Abstract
The purpose of this study was to describe the indications for and technique of transjugular renal biopsy (TJRB) and evaluate the efficacy and complications of this method. We performed a retrospective review of 59 patients who underwent TJRB using the Quick-core needle biopsy system (Cook, Letchworth, UK) over a 4-year period. The indications for obtaining renal biopsy included acute renal failure, chronic renal failure, nephrotic syndrome, and proteinuria with or without other associated disease. Indications for the transjugular approach included coagulopathy, biopsy of a solitary kidney or essentially single functioning kidney, simultaneous renal and hepatic biopsy, morbid obesity, and failed percutaneous biopsy. All but four cases were performed via the right internal jugular vein. The right, left, or both renal veins were cannulated in 41, 14, and 4 cases, respectively. Combined liver and renal biopsies were obtained in seven cases. Diagnostic biopsy specimens were obtained in 56 of 59 patients (95%). The number and size of tissue cores ranged from 1 to 9 mm and from 1 to 20 mm, respectively. The mean numbers of glomeruli per procedure on light microscopy and electron microscopy were 10.3 and 2.6, respectively. Specimens for immunohistology were acquired in 49 cases, of which 40 were adequate. Of the 56 successful TJRB procedures, 34 (61%) were associated with isolated capsular perforation (19), contained subcapsular leak (10), isolated collecting system puncture (1), and concurrent collecting system and capsular perforation (4). There was a significant increase in capsular perforation with six or more needle passes, although no significant correlation was seen between number of needle passes and complication. Six patients had minor complications defined as hematuria or loin pain. Seven patients developed major complications, of whom five received blood transfusion alone. Two required intervention: in one an arteriocalyceal fistula was embolized and the patient was temporarily dialyzed; the remaining patient required ureteric stenting. In conclusion, TJRB provides an adequate yield for diagnosis. Complication rates are relatively high, but patients are also at high risk from the conventional percutaneous approach. Patient selection and optimization are critical to avoid major complications.
Similar content being viewed by others
References
Cluzel P, Martinez F, Bellin MF, Michalik Y, Beaufils H, Jouanneau C, Lucidarme O, Deray G, Grenier PA (2000) Transjugular versus percutaneous renal biopsy for the diagnosis of parenchymal disease: comparison of sampling effectiveness and complications. Radiology 215:689–693
Hergesell O, Felten H, Andrassy K, Kuhn K, Ritz E (1998) Safety of ultrasound-guided percutaneous renal biopsy–retrospective analysis of 1090 consecutive cases. Nephrol Dial Transplant 13:975–977
Song JH, Cronan JJ (1998) Percutaneous biopsy in diffuse renal disease: comparison of 18- and 14-gauge automated biopsy devices. J Vasc Interv Radiol 9:651–655
Whittier WL, Kobert SM (2004) Timing of complications in percutaneous renal biopsy. J Am Soc Nephro 15(1):142–147
Mal F, Meyrier A, Callard P, Kleinknecht D, Altmann JJ, Beaugrand M (1992) The diagnostic yield of transjugular renal biopsy. Experience in 200 cases. Kidney Int 41:445–449
Jouet P, Meyrier A, Mal F et al (1996) Transjugular renal biopsy in the treatment of patients with cirrhosis and renal abnormalities. Hepatology 24(5):1143–1147
Rychlik I, Petrtyl J, Tesar V, Stejskalova A, Zabka J, Bruha R (2001) Transjugular renal biopsy. Our experience with 67 cases. Kidney Blood Press Res 24(3):207–212
Thompson BC, Kingdon E, Johnston M, Tibballs J, Watkinson A, Jarmulowicz M, Burns A, Sweny P, Wheeler DC (2004) Transjugular kidney biopsy. Am J Kidney Dis 43(4):651–662
Abbot KC, Musio FM, Chung EM, Lomis NN, Lane JD, Yuan CM (2002) Transjugular renal biopsy in high-risk patients: an American case series. BMC Nephrol 3:5–11
Fine DM, Arepally A, Hofmann LV, Mankowitz SG, Atta MG (2004) Diagnostic utility and safety of transjugular kidney biopsy in the obese patient. Nephrol Dial Transplant 19:1798–1802
Sam R, Leehey DJ, Picken MM, Borge MA, Yetter EM, Ing TS, Van DH (2001) Transjugular renal biopsy in patients with liver disease. Am J Kidney Dis 37(6):1144–1151
Sofocleous CT, Bahramipour P, Mele C, Hinrichs CR, Barone A, Abujudeh H (2002) Transvenous transjugular renal core biopsy with a redesigned biopsy set including a blunt-tipped needle. CardioVasc Interv Radiol 25(2):155–157 (Epub 19 February 2002)
Stiles KP, Yuan CM, Chung EM, Lyon RD, Lane JD, Abbott KC (2000) Renal biopsy in high-risk patients with medical diseases of the kidney. Am J Kidney Dis 36(2):419–433
Meyrier A (2005) Transjugular renal biopsy. Update on hepato-renal needlework. Nephrol Dial Transplant 20(7):1299–1302 (Epub 3 May 2005)
Stiles KP, Yuan CM, Chung EM, Lyon RD, Lane JD, Abbott KC (2000) Renal biopsy in high-risk patients with medical diseases of the kidney. Am J Kidney Dis 36(2):419–433
Guevara M, Rodes J (2005) Hepatorenal syndrome. Int J Biochem Cell Biol 37:22–26
Montseny JJ, Meyrier A, Kleinknecht D, Callard P (1995) The current spectrum of infectious glomerulonephritis. Experience with 76 patients and review of the literature. Medicine (Baltimore) 74:63–73
Miraglia R, Luca A, Gruttadauria S, Minervini MI, Vizzini G, Arcadipane A, Gridelli B (2006) Contribution of transjugular liver biopsy in patients with the clinical presentation of acute liver failure. CardioVasc Interv Radiol 29(6):1008–1010
Marchetto BE, Meglin AJ, Chiricosta FM, Temo JA, Duhan JL (1997) Transvenous renal biopsy in an ex vivo swine kidney model: comparison of five devices. J Vasc Interv Radiol 8:831–834
Lakin PC, Pavcnik D, Bloch RD et al (1999) Percutaneous transjugular kidney biopsy in swine with use of a side-cutting needle with a blunt-tipped stylet. J Vasc Interv Radiol 10:1229–1232
Banares R, Alonso S, Catalina MV et al (2001) Randomized controlled trial of aspiration needle versus automated biopsy device for transjugular liver biopsy. J Vasc Interv Radiol 12(5):583–587
Ishikawa T, Kamimura H, Tsuchiya A, Togashi T, Watanabe, Ohta H, Yoshiaki Y, Kamimura T (2006) Comparison of a new aspiration needle device and the Quik-Core biopsy needle for transjugular liver biopsy. World J Gastroenterol 12(39):6339–6342
Acknowledgments
We would like to thank Mr. Innies Clatworthy (pathology technician) and Dr. Fiona Miller (consultant radiologist and statistics analyst).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
See, T.C., Thompson, B.C., Howie, A.J. et al. Transjugular Renal Biopsy: Our Experience and Technical Considerations. Cardiovasc Intervent Radiol 31, 906–918 (2008). https://doi.org/10.1007/s00270-008-9308-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-008-9308-6