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Transjugular kidney biopsy: enabling safe tissue diagnosis in high risk patients.
MedLine Citation:
PMID:  21838185     Owner:  NLM     Status:  In-Process    
BACKGROUND: Transjugular kidney biopsy (TJKB) was first described in 1990. Indications for TJKB include uncorrectable bleeding disorders and conditions precluding the prone position.
OBJECTIVES: To describe our initial experience with TJKB.
METHODS: Between February 2008 and December 2009 all patients in whom percutaneous biopsy was contraindicated or unsuccessful underwent image-guided TJKB using a standard set with a 19 gauge core biopsy needle. Prospectively collected data included indication, number of needle passes, contrast dose, tissue yield, and complications.
RESULTS: Twelve patients, age range 15-76 years (mean 55), underwent 14 TJKB procedures. Indications for the transjugular route included bleeding diathesis, dyspnea, ventral hernia, ascites, marked obesity, need for concomitant liver biopsy or concomitant insertion of tunneled dialysis catheter, discrepant kidney size, and failed percutaneous attempt. Thirteen biopsies were performed in 11 patients; in one patient TJKB was abandoned due to unfavorable renal vein anatomy. Four patients were premedicated with desmopressin and one with platelet transfusion due to prolonged bleeding time. Three to six passes (mean 3.8) were made per biopsy, with an overall yield of 9.6 +/- 8.2 glomeruli, providing a definite diagnosis in nine patients and a probable diagnosis in two. In two patients the first biopsy attempt yielded insufficient tissue, necessitating a repeat procedure. There were two minor bleeding episodes not requiring intervention. Serum creatinine was unchanged after the procedure and hemoglobin levels asymptomatically dropped by 0.3 +/- 1.0 g/dl within 48 hours, requiring no treatment.
CONCLUSIONS: TJKB appears to safely allow adequate tissue diagnosis in patients at increased risk for complications from or contraindications to percutaneous renal biopsy.
Irit Mor-Yosef Levi; Iddo Z Ben-Dov; Alexander Klimov; Galina Pizov; Allan I Bloom
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Israel Medical Association journal : IMAJ     Volume:  13     ISSN:  1565-1088     ISO Abbreviation:  Isr. Med. Assoc. J.     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-08-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100930740     Medline TA:  Isr Med Assoc J     Country:  Israel    
Other Details:
Languages:  eng     Pagination:  425-7     Citation Subset:  IM    
Nephrology and Hypertension Services, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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