Kidney biopsy

Some kidney diseases can be definitively diagnosed only by examining kidney tissue obtained through a kidney biopsy.

Biopsies can be done on native or transplanted kidneys.

Process can be open, percutaneous, laparoscopic, and transvenous.

Percutaneous kidney biopsy is performed through the back with the patient in the prone position using ultrasound guidance to localize the lower pole of the kidney.

Percutaneous renal biopsy is performed most often with ultrasonographic guidance and the use of a spring-loaded or other semi-automated needle.

This procedure is generally indicated when renal impairment and/or proteinuria approaching the nephrotic range are present and the diagnosis is unclear after an appropriate workup.

Indications for renal biopsy include: renal mass, and uropathies, nephropathies, or a suspected rejection of a renal allograft.

Biopsies are also indicated to guide management in already-diagnosed conditions, such as lupus, in which the prognosis is highly dependent on the degree of kidney involvement.

The most common complication of this procedure is bleeding, which can be life-threatening in a minority of cases.

Common complications of percutaneous renal biopsy include minor bleeding, with gross hematuria, subcapsular perinephric hematoma, and capsular hematoma, which affects approximately 21% of patients and major bleeding which occurs in approximately 1.5 cases.
Uncorrectable bleeding disorders is considered an absolute contraindication for percutaneous renal biopsy.
Other contraindications include poorly controlled hypertension, active renal infection, or solitary kidney.
Patients are at highest risk for complications in the first four hours after the procedure, and almost 90% of complications occur within the first 24 hours.
Post biopsy patient should be monitored for hematuria, flank pain, hypotension, and acute renal obstruction.
Surgical open renal biopsy can be considered when the risk of renal bleeding is felt to be great, occasionally with solitary kidneys, or when percutaneous biopsy is technically difficult to perform.

Most instances are achieved percutaneously, and the other techniques are reserved for patients with high risk for complications.

Needle biopsy generally performed under imaging guidance with ultrasound or CT scans.

Open biopsy is a surgical procedure providing a wedge biopsy.

Indications include: hematuria to rule out glomerulonephritis, proteinuria, unexplained kidney disease, kidney transplant rejection, systemic diseases, such as SLE or vasculitis, monitoring of previously biopsied kidney disease.

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