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Kidney Biopsy

A biopsy is a procedure performed to remove tissue or cells from the body for examination under a microscope. During a kidney biopsy, tissue samples are removed with a special needle to determine if cancer or other abnormal cells are present, or to determine how well the kidney is working.

There are two types of kidney biopsies:

  1. Needle biopsy/Percutaneous biopsy. After a local anesthetic is given, the doctor inserts the special biopsy needle into the kidney to obtain a sample. Ultrasound (high-frequency sound waves) or computerized tomography (CT scan) may be used to guide the biopsy needle insertion. Most kidney biopsies are performed using this technique.
  2. Open biopsy. After a general anesthetic is given, the doctor makes an incision in the skin and surgically removes a piece of the kidney. Depending on the lab findings, further surgery may be performed.
Hospital Stay: Hospital Stay: Day Care
Duration: Duration: 1 hr
Cost Estimate: Cost Estimate: 350 USD - 420 USD These are indicative prices in Indian Hospitals

A kidney biopsy may be performed to:

  • Determine the reason for poor kidney function
  • Evaluate how well a transplanted kidney is working
  • Blood in the urine that does not go away
  • Determine if a tumor in the kidney is malignant (cancerous) or benign
  • Protein in the urine found during a urine test

There may be other reasons for recommending a kidney biopsy.

Risks:

As with any surgical procedure, complications can occur.
Kidney biopsy is performed with the aid of ultrasound technology. Therefore, the risk for radiation exposure is low. If pregnant or suspect may be pregnant, should notify doctor.

Kidney biopsy may be contraindicated in persons with an active kidney infection, certain bleeding conditions, uncontrolled hypertension (high blood pressure), or with only one functioning kidney.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

A kidney biopsy is done in the hospital. The two most common ways to do a kidney biopsy are percutaneous and open. These are described below.

Percutaneous biopsy

  • Percutaneous means through the skin. Most kidney biopsies are done this way.
  • You may receive medicine to make you drowsy.
  • You lie on your stomach. If you have a transplanted kidney, you lie on your back.
  • The doctor marks the spot on the skin where biopsy needle is inserted.
  • The skin is cleaned.
  • Numbing medicine (anaesthetic) is injected under the skin near the kidney area.
  • The doctor makes a tiny cut in the skin. Ultrasound images are used to find the proper location. Sometimes another imaging method, such as CT, is used.
  • The doctor inserts a biopsy needle through the skin to the surface of the kidney. You are asked to take and hold a deep breath as the needle goes into the kidney.
  • If the health care provider is not using ultrasound guidance, you may be asked to take deep breaths. This allows the doctor to know the needle is in place.
  • The needle may be inserted more than once if more than one tissue sample is needed.
  • The needle is removed. Pressure is applied to the biopsy site to stop the bleeding.
  • After the procedure, a bandage is applied to the biopsy site.

Open biopsy

In some cases, your doctor may recommend a surgical biopsy. This method is used when a larger piece of tissue is needed.

  • You receive medicine (anaesthesia) that allows you to sleep.
  • The surgeon makes a small surgical cut (incision).
  • The surgeon locates the part of the kidney from which the biopsy tissue needs to be taken. The tissue is removed.
  • The incision is closed with stitches (sutures).

After percutaneous or open biopsy, you will likely stay in the hospital for at least 12 hours. You will receive pain medicines and fluids by mouth or through a vein (IV). Your urine will be checked for heavy bleeding. A small amount of bleeding is normal after a biopsy.

Follow instructions about caring for yourself after the biopsy. This may include not lifting anything heavier than 10 pounds for 2 weeks after the biopsy.

Before the procedure:

  • Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
  • You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
  • In addition to a complete medical history, your doctor may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
  • Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
  • Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
  • Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
  • If you are pregnant or suspect that you are pregnant, you should notify your doctor.
  • You may be asked to fast before the procedure, generally after midnight. Your doctor will give you specific instructions.
  • You may receive a sedative prior to the procedure to help you relax. Because the sedative may make you drowsy, you will need to arrange for someone to drive you home.
  • Based on your medical condition, your doctor may request other specific preparation.

