Safety and Diagnostic Yield of Transjugular Renal Biopsy

Misra, Sanjay; Gyamlani, Geeta; Swaminathan, Sundararaman; Buehrig, Christopher K.; Bjarnason, Haraldur; McKusick, Michael A.; Andrews, James C.; Johnson, Christopher M.; Fervenza, Fernando C.; Leung, Nelson

doi:10.1016/j.jvir.2007.12.447

Cited by 47 publications

(35 citation statements)

References 19 publications

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“…A case series of 70 patients who were cirrhotic and underwent TJKB (because of thrombocytopenia and coagulopathy) reported the need for blood transfusion in 3 patients and reversible AKI in 1 patient (65). As noted above, TJKBs carry the risk of other complications, such as contrast-induced nephropathy and capsular perforation (23)(24)(25)65).…”

Section: Hepatic Failurementioning

confidence: 96%

“…One series found no difference in diagnostic yield or major complications in patients undergoing PRB (n=400) or TJKB (n=400; 303 of whom had bleeding disorders) (23). However, contrast-induced nephropathy is a TJKB complication that is not encountered with PRBs, occurring in 7.8% of patients in one study (24), and some studies report high rates of capsular perforation that may require coil embolization (25).…”

Section: Other Biopsy Techniquesmentioning

confidence: 99%

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The Native Kidney Biopsy

Hogan

Mocanu

Berns

2016

Clinical Journal of the American Society of Nephrology

228

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The kidney biopsy is the gold standard in the diagnosis and management of many diseases. Since its introduction in the 1950s, advancements have been made in biopsy technique to improve diagnostic yield while minimizing complications. Here, we review kidney biopsy indications, techniques, and complications in the modern era. We also discuss patient populations in whom special consideration must be given when considering a kidney biopsy and the important role that the kidney biopsy plays in nephrology training. These data are presented to develop best practice strategies for this essential procedure.

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Section: Hepatic Failurementioning

confidence: 96%

Section: Other Biopsy Techniquesmentioning

confidence: 99%

The Native Kidney Biopsy

Hogan

Mocanu

Berns

2016

Clinical Journal of the American Society of Nephrology

228

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“…In a subsequent series, Sam et al [47] described no major bleeding events, even in those with concomitant liver biopsy. Another study by Misra et al [48] reported only one patient out of 39 patients with severe bleeding necessitating hemodynamic support after the transjugular approach [48]. Contrast medium-induced nephropathy was present in 3 of these patients (7.8%).…”

Section: Renal Biopsymentioning

confidence: 95%

Renal Dysfunction in Liver Transplant Candidates: Evaluation, Classification and Management in Contemporary Practice

Gleisner

Jung

Lentine

et al. 2012

J Nephrol Therapeutic

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Renal dysfunction is a common comorbidity in patients with liver failure and is a well-established predictor of both morbidity and mortality among patients awaiting liver transplantation. The etiology of renal failure in patients with cirrhosis can be functional, structural, or represent a combination of potentially reversible physiologic changes and permanent histologic damage. Diagnostic criteria for acute and chronic kidney disease have been established, but cirrhosis poses challenges for accurate assessment of renal function with conventional clinical methods such as serum creatinine and creatinine-based estimating equations. Renal biopsies can have an important role for defining permanent structural damage as part of the pre-transplant evaluation of patients with liver disease; however, coagulopathy, portal hypertension and ascites increase the risk of biopsy-associated complications in cirrhotic patients. While renal dysfunction due to hepatorenal physiology is potentially reversible after liver transplantation, simultaneous kidney liver transplantation and kidney after liver transplant can also improve outcomes in a subset of patients with irreversible renal injury.

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“…The correlation of needle size and complications has been shown in studies on PRB of native kidneys and allografts (8,37,38). The Transjugular Renal Access and Biopsy Set (RABS) by Cook R has been used only in small series of TJRB before including 7-59 patients (19,(39)(40)(41)(42). Results of these studies in terms of safety are inconsistent.…”

Section: Complicationsmentioning

confidence: 99%

“…Since then, several studies have shown that tissue adequacy of TJRB is excellent and comparable to PRB (17)(18)(19). However, the transjugular approach is unsuitable for vascular access to renal transplants because of the length and the curved course of the vascular route to the allograft positioned in the iliac fossa.…”

Section: Introductionmentioning

confidence: 99%

Transvenous Renal Transplant Biopsy via a Transfemoral Approach

Schmid

Jacobi

Kuefner

et al. 2013

American Journal of Transplantation

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Percutaneous renal biopsy (PRB) of kidney transplants might be prevented by an elevated risk of bleeding or limited access to the allograft. In the following, we describe our initial experience with 71 transvenous renal transplant biopsies in 53 consecutive patients with unexplained reduced graft function who were considered unsuitable candidates for PRB (4.2% of all renal transplant biopsies at our institution). Biopsies were performed via the ipsilateral femoral vein with a renal biopsy set designed for transjugular renal biopsy (TJRB) of native kidneys. Positioning of the biopsy system within the transplant vein was achievable in 58 of 71 (81.7%) procedures. The specimen contained a median of 10 glomeruli (range 0-38). Tissue was considered as adequate for diagnosis in 56 of 57 (98.2%) biopsies. With respect to BANFF 50.9% of the specimen were adequate (>10 glomeruli), 47.4% marginally adequate (1-9 glomeruli) and 1.8% inadequate (no glomeruli). After implementation of realtime assessment all specimen contained glomeruli. One of the fifty-eight (1.8%) procedure-related major complications occurred (hydronephrosis requiring nephrostomy due to gross hematuria). Transfemoral renal transplant biopsy (TFRTB) is feasible and appears to be safe compared to PRB. It offers a useful new alternative for histological evaluation of graft dysfunction in selected patients with contraindications to PRB.

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Safety and Diagnostic Yield of Transjugular Renal Biopsy

Cited by 47 publications

References 19 publications

The Native Kidney Biopsy

The Native Kidney Biopsy

Renal Dysfunction in Liver Transplant Candidates: Evaluation, Classification and Management in Contemporary Practice

Transvenous Renal Transplant Biopsy via a Transfemoral Approach

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