3:54 PM Abstract No. 205 Systematic review of transjugular renal biopsy bleed risk and diagnostic yield: do the risks outweigh the benefits?

The aim of this study was to determine the incidence of bleeding complications and diagnostic yield of the transjugular renal biopsy (TJRB) procedure in the current literature. This systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were identified using the medical subject heading (MeSH) terms: biopsy, transjugular AND renal OR kidney. This search produced 48 articles in EMBASE and 101 articles in Pubmed. Duplicate articles, case reports, case series <10 patients, non-relevant articles, and non-English articles were excluded. The final analysis included 14 manuscripts. Article quality was assessed using the Newcastle Ottawa Scale (NOS) for cohort studies. Meta-analysis was not performed due to data heterogeneity precluding pooling. Patient demographics, procedural complications, and diagnostic yield were recorded. Complications were classified as “major” if they were reported as such in the literature or resulted in blood transfusion or invasive procedures to treat bleeding. Complications that did not meet these criteria were classified as “minor.” A total of 1048 TJRB biopsy procedures were performed in 1043 patients. Diagnostic tissue samples were obtained in 925 (88.3%) procedures. Following exclusion of 2 articles for incomplete complication data, the total bleeding complication rate was 184 (29.7%) of 619 procedures. Of these, 36 (5.8%) were major complications and 148 (23.9%) were minor complications. Among the major complications, 34 were associated with bleeding and were managed with 33 blood transfusions and 7 interventions. Additionally, 133 minor complications were due to bleeding and were managed conservatively. No mortality occurred as a direct result of the biopsy. The TJRB is associated with a substantial rate of bleeding complications. Given the high diagnostic yield, TJRB remains a feasible procedure for select patients who require tissue diagnosis but are not candidates for percutaneous biopsy.