During the procedure

A kidney biopsy may be performed on an outpatient basis or as part of your stay in a hospital. The kidney biopsy may be performed in a procedure room, in a hospital bed, or in the radiology department. Procedures may vary depending on your condition and your doctor’s practices.

Generally, a kidney needle biopsy follows this process:

  1. You will be asked to remove clothing and will be given a gown to wear.
  2. An intravenous (IV) line may be started in your arm or hand.
  3. You will be positioned on your stomach so that the doctor can easily reach the kidney. A pillow may be used to hold you in the correct position. If you have a transplanted kidney, you will be positioned on your back.
  4. The skin over the biopsy site will be cleansed with an antiseptic solution.
  5. You will feel a needle stick when the local anesthetic is injected. This may cause a brief stinging sensation.
  6. You will need to lie still during the procedure.
  7. Ultrasound may be used to guide the biopsy needle insertion.
  8. You will be asked breathe in and hold your breath while the doctor inserts the biopsy needle into the kidney. Holding your breath prevents movement of the diaphragm, which may interfere with the placement of the biopsy needle. You should lie quietly without moving.
  9. You may feel discomfort or pressure when the doctor obtains the sample.
  10. There may be more than one puncture performed if the doctor needs more than one tissue sample. If so, the same puncture process will be repeated.
  11. The biopsy needle will be withdrawn and firm pressure will be applied to the biopsy site until the bleeding has stopped.
  12. A sterile bandage or dressing will be applied.
  13. The kidney tissue sample will be sent to the lab for examination.

After the procedure

Your recovery process will vary depending on the type of procedure performed and your doctor’s practices. You may be taken to the recovery room for observation if your procedure was done in a procedure room or in the radiology department. Once your blood pressure, pulse, and breathing are stable and you are alert, you may be taken to a hospital room or discharged to your home.

You will be asked to lie on your back for several hours. A nurse will check your urine for signs of bleeding. You may have blood tests to monitor for internal bleeding. You may be discharged later the same day or the next day.

The biopsy site may be tender or sore for several days after the biopsy. Take a pain reliever for soreness as recommended by your doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

Notify your doctor to report any of the following:

  • Blood in your urine after the first 24 hours
  • Inability to urinate
  • Fever and/or chills
  • Redness, swelling, or bleeding or other drainage from the biopsy site
  • Increased pain around the biopsy site or elsewhere
  • Feeling faint

You may resume your usual diet unless instructed differently. Your doctor may ask you to rest for a day or two and to avoid strenuous physical activity for several days. You should not perform any type of “bouncing” activities, such as jogging, aerobics, playing tennis, or horseback riding for a couple of weeks to prevent bleeding of the biopsy site.

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.
A renal biopsy is the removal of a small piece of kidney tissue for examination.

How the Test Will Feel

Numbing medicine is used, so the pain during the procedure is often slight. The numbing medicine may burn or sting when first injected.
After the procedure, the area may feel tender or sore for a few days.
You may see bright, red blood in the urine the first 24 hours after the test. If the bleeding lasts longer, tell your health care provider.

Normal Results

A normal value is when the kidney tissue shows normal structure.

Abnormal Results

An abnormal result means there are changes in the kidney tissue. This may be due to:

  • Infection
  • Poor blood flow through the kidney
  • Connective tissue diseases such as systemic lupus erythematosus
  • Other diseases that may be affecting the kidney, such as diabetes
  • Kidney transplant rejection, if you had a transplant

Some kidney problems can often be found with blood and urine tests, a sonogram (an image made by ultrasound) or other special x-rays, and a physical exam rather than a biopsy. But in some patients with certain types of kidney disease, and those with a kidney transplant that is not working well, a correct diagnosis can only be made with a kidney biopsy.

