"
                            3 => "M&#46; Zhou"
                            4 => "A&#46; Novick"
                            5 => "S&#46;C&#46; Campbell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.juro.2007.08.124"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Urol"
                        "fecha" => "2008"
                        "volumen" => "179"
                        "paginaInicial" => "20"
                        "paginaFinal" => "27"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17997455"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Renal mass biopsy&#58; results and safety in 2009"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;M&#46; De la Morena"
                            1 => "C&#46; Llorente"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Urol Esp"
                        "fecha" => "2009"
                        "volumen" => "33"
                        "paginaInicial" => "499"
                        "paginaFinal" => "504"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19658302"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Biopsy of a renal mass&#58; where are we now&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;P&#46; Laguna"
                            1 => "I&#46; K&#252;mmerlin"
                            2 => "J&#46; Rioja"
                            3 => "J&#46;J&#46; de la Rosette"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MOU.0b013e32832f0d5a"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Urol"
                        "fecha" => "2009"
                        "volumen" => "19"
                        "paginaInicial" => "447"
                        "paginaFinal" => "453"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19571757"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Renal tumor biopsies for evaluation of small renal tumors&#58; why&#44; in whom&#44; and how&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Remzi"
                            1 => "M&#46; Marberger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.eururo.2008.09.053"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Urol"
                        "fecha" => "2009"
                        "volumen" => "55"
                        "paginaInicial" => "359"
                        "paginaFinal" => "367"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18849108"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "EAU guidelines on renal cell carcinoma&#58; the 2010 update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Ljungberg"
                            1 => "N&#46; Cowan"
                            2 => "D&#46;C&#46; Hanbury"
                            3 => "M&#46; Hora"
                            4 => "M&#46;A&#46; Kuczyk"
                            5 => "A&#46;S&#46; Merseburger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.eururo.2010.06.032"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Urol"
                        "fecha" => "2010"
                        "volumen" => "58"
                        "paginaInicial" => "398"
                        "paginaFinal" => "406"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20633979"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Understanding the role of percutaneous biopsy in the management of patients with a small renal mass"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46;J&#46; Tan"
                            1 => "B&#46;L&#46; Jacobs"
                            2 => "K&#46;S&#46; Hafez"
                            3 => "J&#46;S&#46; Montgomery"
                            4 => "A&#46;Z&#46; Weizer"
                            5 => "D&#46;P&#46; Wood"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Urol"
                        "fecha" => "2012"
                        "volumen" => "79"
                        "paginaInicial" => "372"
                        "paginaFinal" => "377"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Focal therapy and imaging in prostate and kidney cancer&#58; renal biopsy protocols before and after focal therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46;C&#46; Klingler"
                            1 => "M&#46; Susani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1089/end.2009.0526"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Endourol"
                        "fecha" => "2012"
                        "volumen" => "24"
                        "paginaInicial" => "701"
                        "paginaFinal" => "705"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20443725"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The contemporary role of renal mass biopsy in the management of small renal tumors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Lim"
                            1 => "B&#46; O&#8217;Neil"
                            2 => "M&#46;E&#46; Heilbrun"
                            3 => "C&#46; Dechet"
                            4 => "W&#46;T&#46; Lowrance"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3389/fonc.2012.00106"
                      "Revista" => array:5 [
                        "tituloSerie" => "Front Oncol"
                        "fecha" => "2012"
                        "volumen" => "2"
                        "paginaInicial" => "106"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22973552"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735786/0000003800000009/v1_201410250047/S217357861400050X/v1_201410250047/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "6274"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735786/0000003800000009/v1_201410250047/S217357861400050X/v1_201410250047/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357861400050X?idApp=UINPBA00004N"
]
Article information
ISSN: 21735786
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2018 February 9 0 9
2018 January 6 0 6
2017 December 6 0 6
2017 November 7 2 9
2017 October 11 2 13
2017 September 13 1 14
2017 August 16 3 19
2017 July 16 1 17
2017 June 13 3 16
2017 May 8 4 12
2017 April 26 6 32
2017 March 17 3 20
2017 February 5 6 11
2017 January 4 0 4
2016 December 18 8 26
2016 November 18 4 22
2016 October 0 2 2
2016 August 0 1 1
2016 May 0 6 6
2016 April 0 5 5
2016 March 0 5 5
2016 February 0 3 3
2015 November 0 2 2
2015 August 0 1 1
2015 July 0 1 1
2015 March 0 1 1
2015 January 0 1 1
2014 November 1 0 1
Show all

Follow this link to access the full text of the article

es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos