Safety and effectiveness of transjugular renal biopsy: A single center study

Abstract

Although percutaneous renal biopsy remains the preferred method, there are several scenarios where transjugular approach is more suitable. We hereby describe our technique of transjugular renal biopsy (TJRB) and evaluate its safety and efficacy. We retrospectively collected data regarding indication for the transjugular route of biopsy, its complications, clinical and laboratory data, and adequacy of samples from patients' records. TJRB was performed when the patients were at a high risk for bleeding from percutaneous renal biopsy. Tissue samples were assessed by a pathologist for adequacy. All patients were followed up with ultrasonographic scan 3 h after the procedure and on day 3. Nine patients (age 41.5 ± 15.4 years; 8 men) underwent 9 TJRB procedures. The procedure was technically successful in all patients. Six patients (66.67%) had a platelet count of <50,000/mcL, 2 (33.3%) had an elevated International Normalized Ratio of more than 1.4, and 1 had both. 3.2 ± 0.4 cores were obtained, with median (range) number of glomeruli being ten (7–11). Adequate renal tissue sample was obtained in all the patients. Though capsular perforation developed in 5 patients, none had major complication requiring management (endovascular treatment or blood transfusion). TJRB is a safe and effective in patients with contraindications to percutaneous biopsy.

Renal Biopsy: Appraisal of the Methods

“…Major complications are seen in 1-18% of cases when using the aspiration needle [23][24][25][26], compared to 2.7-27% with the core biopsy technique [27,28]. Rathod et al in India reported capsular perforation in five out of nine patients who had TRJRB using the core biopsy approach, although none had major event requiring intervention (blood transfusion or embolisation) [11]. Contrast nephropathy is a concern given that a significant proportion of patients undergoing this procedure have baseline renal impairment, but only 15-30 ml of contrast is used.…”

“…The right internal jugular vein is often preferred due to its straighter course to the inferior vena cava. Following injection of local anaesthetic to skin and subcutaneous area, the vein is punctured with an 18-guage needle just above the thyroid cartilage medial to the sternal head of the sternocleidomastoid [11]. A guide wire is inserted and then a venous sheath is introduced over it.…”

“…Next the catheter is advanced under fluoroscopic guidance through the IVC into the right renal vein. Lastly, the TRJB needle, pre-filled with normal saline and attached to a 20 ml luer lock syringe, is advanced down the catheter to obtain the tissue core (core biopsy technique) [11]. More than one pass is usually possible to improve tissue yield.…”

Safety of Obtaining an Extra Biobank Kidney Biopsy Core

“…Over the years, the technique has evolved to ultrasound-guided kidney biopsy, which was introduced in the 1980s and was associated with a significant reduction of the complications [ 6 , 7 ]. However, percutaneous puncture remains an invasive procedure and it is important to assess the pitfalls and benefits in patients at high risk of bleeding [ 8 ]. In high-risk patients, several centers perform trans-jugular renal biopsy to reduce the rate of complications [ 9 , 10 ].…”

Endoscopic ultrasound-guided renal biopsy: an alternative to transjugular renal biopsy in high-risk patients

“…5). TJRB is the alternative to percutaneous biopsy in high-risk patients with ascites and thrombocytopenia [1]. EUS-guided fine-needle aspiration cytology of renal masses has been described in case series [2,3], but sampling for primary diagnosis of nephrotic syndrome has not been described.…”