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Are You Awake For Kidney Biopsy

What Happens Afterwards

Kidney Biopsy!! Is it Painful ??

We will ask you to rest in bed for six hours . A nurse will monitor your blood pressure. During this time you can eat and drink. You will usually go home later the same day. Rarely, if you have pain or signs of bleeding, you will need to stay in hospital for further treatment. You should avoid strenuous activity, heavy lifting or contact sports for two weeks after the biopsy. You should avoid sexual intercourse for 48 hours. This is important to reduce the likelihood of bleeding after the biopsy. An early result may be available within 48 hours, but the complete result will take longer and can take several weeks.

How Is The Biopsy Done

The biopsy will be carried out in the radiology department. It should take about thirty minutes and you will be awake for the whole procedure. For a biopsy of your own kidney, you will lie face down on the bed. For a biopsy of a transplant kidney, you will lie on your back and the biopsy will be taken from your transplant kidney at the front. The doctor doing the biopsy will find your kidney using an ultrasound machine. He or she will clean your skin and then inject local anaesthetic to numb or freeze your skin. They will then pass a needle through the numb area and into the kidney. They will ask you to hold your breath for a few seconds in order to hold the kidney still. You should not be aware of any sharp pain from the biopsy needle but you may feel pressure and hear a clicking sound when the biopsy sample is taken. This is repeated two or three times .

Risks Of Kidney Biopsy

While risks are rare, a kidney biopsy is a surgical procedure, which means theres a possibility of complications. Some risks include:

  • Damaged blood vessel: Surgery may be needed to fix it.
  • Serious bleeding: You may need a transfusion as a result of blood loss.
  • Infection: As with any surgery, infection is always a risk, but its rare when undergoing a kidney biopsy. If you develop an infection, youll be given antibiotics to treat it.

Because doctors only take a tiny sample of the kidney, its possible they miss the actual cancerthat the area they take the sample from doesnt have cancer. Its also possible for the biopsy needle to spread the cancer.

If you have high blood pressure , youre at greater risk of complications during the procedure. Your doctor may try to control your blood pressure with medications before performing a biopsy.

Discuss the risks and benefits with your care team before you undergo a kidney biopsy.

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Is Kidney Biopsy An Operation

A kidney biopsy is generally done at a hospital as an elective procedure. If ultrasonography or CT scan is required during the operation, it can be performed in a radiology unit. Procedures may differ based on your situation and the procedures of your healthcare practitioner. So, indeed, it is a surgical procedure, and the operation follows these relevant steps-

Youll take off your clothes and change into a hospital gown.

  • An intravenous line will be inserted.
  • You will be lying on your stomach so that the nephrologist may easily access your kidney. You will lie back if you have a transplanted kidney.
  • An antibacterial liquid will be used to clean the skin around the biopsy site.
  • When the local anesthetic is given, you will feel a syringe stick. There may be a short stinging sensation as a result of this.
  • The needle may be guided into the kidney using ultrasound or X-ray.
  • While the nephrologist puts the biopsy needle into the kidney, you will be instructed to breathe in and hold your breath. This stops the diaphragm from moving about and interfering with the biopsy needles insertion.
  • When the nephrologist takes the sample, you may feel uncomfortable or pressed.
  • If the nephrologist requires more than one tissue sample, there may be several punctures. If thats the case, the puncture will be repeated.
  • To halt bleeding, strong pressure will be administered to the biopsy site once the needle is removed.
  • A sterile dressing or bandage will be applied.
  • Why Do I Need A Biopsy

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    • Hematuria with renal disease. Hematuria can occur with a number of conditions that affect the kidneys and urinary tract.
    • Proteinuria. Proteinuria occurs in many patients with kidney conditions. Renal biopsy is usually reserved for people with relatively high or increasing levels of protein when the cause is unclear.
    • Nephrotic syndrome. If you have nephrotic syndrome of the arms and legs) you may need a renal biopsy.
    • Acute renal failure. Acute renal failure refers to sudden kidney injury that hurts function. The cause of acute renal failure can usually be determined without a biopsy. Biopsy is sometimes needed in cases when the cause is uncertain.
    • Acute nephritic syndrome. People with acute nephritic syndrome have hematuria, proteinuria, high blood pressure, and kidney damage. A biopsy may be recommended to determine the cause of nephritic syndrome unless it can be determined through blood testing.

