Transjugular renal biopsy in high-risk patients: an American case series

BMC Nephrology

Christina M Yuan¹  John D Lane²  Nick N Lomis²  Ellen M Chung²  Franco M Musio¹  Kevin C Abbott¹ 

[1] Nephrology Service, Walter Reed Army Medical Center, Washington, DC;Interventional Radiology Service, Walter Reed Army Medical Center, Washington, DC

关键词: renal failure;    horseshoe kidney;    anticoagulation;    liver;    kidney;    transjugular renal biopsy;   

Others  :  1083462
DOI  :  10.1186/1471-2369-3-5

 received in 2002-04-02, accepted in 2002-07-11,  发布年份 2002

【 摘 要 】

Background

In the United States, transjugular renal biopsies using the Quickcore™ side cut needle system have previously been described primarily for transjugular renal biopsy in patients with concurrent liver and kidney disease.

Methods

We describe transjugular renal biopsy with the Quickcore™ system in 9 patients with nephrotic syndrome and contraindications to percutaneous renal biopsy, who underwent biopsy between 23 October 1996 and 12 April 2001. The most common contraindication was oral anticoagulation with coumadin (40%). Other contraindications included horseshoe kidney, severe renal failure, and spontaneous coagulopathy. A 62 cm straight catheter and 60 cm side-cut Quickcore™ biopsy needle were used to obtain cortical tissue. Packing of the biopsy tract with Gelfoam™ was used for venographically identified capsular perforation.

Results

Ten procedures were performed on 9 patients with one requiring re-biopsy (5% of all renal biopsies performed at our institution). There were 9 transjugular renal biopsy and one combined liver-kidney biopsy. A mean of 4 ± 2 passes were made, with a mean of 3 ± 1 cores obtained per procedure. Histologic diagnosis was made in 90% of biopsies and in 100% of patients. Two patients developed transient hydronephrosis associated with gross hematuria; both required transfusion. Capsular perforation occurred in 90%. One patient died of bacterial sepsis, unrelated to the biopsy, several days after the procedure.

Conclusions

Transjugular renal biopsy appears to be efficacious in high-risk patients, for whom the percutaneous approach is contraindicated, including patients on oral anticoagulation. The transfusion rate in the present study was similar to other American reports using this technique.

【 授权许可】

   
2002 Abbott et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

【 参考文献 】

• [1]Stiles KP, Yuan CM, Chung EM, Lyon RD, Lane JD, Abbott KC: Renal biopsy in high-risk patients with medical diseases of the kidney. Am J Kidney Dis 2000, 36:419-433.
• [2]Haas M, Meehan SM, Karrison TG, Spargo BH: Changing etiologies of unexplained adult nephrotic syndrome: a comparison of renal biopsy findings from 1976–1979 and 1995–1997. Am J Kidney Dis 1997, 30:621-631.
• [3]Bellomo R, Atkins RC: Membranous nephropathy and thromboembolism: is prophylactic anticoagulation warranted? Nephron 1993, 63:249-254.
• [4]Arnout J: Antiphospholipid syndrome: diagnostic aspects of lupus anticoagulants. Thromb Haemost 2001, 86:83-91.
• [5]Mal F, Meyrier A, Callard P, Kleinknecht D, Altmann JJ, Beaugrand M: The diagnostic yield of transjugular renal biopsy. Experience in 200 cases. Kidney Int 1992, 41:445-449.
• [6]Cluzel P, Martinez F, Bellin MF, Michalik Y, Beaufils H, Jouanneau C, Lucidarme O, Deray G, Grenier PA: Transjugular versus percutaneous renal biopsy for the diagnosis of parenchymal disease: comparison of sampling effectiveness and complications. Radiology 2000, 215:689-693.
• [7]Jouet P, Meyrier A, Mal F, Callard P, Guettier C, Stordeur D, Trinchet JC, Beaugrand M: Transjugular renal biopsy in the treatment of patients with cirrhosis and renal abnormalities. Hepatology 1996, 24:1143-1147.
• [8]Sam R, Leehey DJ, Picken MM, Borge MA, Yetter EM, Ing TS, Van Thiel DH: Transjugular renal biopsy in patients with liver disease. Am J Kidney Dis 2001, 37:1144-1151.
• [9]Kearon D, Hirsh J: Current concepts: Management of anticoagulation before and after elective surgery. N Engl J Med 1997, 336:1506-1511.
• [10]Stiles KP, Hill C, Lebrun CJ, Reinmuth B, Yuan CM, Abbott KC: The Impact of Performing Bleeding Time Determinations Prior to Percutaneous Real-time Ultrasound-Guided Renal Biopsies on Major Complication Rates. J Nephrol 2001, 4:275-279.
• [11]Ponticelli C, Zucchelli P, Passerinie P, Cagnoli L, Cesana B, Possi C, Pasquali S, Imbasciati E, Gassi C, Redaelli B, Sasdelli M, Locatelli F: A randomized trial of methylprednisolone and chlorambucil in idiopathic membranous nephropathy. N Engl J Med. 1989, 320:8-13.
• [12]Rose BD: Uptodate in Medicine,. BDRinc, Wellesley, MA 2001.
• [13]Stiles KP, Abbott KC, Welch PG, Yuan CM: Effects of angiotensin-converting enzyme inhibitor and steroid therapy on proteinuria in FSGS: a retrospective study in a single clinic. Clin Nephrol 2001, 56:89-95.
• [14]Banares R, Alonso S, Catalina MV, Casado M, Rincon D, Salcedo M, Alvarez E, Guerrero C, Echenagusia A, Camunez F, Simo G: Randomized controlled trial of aspiration needle versus automated biopsy device for transjugular liver biopsy. J Vasc Interv Radiol. 2001, 12:583-587.
• [15]Marchetto BE, Meglin AJ, Chiricosta FM, Temo JA, Duhan JL: Transvenous renal biopsy in an ex vivo swine kidney model: comparison of five devices. J Vasc Interv Radiol 1997, 8:831-834.
• [16]Lakin PC, Pavcnik D, Bloch RD, Uchida BT, Corless CL, Timmermans HA, Kubota Y: Percutaneous transjugular kidney biopsy in swine with use of a side-cutting needle with a blunt-tipped stylet. J Vasc Interv Radiol. 1999, 10:1229-1232.