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What are non percutaneous methods of kidney biopsy?
A non-percutaneous kidney biopsy is performed when contraindications to the percutaneous method exist but tissue is required for diagnosis and treatment.
Transvenous Kidney Biopsy
The transvenous, usually transjugular, kidney biopsy is performed by an interventional radiologist. The major indication for this technique is in patients with a bleeding diathesis.
The reason that the transvenous approach is preferred for patients with bleeding diathesis is not that bleeding complications are less compared to the percutaneous approach, it is that an immediate bleeding complication can be treated quickly with the use of interventional techniques.
A transvenous biopsy is also preferred in patients with morbid obesity, requiring multiple organ biopsies, and following unsuccessful attempts via the percutaneous route. Contraindications include bilateral internal jugular vein thrombosis and allergies to contrast material.
The cost, the risk of contrast induced nephropathy, the variable operator experience, and the obtaining of an inadequate sample to establish a diagnosis are limitations of this technique.
Open Kidney Biopsy
The open, or surgical, kidney biopsy is a safe and effective technique to obtain kidney tissue.
The indications are similar to those outlined for the transvenous kidney biopsy, and it is performed in intensive care patients who are being mechanically ventilated.
The risk of bleeding is low and mortality is rare. However, disadvantages of this technique include the risk of general anesthesia, fever, atelectasis, and a longer recovery time compared to the percutaneous approach.
Laparoscopic Kidney Biopsy
Experience thus far suggests that the laparoscopic route is a safe, reliable, and accurate procedure to obtain kidney tissue.
