Jouët P, Meyrier A, Mal F, Callard P, Guettier C, Stordeur D, Trinchet J C, Beaugrand M
Department of Hepatogastroenterology, Hopital Jean Verdier, Bondy, France.
Hepatology. 1996 Nov;24(5):1143-7. doi: 10.1002/hep.510240527.
When renal lesions are suspected in patients with cirrhosis, clotting disorders often preclude percutaneous renal biopsy. This study was undertaken to determine whether transjugular renal biopsy is possible, safe, and useful in such patients. From 1987 to 1994, 70 patients with cirrhosis and clotting disorders underwent transjugular renal biopsies, providing renal tissue in 55. Of these 55 patients, 41 were Child-Pugh class B or C, 35 were alcoholic, serum creatinine levels were > or = 130 micromol/L in 46, and proteinuria was > or = 0.5 g/d in 37. Clinically significant complications of transjugular renal biopsy were persistent hematuria in 4 and perirenal hematoma in 4, requiring blood transfusions in 1 and 2 cases, respectively. There were no deaths related to renal biopsy. Renal lesions were identified as glomerular in 41 (74.5%), interstitial in 7, and end-stage in 2 and were absent in 5. Transjugular renal biopsy influenced treatment in 21 patients (38%), including 11 who were proposed for liver transplantation and 4 who had chronic liver rejection. Decisions based on results of transjugular renal biopsy were to perform liver transplantation in 8 and combined renal and liver transplantation in 5, whereas 2 were refused. In 6 other patients, the results of renal biopsy modified the medical regimen. We conclude that transjugular renal biopsy may be a useful procedure in patients with cirrhosis and clotting disorders. This technique does not entail undue risks and may influence treatment decisions, particularly in patients proposed for liver transplantation.
当怀疑肝硬化患者存在肾脏病变时，凝血功能障碍常常使经皮肾活检无法进行。本研究旨在确定经颈静脉肾活检在此类患者中是否可行、安全且有用。1987年至1994年，70例患有肝硬化和凝血功能障碍的患者接受了经颈静脉肾活检，其中55例获得了肾组织。在这55例患者中，41例为Child-Pugh B级或C级，35例为酒精性肝硬化，46例血清肌酐水平≥130微摩尔/升，37例蛋白尿≥0.5克/天。经颈静脉肾活检的临床显著并发症为4例持续性血尿和4例肾周血肿，分别有1例和2例需要输血。没有与肾活检相关的死亡病例。肾病变被确定为肾小球病变41例（74.5%），间质病变7例，终末期病变2例，5例未发现病变。经颈静脉肾活检影响了21例患者（38%）的治疗，包括11例拟行肝移植的患者和4例发生慢性肝排斥反应的患者。根据经颈静脉肾活检结果做出的决定是8例行肝移植，5例行肝肾联合移植，2例被拒绝。在其他6例患者中，肾活检结果改变了治疗方案。我们得出结论，经颈静脉肾活检对于患有肝硬化和凝血功能障碍的患者可能是一种有用的方法。该技术不会带来过度风险，并且可能影响治疗决策，特别是对于拟行肝移植的患者。
