Transjugular renal biopsy in patients with liver disease

Although transjugular renal biopsy has been used extensively in Europe, exp erience with its use in the United States has been limited. We report 25 pa tients who underwent both transjugular liver and renal biopsies in the same sitting and 4 patients who underwent only a transjugular renal biopsy. All 29 patients had both liver disease and renal abnormalities. Each patient w as also believed to have a relative or absolute contraindication to a percu taneous renal biopsy (usually in the form of a bleeding abnormality). Trans jugular renal biopsy yielded a quantity of tissue sufficient for diagnosis in all but 1 patient, The mean number of glomeruli obtained per biopsy was 19.4 +/- 12.2 (SD), Pathological diagnoses found were tubular injury in 5 p atients, membranoproliferative glomerulonephritis in 5 patients, nephroscle rosis in 3 patients, diabetic nephropathy in 2 patients, immunoglobulin A ( IgA) nephropathy in 2 patients, minimal change disease in 2 patients, end-s tage renal disease in 2 patients, nonspecific changes in 1 patient, early g lomerulosclerosis in 1 patient, tubular atrophy only in 1 patient, and norm al renal histological characteristics in 4 patients. One patient with suspe cted IgA nephropathy had no histological diagnosis established because of a lack of glomeruli in the biopsy specimen. There were no instances of major bleeding from the perirenal area; however, a small perirenal hematoma was identified in 3 patients by postbiopsy computed tomography or sonography. T hus, based on our experience, transjugular renal biopsy appears to be a saf e and effective procedure for establishing a histological diagnosis and is an attractive alternative biopsy method for patients with advanced liver di sease and contraindications to conventional percutaneous renal biopsy. (C) 2001 by the National Kidney Foundation, Inc.