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Renal Biopsy

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Renal Biopsy

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Renal Biopsy

  1. 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.
  2. 2. ESNT-CNE 1st Course Cairo Sept 10-14, 2012  Introduction.  Indications for renal biopsy.  Contraindications for renal biopsy.  Renal biopsy procedure.  Renal biopsy complications.  References. Renal biopsy: Agenda
  3. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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
  18. 18. ESNT-CNE 1st Course Cairo Sept 10-14, 2012  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
  19. 19. ESNT-CNE 1st Course Cairo Sept 10-14, 2012 Tanta Nephrology Unit Renal Biopsy Histopathology Results 2014-2015 Diagnosis No. % Lupus nephritis 37 26.8 MCD 13 9.4 Glomerulosclerosis 13 9.4 MPGN 12 8.7 FSGS 11 8 ATN 10 7.2 MGN 9 6.5 AIN 7 5 RPGN 6 4.3 TMA 6 4.3 Amyloidosis 5 3.6 CIN 5 3.6 Post-infectious GN 2 1.4 Cast nephropathy 2 1.4 Total 138 100
  20. 20. ESNT-CNE 1st Course Cairo Sept 10-14, 2012 Sales Lupus nephritis MCD Glomerulosclerosis MPGN FSGS ATN MGN AIN RPGN TMA Amyloidosis Tanta Nephrology Unit Renal Biopsy Histopathology Results 2014-2015 0 10 20 30 40 Lupus nephritis MCD Glomerulosclerosis MPGN FSGS ATN MGN AIN RPGN TMA Amyloidosis CIN Post-infectious GN Cast nephropathy
  21. 21. ESNT-CNE 1st Course Cairo Sept 10-14, 2012

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