title: Safety and diagnostic yield of transjugular renal biopsy.
abstract: OBJECTIVE
  To evaluate the safety and tissue acquisition with transjugular renal biopsy (TJRB) by using the Quick-Core method in patients who were at high risk for complications with percutaneous renal biopsy.
  
  
  METHODS
  This was a retrospective study, and indication for the transjugular route, complications, clinical and laboratory data, and adequacy of samples were abstracted from patient records. TJRB was performed when the patient had thrombocytopenia or coagulopathy and was at high risk for bleeding from percutaneous renal biopsy. Follow-up images were available in 25 patients; nine underwent abdominal ultrasonography (US) and 17 underwent computed tomography (CT) (one patient underwent both US and CT). The hemoglobin level, prothrombin time, international normalized ratio (INR), partial thromboplastin time, platelet count, and serum creatinine level were obtained before and after biopsy, and these findings were correlated with clinical outcomes.
  
  
  RESULTS
  Thirty-nine patients underwent 39 TJRB procedures and comprise the current study population. The procedure was technically successful in 38 of the 39 patients (97%). Twenty-four of 39 patients (63%) had a platelet count of less than or equal to 75 x 10(9)/L, 11 (29%) had an elevated INR of more than 1.4, and seven received therapeutic anticoagulation. Patients with a platelet count of less than or equal to 75 x 10(9)/L or those with an elevated INR of more than 1.4 after transfusion were not at increased risk of hematoma formation (P = not statistically significant). The mean serum creatinine level at biopsy was 283 mumol/L +/- 150. A mean of 1.8 cores +/- 1.1 were obtained, with 5.0 glomeruli +/- 3.8, 2.1 glomeruli +/- 2.8, and 2.4 glomeruli +/- 3 at light, immunofluorescence, and electron microscopy, respectively. The renal tissue was sufficient for diagnosis in 92% of patients. Major complications occurred in one patient (2.6%). Minor complications-primarily renal hematoma-occurred in 52% of the patients. Contrast medium-induced nephropathy occurred in three patients (7.8%), two of whom also had renal hematomas.
  
  
  CONCLUSIONS
  TJRB is a relatively safe and effective diagnostic tool in high-risk patients with coagulopathy and thrombocytopenia who require renal tissue for accurate diagnosis.
authors: Department of Radiology, Mayo Clinic Rochester, 200 First St SW, Rochester, MN 55905, USA. misra.sanjay@mayo.edu <misra.sanjay@mayo.edu>
authors: Sanjay
authors: S
authors: Misra
authors: Geeta
authors: G
authors: Gyamlani
authors: Sundararaman
authors: S
authors: Swaminathan
authors: Christopher K
authors: CK
authors: Buehrig
authors: Haraldur
authors: H
authors: Bjarnason
authors: Michael A
authors: MA
authors: McKusick
authors: James C
authors: JC
authors: Andrews
authors: C Michael
authors: CM
authors: Johnson
authors: Fernando C
authors: FC
authors: Fervenza
authors: Nelson
authors: N
authors: Leung
mesh_terms: D001706:Biopsy / Q000379:methods*; D001778:Blood Coagulation Disorders / Q000150:complications; D016009:Chi-Square Distribution; D003287:Contrast Media; D005119:Extravasation of Diagnostic and Therapeutic Materials; D005260:Female; D006801:Humans; D007601:Jugular Veins; D007668:Kidney / Q000098:blood supply / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D012189:Retrospective Studies; D012449:Safety; D013921:Thrombocytopenia / Q000150:complications
chemical_list: D003287:Contrast Media