Kidney Biopsy

1 What is a Kidney Biopsy?

During a kidney biopsy (renal biopsy) your doctor removes a small piece of kidney tissue to be examined under a microscope for signs of damage or disease.

Your doctor may recommend a kidney biopsy to diagnose a suspected kidney problem, determine the severity of kidney disease or monitor treatment for kidney disease.

A kidney biopsy can also be important for you if you have had a kidney transplant that is not working accordingly.

Most often, the doctor performs a kidney biopsy by inserting a needle through the skin (percutaneous kidney biopsy).

An imaging device helps the doctor guide the needle into the kidney to remove the tissue.

2 Reasons for Procedure

A kidney biopsy may be done for the following reasons:

  • Diagnose kidney problem that cannot be usually identified.
  • Help develop treatment plans based on the kidney's condition.
  • Determine the rate of kidney disease progression.
  • Determine the extent of damage from kidney disease to another disease.
  • Evaluate how efficient treatment for kidney disease is working.
  • Monitor the health of a transplanted kidney or find out why a transplanted kidney is not working as it should be.

Your doctor may recommend a kidney biopsy based on the results of a blood or urine test that show the following:

  • Blood in urine (hematuria) originating from the kidney.
  • Protein in the urine (proteinuria) that is rising excessively or accompanied by other signs and of kidney disease.
  • Problems with kidney function, leading to excessive waste products in the blood.

Not everyone with theses complications needs a kidney biopsy. The decision is based on your signs and symptoms,test results and overall health.

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3 Potential Risks

Generally. Percutaneous renal biopsy is a harmless procedure.

Potential risks of kidney biopsy include:

Bleeding. The most common complication of kidney biopsy is blood in the urine (hematuria). This bleeding usually comes to an end within a few days.

Serious bleeding may require a blood transfusion and rarely, surgery may be used to control the bleeding.

Pain. Pain at the biopsy is a very common occurrence. after a kidney biopsy, but it usually goes on for a brief period of time.

Arteriovenous fistula. If the needle used in a renal biopsy accidentally causes damage to a vein or artery in close proximity to the injection site, an abnormal connection known as a fistula can form between the two vessels. However, this type of fistula does not cause any symptom and closes on its own.

Others. In rare situations, a collection of blood or a hematoma around the kidney developed and infection. The complication is treated with antibiotics and surgical drainage.

Another uncommon risk is the development of high blood pressure related to a large hematoma.

4 Preparing for your Procedure

In preparing for your kidney biopsy, you will meet with your doctor to discuss what to expect. This is a good time to have queries about the procedure and make sure you understand any risks and benefits.

Medications. When you make a doctor's appointment, always remember to bring with you a list of medications, vitamins and herbal supplements that you take.

Before your kidney biopsy, you will be asked to stop taking the various medications and supplements that can increase the risk of bleeding.

This includes the following: Blood-thinning medications (anticoagulants such as Warfarin, rivaroxaban, dabigatran or enoxaparin.

Aspirin. Ibuprofen nd other nonsteroidal anti-inflammatory drugs (NSAIDs).

Certain dietary supplements such as omega-3 fatty acids. In general, these medications will be stopped 7 days before the procedure and may be resumed 7 days after the procedure.

Your doctor or nurse will let you know when to stop taking these medications and supplements, and for how long. Blood and urine samples.

Before your biopsy. You will have blood drawn and provide a urine sample to make sure you do not have any infection or any other condition that would make the biopsy risky.

Diet. You may be asked not to eat or drink for eight hours before taking the kidney biopsy.

5 What to Expect

Here’s what you can expect before, during, and after your kidney biopsy.

A kidney biopsy is usually done at a hospital or outpatient centre. An IV will be placed before the procedure starts.

During the procedure. During the biopsy, you'll be awake and lie on your abdomen or your side, depending on which position allows the best access to your kidney. For biopsy of a transplanted kidney, most people lie on their backs.

A percutaneous biopsy takes about an hour and includes these steps:

With an ultrasound probe, your doctor identifies exactly where to insert the needle. In some cases, a CT scan may be used instead of ultrasound.

Your doctor marks your skin, cleans the area and applies a numbing medication (local anaesthetic). If you experience pain not controlled by a local anaesthetic, your doctor may give you pain medication through your IV during the procedure.

Your doctor makes a small incision where the needle will go in and uses the ultrasound device to guide the needle into your kidney. You may be asked to hold your breath as your doctor collects a sample using a spring-loaded instrument.

You may feel a "pop" or pressure and hear a sharp clicking noise. Your doctor may need to insert the needle several times, often through the same incision in order to get enough tissue. Your doctor removes the needle and places a small bandage on the incision.

Other kidney biopsy procedures 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.

After the procedure after the biopsy, you can expect to Spend time in a recovery room where your blood pressure, pulse and breathing will be monitored. Have urinalysis and complete blood count tests are done to check for bleeding and other complications.

Rest quietly for several hours. Receive wrote instructions about your recovery. Feel some soreness or pain at the biopsy site for a few hours. You'll be given medications to relieve pain.

Most people can leave the hospital the same day. You may need to rest in bed for 12 to 24 hours after the biopsy, as directed by your doctor.

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.

Call your doctor if you experience:

  • Significant bright red blood or clots in your urine more than 24 hours after the biopsy
  • Inability to pass urine
  • Worsening pain at the biopsy site
  • Fever over 100.4 F (38 C)
  • Faintness or weakness

6 Procedure Results

Expect your kidney biopsy results from the pathology laboratory within a period of about a week. In very urgent situations, a full or partial report may be available in less than 24 hours.

At a follow-up visit, your doctor will discuss the results. The results may further give an explanation about the cause of the kidney problem, or they may be used to plan or change treatment.

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