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Renal Biopsy
1. Renal biopsy
Dr. Kamal Okasha MD. PhD;
Prof of Int Med & Nephrology, Tanta University,
Egypt.
Member of ESNT, ASN, ISN and ERA-EDTA.
Fellowship of Nephrology, Sask University,
Canada.
3. ESNT-CNE 1st Course Cairo Sept 10-14, 2012
For more than 50 years, renal biopsy has been
an important diagnostic procedure in modern
nephrology.
Increasing perfection of the biopsy technique has
made the procedure very safe, with rare
complications and few contraindications.
Ther Umsch. 2002 Mar;59(3):110-6.
INTRODUCTION
4. ESNT-CNE 1st Course Cairo Sept 10-14, 2012
Definition: a procedure that is used to obtain
small pieces of kidney tissue to look at under a
microscope.
It may be done to determine:
Cause;
Severity.
Treatment of a kidney disorder.
The procedure is generally safe and can provide
valuable information about kidney disease.
INTRODUCTION
5. ESNT-CNE 1st Course Cairo Sept 10-14, 2012
Why?
A renal biopsy is obtained for a number of reasons:
Establishment of the exact diagnosis to determine the
nature of recommended therapy.
Ascertain the degree of active (ie, potentially reversible)
and chronic (ie, irreversible) changes.
The degree of active or chronic changes helps determine
prognosis and likelihood of response to treatment.
In addition, kidney biopsy can be performed to help assess
genetic diseases.
INDICATIONS FOR RENAL BIOPSY
6. ESNT-CNE 1st Course Cairo Sept 10-14, 2012
Four groups of patients benefit from the findings
of renal biopsy:
Nephrotic syndrome,
Renal disease in a context of systemic disorder,
Acute renal failure and
Renal transplant.
Some patients with non-nephrotic proteinuria,
hematuria and chronic renal failure may also
benefit from the procedure.
INDICATIONS FOR RENAL
BIOPSY
7. Contraindications
Absolute contraindications
Patient Refusal
Bleeding diathesis
Uncontrolled severe
hypertension
Uncooperative patient
Presence of a solitary
native kidney
Relative contraindications
Azotemia
certain anatomical
abnormalities of the kidney
skin infection at the desired
biopsy site
Hemostasis-altering drugs
(e.g. warfarin or heparin)
pregnancy
urinary tract infections
obesity.
8. ESNT-CNE 1st Course Cairo Sept 10-14, 2012
Preparation:
Before your biopsy, patients may need testing to see
if they have a blood clotting abnormality or infection.
To decrease the risk of bleeding, patients should be
asked to stop taking medicines that increase the risk
of bleeding (such as aspirin, aspirin-like compounds,
antiplatlets and anticoagulats) for one to two weeks
before the biopsy.
RENAL BIOPSY PROCEDURE
9. ESNT-CNE 1st Course Cairo Sept 10-14, 2012
Biopsy procedure
Renal biopsy is usually performed while patients are
awake, after a cleansing agent is applied, and local
anesthesia is given to minimize pain.
The most common way to perform a biopsy is to use a
needle, which is inserted through the skin and into the
kidney.
Approach is either by using an ultrasound, x-ray, or
CT scan guidance to localise the right position of the
kidney (usually the lower pole)
Biopsy procedure
10. ESNT-CNE 1st Course Cairo Sept 10-14, 2012
Once the needle is in the right position, a sample
of renal tissue will be taken with the needle.
In some cases, a different approach is used to
perform the biopsy. An open renal biopsy under
general anesthesia, and a small incision of the
skin and underlying tissue, which is opened to
obtain the kidney specimen.
11. ESNT-CNE 1st Course Cairo Sept 10-14, 2012
After an open or needle biopsy, patient will be
kept in a recovery or an observation unit for
several hours to monitor for potential
complications, including pain and bleeding.
Patients may have blood drawn for cbc or repeat
x-rays to monitor for bleeding.
In some instances, patient will be sent home
after several hours of monitoring. Alternatively,
may be observed in the hospital overnight.
After renal biopsy
12. ESNT-CNE 1st Course Cairo Sept 10-14, 2012
Once it is deemed safe for the patient to go
home, he is not allowed to perform any heavy
lifting or vigorous exercise for one to two weeks.
Continue to avoid aspirin-like drugs or blood
thinning medications for at least one week or
until your physician has instructed you that it is
safe to take these.
Instructions after renal biopsy:
13. ESNT-CNE 1st Course Cairo Sept 10-14, 2012
The routine evaluation of a percutaneous renal
biopsy involves examination of the tissue under
LM, IMF, and EM.
Full clinical data and lab tests must be clearly
mentioned in the pathology request you sent to
the renal pathologist.
After renal biopsy
14. ESNT-CNE 1st Course Cairo Sept 10-14, 2012
Serious complications of renal biopsy are not
common.
Less serious complications can occur, and
can include bleeding, pain, and development of
an abnormal connection between two blood
vessels (a fistula).
Rare complications include infection, damage
to blood vessels or other organs, or urine leaks.
RENAL BIOPSY COMPLICATIONS
15. ESNT-CNE 1st Course Cairo Sept 10-14, 2012
Bleeding is the most common complication of
renal biopsy.
Many people may notice blood in their urine for several days
after a renal biopsy.
More severe bleeding occurring around the kidney or into
the urine is uncommon but if it occurs you may need a blood
transfusion.
Very rarely, it may become life threatening and possibly
require a procedure or surgery to stop the bleeding.
If the urine is bright red or brown for longer than one week
after your biopsy, FUP is needed.
Bleeding
16. ESNT-CNE 1st Course Cairo Sept 10-14, 2012
Pain is a common problem after a renal biopsy.
Patient may need pain killers to reduce pain post procedure.
Pain usually resolves within a few hours.
If severe or prolonged pain, most propably renal
hematoma.
Pain
17. ESNT-CNE 1st Course Cairo Sept 10-14, 2012
The biopsy needle can accidentally injure the walls
of a nearby artery and vein, and this can lead to
the development of a fistula. Fistulas generally do
not cause problems and usually close on their own
over time.
Arteriovenous fistula
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Mendelssohn D, Cole E (October 1995). "Outcomes
of percutaneous kidney biopsy, including those of
solitary native kidneys.". Am J Kidney Dis 26 (4):
580–585.
Whittier L, Korbet S (November 2004). "Renal
biopsy: update". Current Opinion in Nephrology and
Hypertension 13 (6): 661–665.
Iversen P, Brun C (September 1951). "Aspiration
biopsy of the kidney". Am. J. Med. 11 (3): 324–30.
References
