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Stevens PE, Ahmed SB, Carrero JJ, Foster B, Francis A, Hall RK, Herrington WG, Hill G, Inker LA, Kazancıoğlu R, Lamb E, Lin P, Madero M, McIntyre N, Morrow K, Roberts G, Sabanayagam D, Schaeffner E, Shlipak M, Shroff R, Tangri N, Thanachayanont T, Ulasi I, Wong G, Yang CW, Zhang L, Levin A. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int 2024; 105:S117-S314. [PMID: 38490803 DOI: 10.1016/j.kint.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 03/17/2024]
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Nielly H, Mathian A, Cazenave M, Izzedine H, Haroche J, Cohen-Aubart F, Hie M, Miyara M, Pineton de Chambrun M, Benameur N, Hausfater P, Pha M, Boutin-Lê Thi Huong D, Rouvier P, Brocheriou I, Cluzel P, Amoura Z. Safety and effectiveness of transjugular renal biopsy for systemic lupus erythematosus and antiphospholipid antibody syndrome patients taking antithrombotics. Nephrol Dial Transplant 2021; 35:1721-1729. [PMID: 31157889 DOI: 10.1093/ndt/gfz085] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 03/20/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Renal biopsy is the cornerstone of systemic lupus erythematosus (SLE) nephritis and antiphospholipid syndrome (APS) nephropathy management. However, transcutaneous renal biopsy (TCRB) is hampered by the antithrombotic treatment frequently prescribed for those diseases. Transjugular renal biopsy (TJRB) offers an attractive alternative for patients at increased risk of bleeding. The primary objective of the study was to describe the safety profile and diagnostic performance of TJRB in SLE and APS patients. METHODS All SLE and/or APS patients who underwent a renal biopsy in our department (between January 2004 and October 2016) were retrospectively reviewed. Major complications were death, haemostasis nephrectomy, renal artery embolization, red blood cell transfusion, sepsis and vascular thrombosis; macroscopic haematuria, symptomatic perirenal/retroperitoneal bleeding and renal arteriovenous fistula without artery embolization were considered as minor complications. RESULTS Two hundred and fifty-six TJRBs-119 without antithrombotics (untreated), 69 under aspirin and 68 on anticoagulants and 54 TCRBs without antithrombotics-were analysed. Their major and minor complication rates, respectively, did not differ significantly for the four groups: 0 and 8% for untreated TJRBs, 1 and 6% for aspirin-treated, 6 and 10% for anticoagulant-treated and 2 and 2% for TCRBs. The number of glomeruli sampled and the biopsy contribution to establishing a histological diagnosis was similar for the four groups. CONCLUSIONS TJRBs obtained from SLE and APS patients taking antithrombotics had diagnostic yields and safety profiles similar to those of untreated TCRBs. Thus, TJRB should be considered for SLE and APS patients at risk of bleeding.
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Affiliation(s)
- Hubert Nielly
- Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière (GHPS), French National Referral Center for Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome, Service de Médecine Interne 2, Institut E3M, Paris, France
| | - Alexis Mathian
- Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière (GHPS), French National Referral Center for Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome, Service de Médecine Interne 2, Institut E3M, Paris, France
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Maud Cazenave
- Sorbonne Université, APHP, GHPS, Nephrology and Renal Transplantation Department, Paris, France
| | - Hassan Izzedine
- Hôpital Privé des Peupliers, Service de Néphrologie, Paris, France
| | - Julien Haroche
- Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière (GHPS), French National Referral Center for Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome, Service de Médecine Interne 2, Institut E3M, Paris, France
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Fleur Cohen-Aubart
- Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière (GHPS), French National Referral Center for Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome, Service de Médecine Interne 2, Institut E3M, Paris, France
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Miguel Hie
- Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière (GHPS), French National Referral Center for Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome, Service de Médecine Interne 2, Institut E3M, Paris, France
| | - Makoto Miyara
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
- APHP, GHPS, Département d'Immunologie, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Marc Pineton de Chambrun
- Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière (GHPS), French National Referral Center for Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome, Service de Médecine Interne 2, Institut E3M, Paris, France
| | - Neila Benameur
- APHP, GHPS, Service de Pharmacie, Hôpital de la Pitié-Salpêtriére, Paris, France
| | - Pierre Hausfater
- Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière (GHPS), French National Referral Center for Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome, Service de Médecine Interne 2, Institut E3M, Paris, France
