Safety and effectiveness of transjugular renal biopsy for systemic lupus erythematosus and antiphospholipid antibody syndrome patients taking antithrombotics

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.

Major Bleeding of Transjugular Native Kidney Biopsies. A French Nationwide Cohort Study

“…19 However, the largest series come from France, and the reported major bleeding risk rate in several hundred patients varied from 0% to 10% according to patient selection. 3 , 4 , 5 , 20 Nevertheless, the risk of selection and publication bias may occur in case series. In contrast, we report the result of a nationwide study in which our results reflect real-life practice in the 155 French centers where transjugular procedures were performed during the 2010–2019 period.…”

“… 3 Similar patient characteristics were reported in more recent case series. 3 , 4 , 5 , 7 , 8 , 16 , 17 , 18 , 19 , 20 …”

“…This technique is appealing as no difference in the diagnosis yield was found in 400 patients who had a transjugular kidney biopsy vs patients who had a percutaneous kidney biopsy (4). More recent data from the same center reported similar results (5). However, the exact risk of major J o u r n a l P r e -p r o o f bleeding is unknown as it derives from a few of mostly small case varies and thus they may be submitted to publication and selection biases (4)(5)(6)(7)(8).…”

“… 4 More recent data from the same center reported similar results. 5 However, the exact risk of major bleeding is unknown because it derives from a few, mostly small case studies, which they may be vulnerable to publication and selection biases. 4 , 5 , 6 , 7 , 8 The rate of major complications seem to vary from 0% to 25%.…”

“… 4 , 5 , 6 , 7 , 8 The rate of major complications seem to vary from 0% to 25%. 4 , 5 , 6 , 7 , 8 It is currently difficult to know whether the high risk of major bleeding associated with the transjugular route reported in some case series is due to patient selection or to the procedure itself. 4 , 5 , 6 , 7 , 8 …”