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    What Is A Kidney Biopsy

    A biopsy is done to remove tissue or cells from the body to exam under amicroscope. The tissue sample is removed with a needle to check for canceror other abnormal cells. It also helps check how well the kidney isworking.

    There are 2 types of kidney biopsies:

    • Needle biopsy . After an anesthetic is given, the healthcare provider inserts the biopsy needle into the kidney to get a sample. Ultrasound or computerized tomography may be used to guide the needle. Most kidney biopsies are done using this technique.

    • Open biopsy . After an anesthetic is given, the healthcare provider makes an incision in the skin and surgically removes a piece of the kidney.

    If your healthcare provider wants to sample a specific area of the kidney,the biopsy may be guided by ultrasound, fluoroscopy, or computedtomography.

    Pain And Bruising At The Biopsy Site

    Most children have a small amount of pain or a dull ache around the biopsy site the area where the needle was inserted. You may give your child paracetamol, usually for 12 days, to help with any pain, unless your doctor tells you not to. Give the medicine at least 4 hours apart, and do not give it more than four times in 24 hours. You may also talk with your doctor or nurse about other ways to help your child with any pain or discomfort.

    Do not give your chid ibuprofen unless your doctor tells you otherwise.

    A few children have bruising around the biopsy site.

    In most children, the bruising and the pain go away after a few days.

    See the Medicines for Children leaflet on Paracetamol for mild-to-moderate pain

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    What Can I Expect After A Transplant Kidney Biopsy

    During a standard biopsy, you will be observed for 1-2 hours in the recovery area to ensure you are well, can drink fluids, and pass urine comfortably. When released from the biopsy area, you should go directly home and stay indoors overnight. The next day you can walk or drive a car as needed. It will be important to avoid strenuous activity or heavy lifting for up to another two days after the procedure. If an open biopsy is required, you will receive further instructions.

    How Will I Recover From A Kidney Biopsy

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    Youâll lie flat for several hours after the procedure while your doctor and nurses monitor you. After a native kidney biopsy, most patients spend one night in the hospital.

    After a transplant kidney biopsy, most people go home the same day. Youâll need someone to give you a ride home, because you may feel drowsy from the medications.

    You should expect to remain quiet and rest for about a day after the procedure.

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    How Do I Get Ready For A Kidney Biopsy

    • Your healthcare provider will tell you about the procedure and can ask questions.

    • You will be asked to sign a consent form that gives your permission to do the kidney biopsy. Read the form carefully and ask questions if something is not clear.

    • Your healthcare provider may do a physical exam to be sure you are in otherwise good health. You may have blood tests or other diagnostic tests.

    • Tell your healthcare provider if you are sensitive to or are allergic to any medicines, latex, tape, and anesthesia.

    • Tell your healthcare provider of all medicines and herbal supplements that you are taking.

    • Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any anticoagulant medicines, aspirin, or other medicines that affect blood clotting. You may need to stop these medicines before the procedure.

    • If you are pregnant or think you might be, tell your healthcare provider before the procedure.

    • You may be asked to fast before the biopsy, generally after midnight or at least 6 hours before getting anesthetic or sedatives. Your healthcare team will give you specific instructions.

    • You may get a sedative before 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 healthcare team may request other specific preparation.

    What Happens After The Biopsy

    Following your biopsy it is important to rest on your back in bed for a minimum of four hours.

