Overview
What Is A Kidney Biopsy ?
A biopsy is when a small sample of tissue is removed from a part of the body. The sample is looked at under a microscope, or tested in other ways. A kidney biopsy (sometimes called a renal biopsy) is when a small sample of kidney tissue is removed.
A kidney biopsy is done to diagnose and monitor certain conditions of the kidney. For example, inflammation of the kidney, which can be due to various causes, and cancer of the kidney. It is also used to monitor kidney transplants.
Indications
Diagnostic
- Asymptomatic proteinuria(more than 1gm/day).
- Recurrent isolated hematuria with proteinuria where IVP and cyctoscopy do not show the source.
- Acute nephritis with persisting oliguria.
- Nephrotic syndrome in adults.
- ARF where there is no obvious cause renal tract obstruction is excluded.
- CRF where kidneys are normal on radiograph.
Prognostic
- Follow-up cases of glomerulonephritis
- To asses the effects of steroids or immunosupressants in glomerulonephritis or nephrotic syndrome.
Complications
- Local pain
- Hematuria
- Infections causing renal abscess
- Injury to the ileo-inguinal nerves which causes intense pain
- Peri-renal hematoma, causing dull pain and swelling in the loin, which may require surgical drainage
- Transient intra-renal A-V fistulas
What Are The Procedures For A Kidney Biopsy ?
Kidney biopsies are usually done in a hospital. The patient is fully awake with light sedation. A local anesthetic is given before the needle is inserted.
Patients lie on their stomachs to position the kidneys near the surface of their backs. Patients who have a transplanted kidney lie on their backs. The doctor marks the entry site, cleans the area, and injects a local painkiller. For a biopsy using a needle inserted through the skin, the doctor uses a locating needle and x-ray or ultrasound equipment to find the kidney and then a collecting needle to gather the tissue. Patients are asked to hold their breath as the doctor uses a spring-loaded instrument to insert the biopsy needle and collect the tissue, usually for about 30 seconds or a little longer for each insertion. The spring-loaded instrument makes a sharp clicking noise that can be startling to patients. The doctor may need to insert the needle three or four times to collect the needed samples.
The kidneys filter wastes and extra fluid from the blood and direct them to the bladder as urine.The entire procedure usually takes about an hour, including time to locate the kidney, clean the biopsy site, inject the local painkiller, and collect the tissue samples.
Patients who are prone to bleeding problems should not have a biopsy through the skin. These patients may still undergo a kidney biopsy through an open operation in which the surgeon makes an incision and can see the kidney to collect tissue samples.
After a Kidney Biopsy
You will need to lie on a bed and be observed for several hours to check that you have no bleeding. So, you may wish to bring in a book or an mp3 player for this time. If you come into hospital for the test, you may need to stay in overnight. However, if the biopsy was done early in the morning, you may be able to go home later in the day. You may have some discomfort which is usually eased by painkillers. The result of the biopsy may take a week or so to come back.
Your doctor may advise you not to take part in contact sports such as rugby for a certain length of time after the procedure. This is to make sure the kidney has a chance to heal properly.
You should seek medical advice if:
- Your urine appears blood-stained.
- The biopsy site becomes red or angry looking.
- You develop a fever or temperature.
- The biopsy site is still painful three days later and painkillers do not help.
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