Transjugular renal biopsy - Our experience with 67 cases

Background. Transjugular renal biopsy (TJRB) is still a novel technique of renal tissue sampling exploiting the transjugular route. TJRB should be per formed particularly in situations when the percutaneous route is precluded, i.e. especially in patients with clotting disorders. In the past, only a f ew papers reported the experience with larger numbers of patients. The goal of this paper is to analyze our experience with TJRB. Methods and Results: From 1993 to 1999, 67 patients, mean age 49.8 years (SD +/- 10.2), male/fe male ratio 40/27, underwent TJRB. Fifty-two patients (78%) suffered from re nal insufficiency and 19 of them (28%) were on dialysis treatment at the ti me of TJRB. Arterial hypertension was recorded in 42%. The combined kidney and liver biopsy (46%) and clotting disorders (39%) were the most frequent indications for performing TJRB. Renal tissue was yielded in 53 patients (7 9%) but a sample sufficient for histological diagnosis was taken in 49 (73% ), reaching on average 10.8 glomeruli. Altogether 19 different histological entities were disclosed and out of them, vascular nephro-sclerosis (12%), necrotizing and crescentic glomerulonephritis, IgA nephropathy (IgAN) and a myloidosis (three latter per 10%) represented the most frequent diagnoses. TJRB was combined with liver biopsy in 31 patients (46%) and/or hepatic vei n catheterization in 22 patients (33%) confirming portal hypertension in 8. The clinically significant liver histology was found in 20 patients, of th em cirrhosis/fibrosis in 8, chronic hepatitis in 4 and steatosis in 5. Amon g those 20 patients, IgAN was disclosed as the most common renal diagnosis (6). Clinically symptomatic complications were recorded in 12 cases (18%) b ut 9 of them suffered from clotting disorders. Complications included devel opment of subcapsular hematoma in 6 cases, macroscopic hematuria in 4 cases , and hypovolemic hemorrhagic shock in 2. One patient had to undergo surgic al treatment. Dividing the patients into a subgroup with or without clottin g disorders, the complication rate was 34 vs. 7%. Conclusions: TJRB is a ne w diagnostic method, which, looking at its indications, facilitates the dia gnosis of glomerulopathies in patients who could not be considered for perc utaneous renal biopsy, particularly due to clotting disorders. The technica l aspect of this procedure plays a fundamental role in the final risk/benef it ratio but if done correctly it involves acceptable risk and is well tole rated. Copyright (C) 2001 S. Karger AG, Basel.