renal biopsy proc.

1. RENAL BIOPSY
INDICATIONS-
Hematuria- If s.cr is continuously elevated
Proteinuria- proteinuria > 3 g/d in the absence of diabetes or a rapid increase in proteinuria even with diabetes or
proteinuria < 3 g/d with an elevated Scr level with no clear comorbid conditions such as diabetes or hypertension
AKI-In the setting of ATI, persistent injury despite reversal of cause or if Scr did not return to baseline with 7-14 d of
injury onset; in the setting of presumptive AIN, if there has been no resolution of injury despite removal of culprit
medication
CKD-Rapid elevation in Scr level or new-onset hematuria or proteinuria
PRE-OPERATIVE ASSESSMENT-
Blood Pressure- Should be less than 140/90 mmhg
Bleeding Risk- Platelet Count- More than 1.2 Lakh; INR should not be elevated
METHOD-USG or CT guided, lower pole of kidney is targeted in percutaneous biopsy. Prone position is
preferred but can be done in lateral decubitus or sitting position as well. Usually 2 cores are sufficient and can be
divided into the appropriate fixatives. 14/16/18 G needle is used. Cores are placed in 10% formaldehyde.
COMPLICATIONS-Bleeding(M.C.), Hematoma(75%), Hematuria, Lumbar Vessel Laceration, Infection
CONTRAINDICATIONS-
Local Infection- Absolute contraindication
Bleeding Risk- Less than 1.2 lakh platelets or elevated INR
Use of drugs- Warfarin should be stopped 72 hrs before biopsy, anti platelet drugs should be stopped 1 week
before biopsy
Hypertension- 140/90 mmhg is the upper limit.
Small Hypoplastic Kidney- Avoided if eGFR is less than 30 ml/min/1.73m^2
Horseshoe Kidney-Preferred route is trans-jugular
Hydronephrosis