The diagnostic yield of transjugular renal biopsy. Experience in 200 cases

Renal histology remains the keystone of diagnosis in most parenchymal renal diseases and especially in glomerulopathies [1–3]. Sampling of renal tissue by percutaneous needle biopsy was described by Iversen and Brun in 1951 [4]. This procedure is usually safe, provided contraindications are respected [5–10]. Such contraindications include uncontrolled hypertension and/or bleeding disorders, which can favor severe perirenal hematoma. Even when these contraindications are heeded, systematic computerized tomography (CT) showed that the incidence of perirenal hematoma discovered by CT scan (irrespective of its clinical manifestation) is 57 to 85% [11, 12]. In the absence of contraindications, there are patients in whom the slightest possibility of a complication necessitating lombotomy for hemostasis would be ethically incompatible with renal biopsy. This is the case, for instance, in patients with morbid obesity or with chronic respiratory insufficiency, in whom general anesthesia might represent a considerable hazard. Finally, there are cases where the size or the anatomical location of the kidney makes renal tissue sampling difficult or impossible. Ultrasound or CT scan-guided biopsy [13–15] does not always obviate such pitfalls. Other, more invasive methods have been proposed to sample kidney tissue, for instance by means of a short lombotomy [16–21], but this approach, which in addition necessitates the use of an operating room and several days of hospitalization, is similarly inapplicable in a patient with severe bleeding disorder or morbid obesity. We have described a novel technique of renal biopsy using the transjugular route, inspired from that used for liver biopsy in patients with clotting disorders in whom the percutaneous route would similarly be precluded [22–24]. This new technique was published in abstract form [25], and we reported our preliminary results on 50 cases [26]. The goal of this Technical Note is to analyze our present experience on 200 procedures carried out in 195 patients.