Transjugular kidney biopsy.
BACKGROUND
Most previous studies demonstrating the feasibility of transjugular kidney biopsy have used a modified Colapinto aspiration biopsy needle. We present 25 high-risk patients, with contraindications to percutaneous renal biopsy, who underwent transjugular kidney biopsy using a transvenous side-cut needle. This technique is easier to learn and can be performed by an interventional radiologist with transjugular liver biopsy experience and equipment. The needle is designed for optimal cortical sampling but has a high incidence of capsular perforation. Elective coil embolization was used in selected patients to reduce the risk of bleeding.


METHODS
We retrospectively reviewed the indications for obtaining renal histology, based on clinical presentation, and the specific indications for transjugular biopsy. Transjugular kidney biopsy was assessed for sampling effectiveness and adequacy, the impact of histology on patient management, and technique complication rates.


RESULTS
Renal tissue was obtained in 23 cases, with diagnostic biopsies in 21 of 23 (91.3%). A mean of 3.5 cores were obtained with 9.9 glomeruli per procedure for light microscopy (range, 0 to 32), 2.2 (range, 1 to 7) for electron microscopy, and adequate tissue for immunoflorescence available in 11 of 23 biopsies. Histology influenced patient management in all 23 cases. Capsular perforation was recorded in 73.9% (17 of 23) of cases with 6 undergoing elective coil embolization. Two major complications occurred, both in patients with multiple risk factors for bleeding. One required coil embolization of an arterio-calyseal system fistula. A further patient developed renal vein thrombosis 6 days after a failed transjugular kidney biopsy.


CONCLUSIONS
Transjugular kidney biopsy provides a histological diagnosis in high-risk patients, making an important contribution to patient management.
Thompson
Barbara C
BC
Centre for Nephrology, Department of Radiology, and Department of Histopathology, Royal Free Hospital, London, United Kingdom. sbjbi@hotmail.com
Kingdon
Edward
E
Johnston
Malcolm
M
Tibballs
Jonathan
J
Watkinson
Anthony
A
Jarmulowicz
Michael
M
Burns
Aine
A
Sweny
Paul
P
Wheeler
David C
DC
D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods*; D005260:Female; D006801:Humans; D007601:Jugular Veins; D007668:Kidney / Q000473:pathology; D007674:Kidney Diseases / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015642:Radiology, Interventional; D012306:Risk