Specific reasons to do a kidney biopsy include:

  • Blood in the urine (hematuria) or protein in the urine (proteinuria)
  • Abnormal blood test results
  • Acute or chronic kidney disease with no clear cause
  • Nephrotic syndrome and glomerular disease (which happens when the filtering units of the kidney are damaged)

A kidney biopsy may also help to find:

  • If a disease is getting better with treatment or if it is getting worse. It may also show a problem that cannot be cured, but can be slowed down by other therapy.
  • How much permanent damage has happened in the kidney.
  • Why a transplanted kidney is not working well and helps your doctor decide on further treatment.
  • A kidney tumor.
  • Other unusual or special conditions.
  • If a certain treatment is hurting your kidneys

Your healthcare provider should explain the reasons for the kidney biopsy. You should know why it is necessary, the benefits, and any risks. You will be asked to sign a consent (permission) form to make sure you are aware of any risks. Be sure you understand the risks before you sign the consent form. You may want to write down a list of questions about the biopsy.

The risks of kidney biopsy are very small, but they should be discussed with your healthcare provider. As in other medical and surgical procedures, certain complications may happen even though every effort is taken to prevent them. A blood transfusion may be needed if serious bleeding occurs. Rarely, surgery may be needed to fix a blood vessel that is damaged during the procedure.

For two weeks before the biopsy, you should not take aspirin and other medicines that may cause thinning of the blood. These medicines can change the way the blood clots and raise the risk of bleeding. For the same reason, you should stop taking some supplements such as fish oil. Blood and urine samples are usually taken before the kidney biopsy to make sure you do not have an infection or other condition. Your doctor may also want you to change other medications before the biopsy. You may be told to not eat or drink for eight hours before the procedure.

A kidney biopsy is usually done in a hospital. An overnight stay may be needed to watch for any problems. You may be awake with only light sedation, or asleep under general anesthesia. You will be lying face down with a pillow under your rib cage. If the biopsy is done on a transplanted kidney, you will be lying on your back.

Percutaneous biopsy:

The kidney is found using a sonogram, x-ray images, or both. Sometimes, an injection of dye into your veins may be needed to help the doctor find the kidney and important blood vessels. Once the biopsy site is found, your skin is marked, and cleaned where the biopsy needle will be inserted. You will receive a local anesthetic to numb the area where the biopsy needle enters. You will be asked to take in a deep breath and hold it as the doctor puts in the needle. When the needle pushes through the skin to the kidney, you may feel a “pop” or pressure. It is important to stay still and to hold your breath (about 45 seconds or less). Sometimes two needle passes are needed to get enough of the kidney sample for diagnosis. When enough is taken, the needle is removed and a bandage is placed over the needle puncture site. The entire procedure, from start to finish, usually lasts about one hour. Sometimes the biopsy may take longer than an hour.

Open kidney biopsy:

Some patients should not have a percutaneous biopsy because they may have a history of bleeding problems. For these patients, an open operation may be done where the surgeon can actually see the kidney to get a good sample to study.

After the test

You may need to rest in bed for 12 to 24 hours after the biopsy, as directed by the doctor. Staying still on bed helps to heal the site where the kidney sample was taken and lessen the chance of bleeding. Your blood pressure and pulse are checked often to look for any signs of bleeding inside your body, or other problems. Blood tests are also done. You may eat and drink fluids after the biopsy. If your blood tests, blood pressure and pulse are stable, you should be allowed to leave the hospital the next day.
Your doctor will talk to you about physical activity and things to watch for after going home from the hospital. Heavy lifting, strenuous exercise, including contact sports, and sexual intercourse should be avoided for two weeks after the biopsy. If you had an open biopsy, be sure to ask your doctor for any specific instructions you need to follow after the surgery.

Test results

After the kidney sample is taken, it is sent to specially trained pathologists who will read and interpret your kidney biopsy. It often takes three to five days to get the full biopsy results. In some cases, you may have a partial or full report within 24 hours or less.

THINGS TO REMEMBER

Before the biopsy:

  • Talk with your health care provider to make sure you understand the need for a biopsy and the risks and benefits.
  • Tell your doctor about any allergies you have and medicines you take.
  • Avoid blood thinning medications and supplements.
  • Avoid food and fluid for eight hours before the test.

After the biopsy:

  • Follow your doctor’s instructions.
  • Rest in bed for 12 to 24 hours.
  • Avoid blood thinning medications.
  • Report any problems, such as:
    • Bloody urine for more than 24 hours after the biopsy
    • Unable to pass urine
    • Fever
    • Worsening pain at the biopsy site
    • Feeling faint or dizzy

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