Transjugular Renal Biopsy

Abstract

Background: Transjugular renal biopsy (TJRB) is still a novel technique of renal tissue sampling exploiting the transjugular route. TJRB should be performed particularly in situations when the percutaneous route is precluded, i.e. especially in patients with clotting disorders. In the past, only a few papers reported the experience with larger numbers of patients. The goal of this paper is to analyze our experience with TJRB. Methods and Results: From 1993 to 1999, 67 patients, mean age 49.8 years (SD ± 10.2), male/female ratio 40/27, underwent TJRB. Fifty-two patients (78%) suffered from renal insufficiency and 19 of them (28%) were on dialysis treatment at the time of TJRB. Arterial hypertension was recorded in 42%. The combined kidney and liver biopsy (46%) and clotting disorders (39%) were the most frequent indications for performing TJRB. Renal tissue was yielded in 53 patients (79%) but a sample sufficient for histological diagnosis was taken in 49 (73%), reaching on average 10.8 glomeruli. Altogether 19 different histological entities were disclosed and out of them, vascular nephrosclerosis (12%), necrotizing and crescentic glomerulonephritis, IgA nephropathy (IgAN) and amyloidosis (three latter per 10%) represented the most frequent diagnoses. TJRB was combined with liver biopsy in 31 patients (46%) and/or hepatic vein catheterization in 22 patients (33%) confirming portal hypertension in 8. The clinically significant liver histology was found in 20 patients, of them cirrhosis/fibrosis in 8, chronic hepatitis in 4 and steatosis in 5. Among those 20 patients, IgAN was disclosed as the most common renal diagnosis (6). Clinically symptomatic complications were recorded in 12 cases (18%) but 9 of them suffered from clotting disorders. Complications included development of subcapsular hematoma in 6 cases, macroscopic hematuria in 4 cases, and hypovolemic hemorrhagic shock in 2. One patient had to undergo surgical treatment. Dividing the patients into a subgroup with or without clotting disorders, the complication rate was 34 vs. 7%. Conclusions: TJRB is a new diagnostic method, which, looking at its indications, facilitates the diagnosis of glomerulopathies in patients who could not be considered for percutaneous renal biopsy, particularly due to clotting disorders. The technical aspect of this procedure plays a fundamental role in the final risk/benefit ratio but if done correctly it involves acceptable risk and is well tolerated.

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

“…[15161718] Diagnosis is dependent on adequate cortical sampling, providing a sufficient number of glomeruli. The median number of glomeruli per patient of ten for light microscopy in our series is comparable to the 9.8–10.8 in the aspiration series[7101314] and 9–9.8 reported in the core biopsy series. [1618] The samples were adequate for pathological diagnosis in all patients.…”

“…In patients in whom a percutaneous biopsy is contraindicated, when the pathological diagnosis alters clinical management, TJRB provides an alternative approach. Though the procedure is utilized commonly in the Western world with published data showing its safety and efficacy using both the aspiration[7101314] and the core biopsy[1516171819] techniques, it has still not gained popularity in the Indian subcontinent despite its potential to open possibilities for the management of a significant subgroup of patients who are considered high risk for both percutaneous and open kidney biopsy. Considering the cost of the procedure (approximately INR 40,000 at our center including the cost of hardware which is approximately INR 35,000), it has the potential for widespread application.…”

Transjugular versus Percutaneous Renal Biopsy for the Diagnosis of Parenchymal Disease: Comparison of Sampling Effectiveness and Complications

“…This meritorious technique has, surprisingly, been exploited poorly (12)(13)(14); perhaps this is because the technical aspects have been described inadequately. Unlike transjugular hepatic biopsy, in which tissue is obtained with the catheter in a free position-not blocked in the parenchyma-within the hepatic vein, renal biopsy requires that the device be wedged as far as possible into the peripheral renal vein to obtain contrast medium enhancement of a wedge of cortical parenchyma before puncture.…”

“…However, to our knowledge this technique has gained little acceptance; the only large series we know of, comprising 200 patients, came from the same institution as the modified transjugular hepatic biopsy technique (12). A few reports (13,14) also were published and describe the results of transjugular renal biopsy, and some limitations, which include the absence of a right kidney, that prevent its use have been emphasized (12).…”

Viral Hepatitis Infections in Chronic Kidney Disease Patients and Renal Transplant Recipients

“…Transcutaneous liver biopsy is often considered to be contraindicated in CKD patients (or even dialysis patients) due to platelet dysfunction and impaired blood coagulation in uremia. Transjugular liver (and kidney) biopsy seems to be a reasonable option; unfortunately, however, it is not routinely available [19]. Furthermore, a lot of oral antiviral agents are now licensed for use in CHB, even in HBV-infected dialysis patients, creating a limitation in our ability to obtain information on the natural (e.g.…”