Diagnostic utility and safety of transjugular kidney biopsy in the obese patient

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Abstract
Background. The obese patient may be potentially at high risk for traditional percutaneous ultrasound- guided biopsy. The utility of transjugular kidney biopsy (TJKB) in this group of patients has not been established. Methods. We conducted a retrospective analysis of 37 obese patients who underwent TJKB at our centre. The kidney was approached via the right renal vein in 31 patients. Under fluoroscopy, core biopsies were obtained from the lower pole with a 19G biopsy needle. Post-procedure venogram was performed to assess for contrast extravasation indicating capsule perforation or communication with the collecting system. Patients were followed for procedure-related complications. Mean weight was 128 kg (range: 77-187 kg) and body mass index was 44 kg/m2 (range: 34-64 kg/m2). Mean creatinine was 2.2 mg/dl (range: 0.5-6.5 mg/dl). Fifteen patients had diabetes, five of whom were nephrotic; 10 other patients had nephrotic range proteinuria. Results. Of the 37 patients, six were hospitalized at the time of biopsy and three were admitted for obser- vation. All patients returned to baseline activity the day following procedure. Histopathological diagnosis was made in 33 cases (89.2%) with a mean of 19.2 glomeruli (range: 0-62 glomeruli) per patient. There was one major complication: a delayed retroperitoneal bleed requiring multiple transfusions. Contrast extrav- asation outside the capsule occurred in five patients and extravasation into the collecting system occurred in three. Body mass index was not associated with number of glomeruli obtained or complication rate. Conclusions. TJKB in obese patients is a relatively safe, reliable and minimally invasive procedure with an excellent diagnostic yield.