Handheld portable ultrasound as an affordable alternative in resource-limited countries

A single-center observational study.

Abstract

Background:  Percutaneous native kidney biopsy (PNKB) is crucial for diagnosing renal pathology. In resource-limited environments, handheld ultrasound devices may offer a cost-effective alternative for procedural guidance. We aimed to compare the safety and diagnostic yield of PNKB performed with handheld versus high-end ultrasound systems.

Methods:  retrospective cohort study at Calderón General Teaching Hospital (2021–2023), including adult patients undergoing ultrasound-guided PNKB. Procedures were categorized by device: handheld (Butterfly iQ with iPhone) versus high-end (Philips Sparq). We collected data on demographics, biopsy indications, number of passes, glomerular yield, histological diagnosis, and complications. Diagnostic adequacy and safety outcomes were compared using chi-square and t-tests.

Results:  A total of 57 PNKBs were analyzed (22 handheld; 35 high-end). Patients were 56% female, with a mean age of 33.8 ± 12.7 years. The average number of glomeruli obtained per core was 15.7 ± 8.1. Overall, 82.5% of procedures were free of complications; 17.5% had minor complications (pain ≥12 h, hematoma, or macroscopic hematuria), and no major complications occurred. Complication-free rates were similar between groups (handheld: 72.7% vs. high-end: 88.6%; p = 0.39). Diagnostic adequacy was achieved in 85.7% of biopsies, with no significant difference between handheld (81.8%) and high-end (88.2%; p = 0.50).

Conclusion:  Handheld ultrasound-guided PNKB demonstrates comparable safety and diagnostic yield to high-end systems, offering a low-cost and effective alternative in resource-limited settings. Wider adoption may enhance access to renal biopsy without compromising quality or safety.