cirrhosis. Chronic hepatitis B virus infection can also be asso-When renal lesions are suspected in patients with circiated with various patterns of renal disease, including memrhosis, clotting disorders often preclude percutaneous branous nephropathy, membranoproliferative glomerulonerenal biopsy. This study was undertaken to determine phritis, and mesangial proliferative glomerulonephritis. 10 whether transjugular renal biopsy is possible, safe, and Finally, cirrhosis caused by hepatitis C virus may be accomuseful in such patients. From 1987 to 1994, 70 patients
panied by cryoglobulinemic related glomerulopathy. 11,12 with cirrhosis and clotting disorders underwent trans-The prevalence of cirrhosis-associated glomerular abnorjugular renal biopsies, providing renal tissue in 55. Of malities has not been clearly determined. Results of autopsy these 55 patients, 41 were Child-Pugh class B or C, 35 series are often flawed by the technical drawbacks inherent were alcoholic, serum creatinine levels were Β’130 mmol/ in the examination of postmortem renal tissue. Most patients L in 46, and proteinuria was Β’0.5 g/d in 37. Clinically in these series died of hepatocellular insufficiency, and little significant complications of transjugular renal biopsy
information could be provided about previous renal function were persistent hematuria in 4 and perirenal hematoma and urinary abnormalities. 13,14 Series based on percutanein 4, requiring blood transfusions in 1 and 2 cases, reous renal biopsies are few and deal with patients suffering spectively. There were no deaths related to renal biopsy.
from cirrhosis with moderate hepatic failure. In the re-Renal lesions were identified as glomerular in 41 (74.5%), maining patients with severe hepatic lesions, profound clotinterstitial in 7, and end-stage in 2 and were absent in ting disorders preclude percutaneous renal biopsy. This lack 5. Transjugular renal biopsy influenced treatment in 21 of information may be detrimental to patient care, particupatients (38%), including 11 who were proposed for liver larly in patients with end-stage hepatic failure and with renal transplantation and 4 who had chronic liver rejection.
insufficiency who are considered for orthotopic liver trans-Decisions based on results of transjugular renal biopsy plantation (OLT). If renal insufficiency in these patients is were to perform liver transplantation in 8 and combined caused by the hepatorenal syndrome, renal function can rerenal and liver transplantation in 5, whereas 2 were return to reasonably good after OLT in most cases. 15 However, fused. In 6 other patients, the results of renal biopsy if renal insufficiency is caused by severe renal lesions, there modified the medical regimen. We conclude that transis a potential contraindication to OLT because of cyclosporin jugular renal biopsy may be a useful procedure in pa-A nephrotoxicity. [16] Assessment of renal histology may also tients with cirrhosis and clotting disorders. This techbe important after OLT because postoperative acute and nique does not entail undue risks and may influence chronic renal failure have been reported to be as high as treatment decisions, particularly in patients proposed 66% 21 and 83%, 22 respectively. This posttransplant impairfor liver transplantation. (HEPATOLOGY 1996;24:1143ment of renal function may be caused by preexisting renal 1147.) lesions, severe dysfunction of the liver graft, ischemic acute tubular necrosis, or drug nephrotoxicity. 22 Renal lesions associated with cirrhosis were first identified
We have reported a novel technique of transjugular renal in 1946 1 and were further characterized when immunofluobiopsy in patients with clotting disorders in whom renal tisrescence became available. The distinctive although nonspesue sampling by the conventional percutaneous route is imcific glomerular lesion seen in patients with cirrhosis consists possible. 24 This procedure has been used in patients with of mesangial and/or subendothelial immunoglobulin (Ig)A decirrhosis, urinary abnormalities, and/or renal failure. More posits. These lesions may be present despite the absence than 500 transjugular renal biopsies have been performed in of urinary abnormalities or renal failure. [4] Another type of our center, including 70 in patients with cirrhosis. The purglomerulopathy, which resembled membranoproliferative pose of this study is to describe the spectrum of renal lesions glomerulonephritis, was later described. This is usually acobserved in this subgroup of patients. We found that in many companied by proteinuria and microhematuria and may lead instances the clinical data available before renal biopsy were to progressive and sometimes terminal renal failure. 7 Some not sufficient to predict the presence or absence of renal lestudies suggest a correlation between the severity of renal sions or, when present, to determine their severity and type. lesions and the extent of liver damage, 1 whereas others have In patients considered for OLT, the results of transjugular found no correlation. 4, Most of these patients had alcoholic renal biopsy were essential to decide whether the patient could undergo OLT and whether renal transplantation should also be performed.