A renal biopsy is a procedure to extract kidney tissue samples for analysis. It can be done through a needle inserted through the skin (percutaneous biopsy) or by making an incision (open biopsy). The biopsy helps doctors identify kidney diseases, determine severity, and develop treatment plans. During the procedure, local anesthesia is used and samples are taken using thin needles or a spring-loaded needle. Patients recover in the hospital for several hours before being discharged with instructions to rest for a few weeks. Potential risks include infection, bleeding, and pain at the biopsy site.

2. RENAL BIOPSY
GM SIDDIQUI
CLINICAL INSTRUCTOR/REGESTERED NURSE
THE KIDNEY CENTER PGTI

3. Renal Biopsy
A renal biopsy is a procedure used to extract kidney
tissue for laboratory analysis. The word “renal”
describes the kidneys. A renal biopsy is also called a
kidney biopsy.
The test helps your physician to identify the type of
kidney disease you have, how severe it is, and the best
treatment for it. A renal biopsy can also be used to
monitor the effectiveness of kidney treatments and see
if there are any complications following a kidney
transplant.

4. Types of Renal Biopsy.
There are two different ways to perform a renal biopsy.
1. Percutaneous Biopsy
The most common type of renal biopsy is called a
percutaneous biopsy, or a renal needle biopsy. For this
procedure, a doctor inserts a thin biopsy needle
through the skin to remove your kidney tissue. He or
she may use an ultrasound or computed tomography
(CT) scan to direct the needle to a specific area of the
kidney.

5. 2. Open Biopsy:
In an open biopsy—or surgical biopsy—your doctor
makes a cut in the skin near the kidneys. This allows the
physician to look at the kidneys and determine from
which area the tissue samples should be taken.

6. Purpose of Renal Biopsy
A renal biopsy can identify problems that are interfering
with your normal kidney function. Healthy individuals
have two kidneys that perform many functions. It is the
kidneys’ job to:
• remove urea—or liquid waste—from the blood by
producing urine
• maintain a balance of chemicals, such as sodium and
potassium, in the blood
• supply the hormone erythropoietin, which supports red
blood cell growth
• control blood pressure by producing the hormone rennin
• provide the hormone calcitriol, which regulates calcium
absorption and calcium blood levels

7. If your routine blood and urine tests indicate that your
kidneys are not doing their job properly, your doctor
may decide to perform a renal biopsy. Your doctor
might also order this test to:
• find the reason for an abnormal level of waste products
in the blood
• see if a kidney tumor is malignant or benign
• gauge how well a transplanted kidney is working
• investigate the cause of hematuria (blood in your urine)
or proteinuria (a high level of protein in your urine)
• see the severity of progressive kidney failure and how
quickly the kidneys are failing
• create a treatment plan for a diseased kidney

8. Renal Biopsy Procedure
A renal biopsy usually is performed as an outpatient
procedure at a hospital. However, it can also be done in
a radiology department if an ultrasound or CT scan is
necessary during the procedure.

9. Percutaneous Biopsies
Typically, a percutaneous or renal needle, biopsy is done
by a doctor and takes about an hour.
Just before the procedure, you’ll change into a hospital
gown. Your doctor might give you a sedative through
an intravenous (IV) line in your hand or arm to help
you relax. However, you will not receive general
anesthesia for this procedure, meaning you will be
awake throughout.

10. You will be positioned so that you are lying on your
stomach. This will keep your kidneys easily accessible
from your back. You may be given a pillow or towel,
since you will have to remain still and stay in this
position for about 30 minutes. If you have already had
a kidney transplant, you will be told to lie on your back.

11. Next, a doctor will inject a local anesthesia into the
entry site to numb the area and make a small incision
there. He or she will insert the needle through the
incision and into your kidney. Your doctor might use an
ultrasound or a CT scan to direct the needle.
You will have to take a deep breath and hold it as your
physician takes the tissue sample. This may take about
30 to 45 seconds. You may feel some discomfort when
the tissue sample is being extracted.
If more than one tissue sample is needed, the process
will be repeated several times. Each time, the needle will
be inserted through the same incision. You will have to
hold your breath while each sample is retrieved.

12. There are two main types of percutaneous
biopsies.
The type of procedure your physician uses will
determine the instrument required to remove the tissue.
In a fine needle aspiration biopsy, your physician
extracts a small tissue sample from your kidney using a
small, thin needle that is attached to a syringe.

13. For larger tissue samples, your physician may use a
needle core biopsy. In this procedure, the physician
removes a larger sample of kidney tissue using a spring-
loaded needle. If you are having a needle core biopsy,
you will hear a loud clicking or popping sound when
the tissue sample is being removed.
After the sample is retrieved, pressure will be applied to
the biopsy site until any bleeding has stopped and a
bandage will be applied over the incision site.

15. Open Biopsies
Depending on your physical condition and medical
history, your doctor may recommend an open biopsy.
Usually, you will have this type of biopsy if you have
had problems with bleeding or blood clotting in the
past, or if you have only one kidney.
If you are having an open biopsy, you will receive
general anesthesia. This means you will be asleep
throughout the procedure. Your doctor will make an
incision and surgically remove a tissue sample from
your kidneys while you are unconscious.

17. Recovery from a Renal Biopsy
After your renal biopsy, you will need time for recovery
and observation before you are released from the
hospital. The timing of your release will vary,
depending on your overall physical condition, your
doctor’s practices, and your reaction to the procedure.
Generally, you will be taken to a recovery room for rest
and observation. During this time, you will lie on your
back—or on your stomach if you have had a kidney
transplant—for about six to eight hours.

18. A nurse or doctor will keep track of your vital signs,
including blood pressure, temperature, pulse and
breathing rate. A complete blood count test and urine
test will be done to see if there is any internal bleeding
or other problems. You will also be given medication to
reduce pain at the biopsy site.
When your vital signs are stable, you will be released
from the hospital to go home. It is normal to have
bright red blood in your urine up to 24 hours after the
biopsy. If this condition lasts more than a day however,
you should report it to your doctor.

19. Typically, you can go back to eating your normal diet
when you feel hungry. Your doctor may ask that you
rest in bed for 12 to 24 hours after your biopsy and
avoid strenuous activity and heavy lifting for two weeks.
You should also avoid jogging, aerobics, or any other
activity that involves bouncing for two weeks after your
biopsy. You may want to take a pain reliever for any
discomfort you have at the biopsy site.

20. Risks of a Renal Biopsy
A renal biopsy can provide valuable information that allows
your doctor to diagnose kidney abnormalities and decide on
appropriate treatments.
Post-procedure infection is a serious potential risk. However,
this rarely occurs. Always be on the lookout for symptoms
that could indicate an infection after your renal biopsy.
Contact your doctor if you:
• have bright, red blood or blood clots in your urine for longer
than 24 hours after your biopsy
• cannot urinate
• have chills or a fever
• experience pain at the biopsy site that increases in intensity
• have redness, swelling, bleeding, or any other discharge from
the biopsy site
• feel faint or weak