You'll have a kidney biopsy at a hospital or outpatient center. An IV will be placed before the procedure starts. Sedatives may be given through the IV. During the biopsy, you'll be awake and lie on your abdomen or your side, depending on which position allows best access to your kidney. For a biopsy of a transplanted kidney, most people lie on their backs. Percutaneous kidney biopsy isn't an option for some people.
If you have a history of bleeding problems, have a blood-clotting disorder or have only one kidney, your doctor may consider a laparoscopic biopsy. In this procedure, your doctor makes a small incision and inserts a thin, lighted tube with a video camera at its tip laparoscope. This tool allows the doctor to view your kidney on a video screen and remove tissue samples. Most people can leave the hospital the same day, about 12 to 24 hours after the procedure.
Once home, your doctor will probably recommend that you rest for another day or two. Your health care team will let you know about any activity restrictions, such as avoiding heavy lifting and strenuous exercise.
Your kidney tissue goes to a lab to be examined by a doctor who specializes in diagnosing disease pathologist. The pathologist uses microscopes and dyes to look for unusual deposits, scarring, infection or other abnormalities in the kidney tissue.
It may take up to a week before your doctor has your biopsy report from the pathology lab. In urgent situations, a full or partial report may be available in less than 24 hours.
Your doctor will usually discuss the results with you at a follow-up visit. The results may further explain what's causing your kidney problem, or they may be used to plan or change your treatment. Explore Mayo Clinic studies of tests and procedures to help prevent, detect, treat or manage conditions. Mayo Clinic does not endorse companies or products. Thus, it is not surprising that the indications for kidney biopsy vary considerably among nephrologists [10,11].
Rapidly progressive glomerulonephritis failure RPGN :- In patients with rapid fall of kidney function when an acute inflammation involving small vessels, glomeruli, or interstitium is suspected, renal biopsy should be done. In these circumstances, the clinical diagnosis may be difficult and incomplete. In such a condition, renal biopsy is indicated despite a high risk of complication is the determining factor in identifying potentially treatable diseases.
Haematuria:- There is no rule of renal biopsy in patients with isolated haematuria with or without asymptomatic proteinuria. Only renal biopsy can allow a firm diagnosis in these cases. Chronic renal failure:- Chronic renal failure represents a contraindication to renal biopsy.
However, for patients with moderate renal insufficiency and a normal sized kidney, a kidney biopsy may be indicated to recognize the type of renal disease and the potential reversibility of histological lesions. Non-nephrotic proteinuria:- The indications for renal biopsy in patients with proteinuria less than I to 2 g per day, normal renal function, and mild urine sediment abnormalities.
However, biopsy is considered if the clinical setting is compatible with a primary glomerular disease. Diabetic nephropathy:- Proteinuric non-insulin-dependent diabetic patients without retinopathy may require renal biopsy. However, non-diabetic renal disease may develop in diabetic patients. Moreover, a multitude of glornerulopathies may be associated with diabetic nephropathy, including membranous nephropathy [11], minimal change nephropathy [12] , acute glomerulonephritis [13] , anti-GBM nephritis [14], and IgA nephropathy [15].
These events are particularly frequent in type 1 diabetes mellitus [16]. The indications of renal biopsy in patients with diabetes are. Renal disease in SLE:- Renal biopsy permits the correct classification for staging and therefore for treatment of lupus nephritis. In Patients with SLE who have proteinuria, haematuria, and normal or subnormal renal function can have any stage of underlying glomerular lesions.
Patients with SLE may present initially with renal disease and only exhibit systemic features of SLE later in their course of illness. This is frequent in patients with an underlying membranous glomerulonephritis. In some patients, the biological markers of SLE may be absent for years and the diagnosis of idiopathic and lupus membranous nephritis can be established only by renal biopsy, which may show mesangial immune deposits, occasional subendothelial deposits, a full house immunofluorescence pattern typical of lupusnephritis.
A different situation is represented by those patients who have no clinical evidence of renal involvement despite underlying glomerular disease on histological examination of renal biopsy. This silent nephritis is characterized by mesangial or mild focal proliferative lesions.
Post transplant renal biopsy:- There are a number of possible indications for core renal biopsy of a transplanted kidney. In the early posttransplant period, renal biopsy can show whether oligoanuria is caused by acute tubular necrosis or by irreversible lesions, for example, infarction, and hyperacute accelerated rejection. Graft biopsy has also been largely used to differentiate acute rejection from drug toxicity, infections, or other causes of allograft dysfunction. In a later period, transplant biopsy may help in diagnosing whether a slow deterioration of renal function is caused by chronic rejection, by calcineurin-inhibitor toxicity, by recurrent disease, by a viral infection, or by a de novo glomerulonephritis.
Renal mass:- The presence of polycystic kidney disease is a formal contraindication to renal biopsy. Large cysts and renal neoplasm are not an absolute contraindication if they are well localized, renal biopsy under the guidance of ultrasonography or an open surgical biopsy should be done in these cases.
Single kidney:- This condition is generally considered as a contraindication to percutaneous renal biopsy. An exception is the transplanted kidney, which is commonly biopsied both because it is easy to puncture, being almost subcutaneous, and because compressive haemostasis can be carried out.
However, technical advances, such as real-time ultrasound guidance and automated biopsy guns, have improved the safety profile of biopsy in native single kidney. Good results have been obtained in selected cases both in adults [19] and in children [20]. Open biopsy is an alternative option in patients with a single kidney.
Chronic renal failure:- Patients with decreased renal function have a high rate of complications. Moreover, useful information cannot be obtained from the biopsy of small, contracted kidneys. For these reasons, renal biopsy should be considered only in patients with almost normal-sized kidneys after careful control of hypertension and correction of coagulation disorders.
