Combined Fluoroscopy and Ultrasound-Guided Transjugular Kidney Biopsy in Cirrhotic Patients

Purpose: To evaluate the safety and diagnostic yield of combined fluoroscopy and ultrasound-guided transjugular kidney biopsy (TJKB) in cirrhotic patients with suspected renal parenchymal disease. Materials and Methods: A retrospective review was made of 27 patients (21 men; overall mean age 44.7 y) who underwent TJKB from June 2013 to June 2016; 21 patients had coagulopathy and/or thrombocytopenia, 4 underwent simultaneous TJKB with transjugular liver biopsy, and 1 patient each had severe obesity and gross ascites. All procedures were performed with the use of fluoroscopy and simultaneous transabdominal ultrasound guidance. The data were analyzed for number of passes taken, number of glomeruli in the tissue cores, adequacy of tissue core for histopathologic diagnosis, and incidence and severity of complications. Results: The average number of passes per case was 3.6 (range 2-6). The total length of tissue cores ranged from 0.4 cm to 2.5 cm. The mean numbers of glomeruli per procedure on light microscopy were 6.7 (range 0-17). Diagnostic biopsy specimens were obtained in 23 out of 27 patients (85%). Eleven patients had minor complications. One patient had major complication in the form of hemoglobin drop of 2.1 mg/dL which required embolization and blood transfusion. Conclusions: Combined use of fluoroscopy and ultrasound guidance for TJKB yielded adequate tissue samples with fewer passes and a low rate of complications in high-risk patients with cirrhosis.