| | - Micheline Pha
- Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière (GHPS), French National Referral Center for Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome, Service de Médecine Interne 2, Institut E3M, Paris, France
| | - Du Boutin-Lê Thi Huong
- Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière (GHPS), French National Referral Center for Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome, Service de Médecine Interne 2, Institut E3M, Paris, France
| | - Philippe Rouvier
- Sorbonne Université, APHP, GHPS, Service d'Anatomie et Cytologie Pathologiques, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Isabelle Brocheriou
- Sorbonne Université, APHP, GHPS, Service d'Anatomie et Cytologie Pathologiques, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Philippe Cluzel
- Sorbonne Université, APHP, GHPS, Département d'Imagerie Cardiovasculaire et de Radiologie Interventionnelle, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Zahir Amoura
- Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière (GHPS), French National Referral Center for Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome, Service de Médecine Interne 2, Institut E3M, Paris, France
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
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St Jeor JD, Reisenauer CJ, Andrews JC, Fleming CJ, Misra S, Takahashi EA. Transjugular Renal Biopsy Bleeding Risk and Diagnostic Yield: A Systematic Review. J Vasc Interv Radiol 2020; 31:2106-2112. [PMID: 33023806 DOI: 10.1016/j.jvir.2020.07.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/05/2020] [Accepted: 07/14/2020] [Indexed: 11/16/2022] Open
Abstract
This study aimed to better define the safety and efficacy of transjugular renal biopsy (TJRB) based on published studies. Seventeen published articles were included (1,321 biopsies). Complications were classified as major if they resulted in blood transfusion or additional invasive procedures. All other bleeding complications were considered minor. Diagnostic tissue was obtained in 1,193 procedures (90.3%). The total incidence of bleeding complications among 15 articles with complete data was 202 of 892 procedures (22.6%): 162 (18.2%) minor and 40 (4.5 %) major. These results show that TJRB is a feasible procedure for obtaining renal tissue for diagnosis and that most complications are self-limiting.
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Affiliation(s)
- Jeffery D St Jeor
- School of Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905
| | - Christopher J Reisenauer
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905
| | - James C Andrews
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905
| | - Chad J Fleming
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905
| | - Sanjay Misra
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905
| | - Edwin A Takahashi
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905.
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Gleisner AL, Jung H, Lentine KL, Tuttle-Newhall J. Renal Dysfunction in Liver Transplant Candidates: Evaluation, Classification and Management in Contemporary Practice. Nephrol Ther 2012; Suppl 4. [PMID: 32874772 DOI: 10.4172/2161-0959.s4-006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Renal dysfunction is a common comorbidity in patients with liver failure and is a well-established predictor of both morbidity and mortality among patients awaiting liver transplantation. The etiology of renal failure in patients with cirrhosis can be functional, structural, or represent a combination of potentially reversible physiologic changes and permanent histologic damage. Diagnostic criteria for acute and chronic kidney disease have been established, but cirrhosis poses challenges for accurate assessment of renal function with conventional clinical methods such as serum creatinine and creatinine-based estimating equations. Renal biopsies can have an important role for defining permanent structural damage as part of the pre-transplant evaluation of patients with liver disease; however, coagulopathy, portal hypertension and ascites increase the risk of biopsy-associated complications in cirrhotic patients. While renal dysfunction due to hepatorenal physiology is potentially reversible after liver transplantation, simultaneous kidney liver transplantation and kidney after liver transplant can also improve outcomes in a subset of patients with irreversible renal injury.
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Affiliation(s)
- Ana L Gleisner
- Division of Abdominal Organ Transplantation, Department of Surgery, Saint Louis University Medical Center, St. Louis, MO
| | - HeeSoo Jung
- Division of Abdominal Organ Transplantation, Department of Surgery, Saint Louis University Medical Center, St. Louis, MO
| | - Krista L Lentine
- Division of Abdominal Organ Transplantation, Department of Surgery, Saint Louis University Medical Center, St. Louis, MO
| | - Janet Tuttle-Newhall
- Division of Abdominal Organ Transplantation, Department of Surgery, Saint Louis University Medical Center, St. Louis, MO
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