title: Transjugular kidney biopsy: enabling safe tissue diagnosis in high risk patients.
abstract: BACKGROUND
  Transjugular kidney biopsy (TJKB) was first described in 1990. Indications for TJKB include uncorrectable bleeding disorders and conditions precluding the prone position.
  
  
  OBJECTIVE
  To describe our initial experience with TJKB.
  
  
  METHODS
  Between February 2008 and December 2009 all patients in whom percutaneous biopsy was contraindicated or unsuccessful underwent image-guided TJKB using a standard set with a 19 gauge core biopsy needle. Prospectively collected data included indication, number of needle passes, contrast dose, tissue yield, and complications.
  
  
  RESULTS
  Twelve patients, age range 15-76 years (mean 55), underwent 14 TJKB procedures. Indications for the transjugular route included bleeding diathesis, dyspnea, ventral hernia, ascites, marked obesity, need for concomitant liver biopsy or concomitant insertion of tunneled dialysis catheter, discrepant kidney size, and failed percutaneous attempt. Thirteen biopsies were performed in 11 patients; in one patient TJKB was abandoned due to unfavorable renal vein anatomy. Four patients were premedicated with desmopressin and one with platelet transfusion due to prolonged bleeding time. Three to six passes (mean 3.8) were made per biopsy, with an overall yield of 9.6 +/- 8.2 glomeruli, providing a definite diagnosis in nine patients and a probable diagnosis in two. In two patients the first biopsy attempt yielded insufficient tissue, necessitating a repeat procedure. There were two minor bleeding episodes not requiring intervention. Serum creatinine was unchanged after the procedure and hemoglobin levels asymptomatically dropped by 0.3 +/- 1.0 g/dl within 48 hours, requiring no treatment.
  
  
  CONCLUSIONS
  TJKB appears to safely allow adequate tissue diagnosis in patients at increased risk for complications from or contraindications to percutaneous renal biopsy.
authors.affiliation: Nephrology and Hypertension Services, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Irit Mor-Yosef
authors.initials: IM
authors.lastname: Levi
authors.forename: Iddo Z
authors.initials: IZ
authors.lastname: Ben-Dov
authors.forename: Alexander
authors.initials: A
authors.lastname: Klimov
authors.forename: Galina
authors.initials: G
authors.lastname: Pizov
authors.forename: Allan I
authors.initials: AI
authors.lastname: Bloom
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods*; D002405:Catheterization, Central Venous / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging; D007668:Kidney / Q000473:pathology*; D007674:Kidney Diseases / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult