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                                                                           Kidney Biopsy 

A kidney biopsy is a diagnostic procedure used to extract the kidney tissue for identifying the type of kidney disease and its severity. This procedure is also used to identify any complications associated with kidney transplantation procedure. Kidney biopsy is also called as a renal biopsy.

The two types of kidney biopsy are:

  1. Percutaneous kidney biopsy
  2. Surgical or open biopsy

Percutaneous kidney biopsy:  In this procedure, the doctor inserts a thin biopsy needle through the skin to remove the kidney tissue with the help of CT scan and ultrasound.

Surgical or open biopsy: In this procedure, after anesthesia is given, the doctor removes a piece of the kidney by surgery.

Purpose of kidney biopsy or causes

Kidney biopsy is performed to identify the following problems:

  • Finding out the kidney disease in the case of proteinuria and hematuria
  • Finding out status of a transplanted kidney
  • Finding the reason for abnormal levels of waste products in the blood
  • Checking the severity of renal failure
  • Checking and confirming kidney diseases identified in a CT scan or an ultrasound
  • Checking the progress of the treatment for kidney disease

Preparation

The doctor should be informed about the patient’s medical history and medications taken. Also, the doctor should be informed if the patient plans for a pregnancy.

Special instructions are given to the patients taking the following medications:

  • Anticoagulants
  • Blood Thinners
  • Nonsteroidal anti-inflammatory drugs
  • Medications that affect clotting factors, and blood clotting

Procedure

Percutaneous kidney biopsy

The doctor may recommend a few tests to check for any clotting problems before the start of the procedure. Tests like CT scan and ultrasound are performed by the doctor to identify the exact location of the kidney which is suitable for the biopsy procedure. The duration for percutaneous type of biopsy is 1 to 2 hours. A consent form is signed between the patient and the doctor regarding the procedure, risks associated etc.

A nephrologist, urologist, and radiologist perform the biopsy procedure in a hospital or a clinic. A sedative is given through an intravenous line in the arm that helps the patient relax. A local anesthetic drug is given at the site, where the biopsy needle is to be inserted, in order to numb that area.

The doctor puts the biopsy needle into the kidney through the skin using ultrasound, fluoroscopy, CT scan, and MRI scan. The doctor asks the patient to lay still, hold his breath when the biopsy needle is being inserted into the kidney. The needle is removed after the kidney sample is taken. Pressure is applied at the biopsy site to stop bleeding for several minutes. A bandage is placed at the site of biopsy.

Surgical or open biopsy:

This type of biopsy is preferred only when there is one kidney; patient is suffering from clotting and bleeding problems. The patient is given anesthesia and a tissue sample of the kidney is withdrawn surgically. Sometimes, a special instrument called laparoscope is used to send pictures of the kidney to a video monitor.

Recovery

The patient requires adequate time for recovery post surgery. Patients are kept under observation for a period of 24 hours during which their vital parameters such as blood pressure, temperature, and breathing rate are monitored closely and carefully by a nurse and the doctor. A complete blood count test and urine test is performed to identify internal bleeding or any other problems.

The timing of their discharge from the hospital is dependent on their body responses, physical condition of the patient, and the reaction of the patient to the procedure. The patient might see bright red blood in the urine for a period of 24 hours post the procedure. If this extends for more than 24 hours, it must be reported to the doctor immediately.

The patient is advised to take normal diet whenever he feels hungry and advised bed rest for a period of 24 hours after the procedure. The patient is advised not to do vigorous activities, lifting weights, jogging, etc that involve bouncing for a period of 2 weeks post the biopsy procedure. 

 

Risks or complications

Risks related to renal biopsy are rare, but they must not be neglected if they occur. The risks associated are:

  • Skin infections at the biopsy site
  • Bleeding into the kidney
  • Bleeding into the muscle, causing a soreness in that area
  • Collapsing of the lung (Pneumothorax)
  • Puncturing of a major blood vessel
  • Shocks
  • Collapse or passing out
  • Less alertness
  • Dizziness or lightheadedness
  • Weakness
  • Severe pain in the chest, shoulder, and belly
  • Difficulty in breathing
  • Burning urination
  • Fever
  • Pus discharge at the biopsy site
  • Bleeding from the site

Biopsy results

The biopsy results are available within a period of 24 hours if the requirement is an emergency and immediate one. In the case of infections related biopsy, it takes several weeks.

The doctor confirms the results based on the diagnostic test results into abnormal and normal cases. In normal cases, the structure, cells of the kidneys look normal. There are no signs of inflammation, infection, scarred tissues, kidney transplantation rejection and cancer.

In abnormal cases, kidney tissue shows presence of Wilms’ tumor, renal cell cancer, Glomerulonephritis, poor blood flow, tissue scarring due to infection, systemic lupus erythematosus, kidney transplant rejection and failure.

 

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