Urinary tract infection:- Active untreated infection of the upper urinary tract is considered a contraindication to renal biopsy, in view of the potential communication between the collecting system and a possible perirenal hematoma, with consequent catastrophic infection of the hematoma.
High blood pressure:- The risk of complications after biopsy is directly related to the degree of elevation of blood pressure. Although normalization of blood pressure with antihypertensive agents may reduce the risk of complications, nevertheless, the transaction of sclerotic vessels is more likely to produce severe hemorrhage. Uncontrolled hypertension should be considered as a high-risk factor for complications.
Coagulation disorders:- Hemorrhagic diathesis is a formal contraindication to renal biopsy. Many patients with renal dysfunction present a prolongation of the skin bleeding time associated with normal results on coagulation tests. The risk of hemorrhagic complications after biopsy is high in patients with very prolonged bleeding time. However, in many cases preoperative infusion of desmopressin 0.
Others: - Renal artery aneurysm marked calcified atherosclerosis, perinephric abscess, and horseshoe kidney are generally considered as contraindications to percutaneous renal biopsy.
However, in particular cases an open biopsy may be considered if the clinical situation warrants the risk. Renal biopsy in pregnancy: Renal biopsy before 30 weeks of gestation is not associated with significant complications [21]. However, in the pre-or postpartum period it is often complicated by perirenal hematomas [22]. Thus, biopsy should be considered only if it may offer the opportunity to make a diagnosis other than severe pre-eclampsia in a patient remote from term.
Patients with AL amyloidosis may have a factor X deficiency due to binding of this factor to the amyloid tissue deposit [23]. Moreover, vascular amyloid deposits may impair vascular occlusion and vasoconstriction after transaction of vascular structures by biopsy. In view of the increased risk of hemorrhage, patients with amyloidosis should be assessed carefully to rule out possible haemostatic defects.
The goal of a renal biopsy should be to maximize the yield of adequate renal tissue while minimizing the risk of complications. Percutaneous renal biopsies have evolved from a blind procedure to a real-time ultrasound-guided needle biopsy. Although some nephrologists still use the FranklinSilverman needle and the Tru-Cut needle for blind biopsy, several authors have documented that the use of real-time ultrasonography along with the use of an automatic biopsy gun minimizes complications and provides a high yield of adequate tissue for pathologic diagnosis.
Cozens and co-workers [24] retrospectively compared a gauge Tru-Cut renal biopsy with ultrasound localization and marking with an gauge, spring-loaded gun renal biopsy under real-time ultrasound guidance.
Similarly, two other comparative studies reported a higher mean number of glomeruli from biopsies obtained under realtime ultrasound compared with those performed blindly [25, 26]. The objective of this study was to find out the correlation between indications and histopathology of renal biopsy.
Patients and methods. This prospective study was conducted in department of nephrology Sher-i-kashmir institute of medical sciences a tertiary care hospital. The average admission rate during the period was patients per year. Subjects:- Patients with renal disease were admitted and subjected to renal biopsy in department of nephrology. Methods:- The patients who were eligible for the study were taken for detailed history and examination according to prescribed proforma. All patients were subjected to Percutaneous Renal biopsy after ruling out cause of renal disease by other noninvasive methods.
Percutaneous renal biopsy was performed with an automated spring loade device of various size 15 to 22G. The skin and subcutaneous tissue was anesthetized with lidocaine followed by deeper anesthesia with a spinal needle. The depth on some occasions was noted with an ultrasonography and was confirmed with spinal needle. The biopsy needle was then inserted to the depth and engaged if the renal tissue was not obtained a deeper biopsy was performed. The biopsy was repeated until an adequate amount of tissue was obtained usually three specimens.
After the procedure patient was advised to lie flat on bed on his back and no activity was allowed for six hours and was observed for 24hrs for any complication. Patient blood pressure for initial 3hours was monitored every 30 minutes then hourly for 5 hours then 4 hourly for 16 hrs. Patient was monitored for Hematuria, pain, fever, and any other complication post biopsy Hemoglobin was done after 24hrs of biopsy to see for drop in hemoglobin. Biopsy tissue was sent for histopathology and immunohistochemistry.
It often takes three to five days to get the full biopsy results. In some cases, you may have a partial or full report within 24 hours or less. Skip to main content. What is a Kidney Biopsy? The biopsy sample may be taken in one of two ways: Percutaneous through the skin biopsy: a needle placed through the skin that lies over the kidney and guided to the right place in the kidney, usually with the help of ultrasound. Open biopsy: the kidney sample is taken directly from the kidney during surgery.
The kidney sample is then sent to a pathology lab to check for any signs of disease. He or she will check for any signs of disease. Specific reasons to do a kidney biopsy include: Blood in the urine hematuria or protein in the urine proteinuria Abnormal blood test results Acute or chronic kidney disease with no clear cause Nephrotic syndrome and glomerular disease which happens when the filtering units of the kidney are damaged A kidney biopsy may also help to find: If a disease is getting better with treatment or if it is getting worse.
It may also show a problem that cannot be cured, but can be slowed down by other therapy. How much permanent damage has happened in the kidney. Why a transplanted kidney is not working well and helps your doctor decide on further treatment.
A kidney tumor. Other unusual or special conditions. If a certain treatment is hurting your kidneys Your healthcare professional should explain the reasons for the kidney biopsy. Tell your doctor about any allergies you have and medicines you take. Avoid blood thinning medications and supplements.
Avoid food and fluid for eight hours before the test. After the biopsy: Follow your doctor's instructions. Rest in bed for 12 to 24 hours. Avoid blood thinning medications. Report any problems, such as: Bloody urine for more than 24 hours after the biopsy Unable to pass urine Fever Worsening pain at the biopsy site Feeling faint or dizzy.
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