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

Kevin C Abbott,Ellen M Chung,John D Lane,Nick N Lomis,Christina M Yuan,Franco M Musio

doi:10.1186/1471-2369-3-5

Abstract

BackgroundIn 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.MethodsWe 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.ResultsTen 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.ConclusionsTransjugular 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.

Highlights

In the United States, transjugular renal biopsies using the QuickcoreTM side cut needle system have previously been described primarily for transjugular renal biopsy in patients with concurrent liver and kidney disease
[2] This condition has been associated with an increased risk of thromboembolism, in patients with membranous nephropathy [3] or systemic lupus erythematosus, [4] and such patients may require anticoagulation
[1] Most reports and the largest series, in a broad array of settings, have come from Europe. [5,6,7] In the United States, the only reports of experience with transjugular renal biopsy (TJRB) have been in patients with concurrent liver and kidney disease. [8]

Summary

Introduction

In the United States, transjugular renal biopsies using the QuickcoreTM side cut needle system have previously been described primarily for transjugular renal biopsy in patients with concurrent liver and kidney disease. [5,6,7] In the United States, the only reports of experience with TJRB have been in patients with concurrent liver and kidney disease. The endovascular automated side-cut core biopsy sets such as the Quick-CoreTM (Cook, Bloomington, IN) may allow even higher yields of diagnostic tissue with possibly less operator-dependence. No American center has reported results on the use of the Quick-CoreTM biopsy set in patients with contraindications to PRB (other than combined liver and kidney disease) referred for TJRB. We report our experience with this technique at our institution from October 1996–April 2001

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Conclusion