Iliac crest bone biopsy by interventional radiologists to improve access to bone biopsy in chronic kidney disease populations: technical note and a case series.

INTRODUCTION: Chronic kidney disease-mineral and bone disorder (CKD-MBD) leads to increased fracture risk. Iliac crest biopsy remains the gold standard for diagnosing bone disease in CKD. Unfortunately, bone biopsy is rarely performed which is mainly due to the inability of clinicians to perform the procedure. In this paper, we propose a fluoroscopy-guided procedure performed by interventional radiologists as a novel approach to iliac crest biopsy in adult population. We describe the implementation of the procedure and present the first 11 cases of CKD patients who underwent iliac crest biopsy with this new approach. METHODS: A nephrologist already trained in performing iliac crest biopsy initiated the creation of a fluoroscopy-based iliac crest biopsy program. Two interventional radiologists underwent a short training. Patients' demographical, clinical and biochemical data were collected on the day of the biopsy. Complications within the first three months after the procedure were collected from electronical records. RESULTS: IR rapidly mastered the procedure. The use of fluoroscopy allowed a precise localisation of the biopsy site and standardization of the intervention, which ensured specimen quality. The new approach allowed CKD patients to access iliac crest biopsy, which resulted in precise bone disease diagnosis (levels of bone turnover and mineralization) and targeted therapy for each case. There were no complications during, nor within 3 months after the intervention. CONCLUSIONS: We believe this approach will increase the access to iliac crest biopsy for diagnosing bone disease in CKD population. Studies are now needed to evaluate whether CKD patients will benefit from anti-osteoporotic therapy based on the results of iliac crest biopsy.

Management of retroperitoneal hemorrhage compressing the inferior vena cava in a patient with a renal transplant: A case report.

We report a case of a right retroperitoneal hematoma compressing the inferior vena cava (IVC) in a patient with a left pelvic renal transplant. Noncontrast abdominal computed tomography scan diagnosed the cause of the hematoma, which was a ruptured nontraumatic renal cyst hemorrhage from the right native kidney. The patient had been anticoagulated for 5 days to treat pulmonary embolism upon clinical presentation. To minimize the risk of venous renal transplant thrombosis and to resume anticoagulation as fast as possible without the need of a long-term IVC filter, priority in management was to relieve the IVC compression and to stop the hemorrhage by selective embolization of the right native kidney. This case report will review the clinical presentation, the radiological findings and the management of retroperitoneal hematoma compressing the IVC in a patient with renal transplant.