Efficacy and Safety Of Transjugular Renal Biopsy In Systemic Lupus Erythematosus and Antiphospholipid Syndrome: A Retrospective Monocentric Study Of 91 Procedures

Alexis Mathian¹, Maud Cazenave², Laurent Arnaud³, Nathalie Costedoat-Chalumeau⁴, Du Boutin-LE Thi Huong⁵, Ahlem Chaib⁵, Fleur Cohen-Aubart⁶, Julien Haroche³, Miguel Hié⁵, Makoto Miyara⁵, Philippe Rouvier⁷, Jean-Charles Piette⁸, Philippe Cluzel⁹ and Zahir Amoura¹⁰, ¹Hôpital Pitié-Salpêtrière, AP-HP, UPMC Univ Paris 06 & French National Reference Center For Systemic Lupus and Antiphospholipid Syndrome, Internal Medicine, Paris, France, ²Service de médecine interne 2, Centre de référence National pour le Lupus et le Syndrome des antiphospholipides, CHU Pitié-Salpêtrière, APHP, Paris, France, Paris, France, ³Internal Medicine, Hôpital Pitié-Salpêtrière, AP-HP, UPMC Univ Paris 06 & French National Reference Center For Systemic Lupus and Antiphospholipid Syndrome, Paris, France, ⁴Internal Medicine, Assistance Publique-Hôpitaux de Paris, Hopital Pitié-Salpétrière, Paris, France, ⁵Hôpital Pitié-Salpêtrière, AP-HP, UPMC Univ Paris 06 & French National Reference Center For Systemic Lupus and Antiphospholipid Syndrome, Paris, France, ⁶Internal Medicine Dpt 2, Pitié-Salpêtrière Hospital, APHP, Paris, France, ⁷Service d'anatomie pathologie, CHU Pitié-Salpêtrière, APHP, Paris, France, Paris, France, ⁸Department of Internal Medicine 1., CHU Pitié-Salpêtrière, Paris, France, ⁹Cadiovascular Imaging and Interventional Radiology, Pitié-Salpétrière, Paris, France, ¹⁰Department of Internal Medicine 2. Referal center for SLE/APS, CHU Pitié-Salpêtrière, Paris, France

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: antiphospholipid syndrome, biopsies and lupus nephritis

Session Information

Title: Systemic Lupus Erythematosus - Clinical Aspects I - Renal, Malignancy, Cardiovascular Disease

Session Type: Abstract Submissions (ACR)

Background/Purpose:

Percutaneous renal biopsy requires a long duration discontinuation of antithrombotic treatment which can increase the risk of thrombosis in patient with Systemic Lupus Erythematosus (SLE) or antiphospholipid syndrome (APS). Transjugular kidney biopsy has been used successfully to obtain renal tissue in patients with high risk of bleeding. The aim of this study was to describe the efficacy and safety of transjugular renal biopsy in SLE and APS.

Methods:

We conducted a monocentric single-center and retrospective study of transjugular renal biopsies performed between January 2004 and September 2013 for patients with SLE or APS. Number of glomeruli per tissue core, histopathologic diagnosis, and rate and severity of complications were analyzed.

Results:

Ninety-one consecutive procedures were analyzed: 56 patients with SLE without APS, 30 patients with SLE and APLS and 5 patients with APLS without SLE. The main indication to perform the kidney biopsy using the transjugular instead of the percutaneous way was a risk of excessive bleeding (antithrombotic treatment in 65 patients and thrombopenia in 3 patients). Renal tissue was obtained in 89 (97.8%) of 91 procedures. The median [range] numbers of intact glomeruli per tissue core were 14 [4 – 61] with optical microscopy and 7 [0 – 28] with immunofluorescent microscopy. Twenty-three (25.3%) biopsies for optical microscopy contained less than 10 glomeruli but only 3 (3.3%) less than 5 glomeruli. Tissue cores were adequate for histopathologic diagnosis in 89 procedures (97.8%). Symptomatic perirenal hematoma occurred in 7 patients with a good outcome without treatment. One patient had a major complication.

Conclusion:

Use of transjugular renal biopsy provides a good diagnostic yield and safety for the diagnosis of kidney disease in SLE or APLS. It can be recommended in patients with percutaneous renal biopsy contraindication or failure.

Disclosure:

A. Mathian,
None;

M. Cazenave,
None;

L. Arnaud,
None;

N. Costedoat-Chalumeau,
None;

D. Boutin-LE Thi Huong,
None;

A. Chaib,
None;

F. Cohen-Aubart,
None;

J. Haroche,
None;

M. Hié,
None;

M. Miyara,
None;

P. Rouvier,
None;

J. C. Piette,
None;

P. Cluzel,
None;

Z. Amoura,
None.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/efficacy-and-safety-of-transjugular-renal-biopsy-in-systemic-lupus-erythematosus-and-antiphospholipid-syndrome-a-retrospective-monocentric-study-of-91-procedures/