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Title: Transjugular Renal Biopsy: Our Experience and Technical Considerations

Abstract

The purpose of this study was to describe the indications for and technique of transjugular renal biopsy (TJRB) and evaluate the efficacy and complications of this method. We performed a retrospective review of 59 patients who underwent TJRB using the Quick-core needle biopsy system (Cook, Letchworth, UK) over a 4-year period. The indications for obtaining renal biopsy included acute renal failure, chronic renal failure, nephrotic syndrome, and proteinuria with or without other associated disease. Indications for the transjugular approach included coagulopathy, biopsy of a solitary kidney or essentially single functioning kidney, simultaneous renal and hepatic biopsy, morbid obesity, and failed percutaneous biopsy. All but four cases were performed via the right internal jugular vein. The right, left, or both renal veins were cannulated in 41, 14, and 4 cases, respectively. Combined liver and renal biopsies were obtained in seven cases. Diagnostic biopsy specimens were obtained in 56 of 59 patients (95%). The number and size of tissue cores ranged from 1 to 9 mm and from 1 to 20 mm, respectively. The mean numbers of glomeruli per procedure on light microscopy and electron microscopy were 10.3 and 2.6, respectively. Specimens for immunohistology were acquired in 49 cases, of which 40more » were adequate. Of the 56 successful TJRB procedures, 34 (61%) were associated with isolated capsular perforation (19), contained subcapsular leak (10), isolated collecting system puncture (1), and concurrent collecting system and capsular perforation (4). There was a significant increase in capsular perforation with six or more needle passes, although no significant correlation was seen between number of needle passes and complication. Six patients had minor complications defined as hematuria or loin pain. Seven patients developed major complications, of whom five received blood transfusion alone. Two required intervention: in one an arteriocalyceal fistula was embolized and the patient was temporarily dialyzed; the remaining patient required ureteric stenting. In conclusion, TJRB provides an adequate yield for diagnosis. Complication rates are relatively high, but patients are also at high risk from the conventional percutaneous approach. Patient selection and optimization are critical to avoid major complications.« less

Authors:
 [1];  [2];  [3]; ; ; ;  [4]
  1. Addenbrookes Hospital, Radiology Department (United Kingdom)
  2. Royal Free Hospital, Department of Nephrology (United Kingdom)
  3. University College London, Department of Pathology (United Kingdom)
  4. Royal Free Hospital, Department of Radiology (United Kingdom)
Publication Date:
OSTI Identifier:
21450344
Resource Type:
Journal Article
Journal Name:
Cardiovascular and Interventional Radiology
Additional Journal Information:
Journal Volume: 31; Journal Issue: 5; Other Information: DOI: 10.1007/s00270-008-9308-6; Copyright (c) 2008 Springer Science+Business Media, LLC; Journal ID: ISSN 0174-1551
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BIOPSY; ELECTRON MICROSCOPY; FAILURES; GLOMERULI; LIVER; VEINS; BLOOD VESSELS; BODY; CARDIOVASCULAR SYSTEM; DIAGNOSTIC TECHNIQUES; DIGESTIVE SYSTEM; GLANDS; KIDNEYS; MICROSCOPY; ORGANS

Citation Formats

See, Teik Choon, E-mail: teikchoon.see@addenbrookes.nhs.u, Thompson, Barbara C., Howie, Alexander J., Karamshi, M., Papadopoulou, Anthie M., Davies, Neil, and Tibballs, Jonathan. Transjugular Renal Biopsy: Our Experience and Technical Considerations. United States: N. p., 2008. Web. doi:10.1007/S00270-008-9308-6.
See, Teik Choon, E-mail: teikchoon.see@addenbrookes.nhs.u, Thompson, Barbara C., Howie, Alexander J., Karamshi, M., Papadopoulou, Anthie M., Davies, Neil, & Tibballs, Jonathan. Transjugular Renal Biopsy: Our Experience and Technical Considerations. United States. doi:10.1007/S00270-008-9308-6.
See, Teik Choon, E-mail: teikchoon.see@addenbrookes.nhs.u, Thompson, Barbara C., Howie, Alexander J., Karamshi, M., Papadopoulou, Anthie M., Davies, Neil, and Tibballs, Jonathan. Mon . "Transjugular Renal Biopsy: Our Experience and Technical Considerations". United States. doi:10.1007/S00270-008-9308-6.
@article{osti_21450344,
title = {Transjugular Renal Biopsy: Our Experience and Technical Considerations},
author = {See, Teik Choon, E-mail: teikchoon.see@addenbrookes.nhs.u and Thompson, Barbara C. and Howie, Alexander J. and Karamshi, M. and Papadopoulou, Anthie M. and Davies, Neil and Tibballs, Jonathan},
abstractNote = {The purpose of this study was to describe the indications for and technique of transjugular renal biopsy (TJRB) and evaluate the efficacy and complications of this method. We performed a retrospective review of 59 patients who underwent TJRB using the Quick-core needle biopsy system (Cook, Letchworth, UK) over a 4-year period. The indications for obtaining renal biopsy included acute renal failure, chronic renal failure, nephrotic syndrome, and proteinuria with or without other associated disease. Indications for the transjugular approach included coagulopathy, biopsy of a solitary kidney or essentially single functioning kidney, simultaneous renal and hepatic biopsy, morbid obesity, and failed percutaneous biopsy. All but four cases were performed via the right internal jugular vein. The right, left, or both renal veins were cannulated in 41, 14, and 4 cases, respectively. Combined liver and renal biopsies were obtained in seven cases. Diagnostic biopsy specimens were obtained in 56 of 59 patients (95%). The number and size of tissue cores ranged from 1 to 9 mm and from 1 to 20 mm, respectively. The mean numbers of glomeruli per procedure on light microscopy and electron microscopy were 10.3 and 2.6, respectively. Specimens for immunohistology were acquired in 49 cases, of which 40 were adequate. Of the 56 successful TJRB procedures, 34 (61%) were associated with isolated capsular perforation (19), contained subcapsular leak (10), isolated collecting system puncture (1), and concurrent collecting system and capsular perforation (4). There was a significant increase in capsular perforation with six or more needle passes, although no significant correlation was seen between number of needle passes and complication. Six patients had minor complications defined as hematuria or loin pain. Seven patients developed major complications, of whom five received blood transfusion alone. Two required intervention: in one an arteriocalyceal fistula was embolized and the patient was temporarily dialyzed; the remaining patient required ureteric stenting. In conclusion, TJRB provides an adequate yield for diagnosis. Complication rates are relatively high, but patients are also at high risk from the conventional percutaneous approach. Patient selection and optimization are critical to avoid major complications.},
doi = {10.1007/S00270-008-9308-6},
journal = {Cardiovascular and Interventional Radiology},
issn = {0174-1551},
number = 5,
volume = 31,
place = {United States},
year = {2008},
month = {9}
}