    The nurses will keep a close eye on your blood pressure and pulse. If you need to go to the toilet the nurses will give you a bottle or bedpan to use, so they can check whether there is blood in your urine. You should not get up until the nurses have told you it is safe to do so.

    Usually you can go home that evening, as long as you have someone to stay with you, or you may stay until the following morning. You should not drive or take public transport to get home and so you may need to arrange a lift home with a friend or family member. You should avoid heavy lifting, contact sport or strenuous exercise for one to two weeks after the procedure. Provided you feel well you can usually return to work within a day or two.

    There may be some discomfort as the local anaesthetic wears off and this usually settles within a few days. It is okay to take paracetamol for the discomfort, but do not take non-steroidal anti inflammatory painkiller such as ibuprofen or diclofenac as these can damage your kidneys.

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    Why Is A Transplant Kidney Biopsy Performed

    A transplant kidney biopsy is done either to screen for otherwise undetected problems with the kidney or when there are signs that the kidney is not working well. Kidney disease can occur anytime after the transplant, and biopsies can help with diagnosing and treating these problems. Signs of problems may include little or no urine output, fever, high blood pressure, and abnormal lab values. These could include an increasing serum creatinine level. Other signs may include blood or protein in the urine, damage to the filtering parts of the kidney or kidney disease with no clear reason. A biopsy may detect rejection of the kidney before actual signs are seen, improving the chance of better long term outcomes.

    What Are Potential Complications

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    • Bleeding. Bleeding is the most common complication of renal biopsy. Most people who have a renal biopsy notice blood in the urine for several days after the procedure. If you notice urine that is bright red or brown for longer than one week please consult with your healthcare provider. Rarely, bleeding is severe enough to require a blood transfusion or surgery.
    • Pain. Pain is a common problem, although it is usually mild to moderate and resolves within a few hours. Medications can be given to reduce pain after the procedure. If you experience severe or prolonged pain please call your healthcare provider this can be a sign of a blood clot that is obstructing the ureter or a large hematoma that stretches the kidney.
    • Arteriovenous fistula. Damage caused by the biopsy needle to the walls of an adjacent artery and vein can lead to a fistula . Fistulas usually do not cause problems and most often close on their own over time.

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    Preparation For Kidney Biopsy

    • Adequate blood pressure control in patients who are already hypertensive preferably below 140/90mmHg
    • Blood tests are done to check if the patient has adequate haemoglobin and clotting capacity
    • Tests done are- complete blood count, PT-INR, APTT, Bleeding and clotting time
    • Urine tests are done to rule out any infection
    • Ultrasound kidneys to see if the kidneys are in normal position and size of kidneys are checked
    • Medications are reviewed to see if the patient is on blood thinners like Aspirin, clopidogrel, warfarin, rivaroxaban, dabigatran, heparin etc
    • Blood thinners like aspirin and clopidogrel are stopped 7 days before procedure

    What Are The Risks Of Kidney Biopsy

    Complications are uncommon. In a small number of cases there is some bleeding from the site where the sample has been taken. This is usually minor and soon stops. Occasionally, the bleeding is more severe. Rarely, the bleeding requires a blood transfusion and/or an operation to deal with it. The main reason that you are monitored for several hours after the biopsy is to check for bleeding. There is a small risk that the small wound will become infected after the biopsy.

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    How Should I Prepare For My Biopsy

    The main risk of a kidney biopsy is bleeding. Therefore it is vital that you let your doctor know if you take medication to thin the blood . Usually we will ask you to stop these for 7 days before the biopsy and 2 days afterwards. Do not stop taking these tablets without first discussing with your doctor.

    You should eat a light breakfast at 7 a.m. on the morning of the biopsy and then not eat or drink anything after this until after the procedure. A light breakfast could be a bowl of cereal, two slices of toast or a piece of fruit If you take insulin for diabetes then this period of fasting might interfere with your blood sugar levels. Therefore you may need to adjust your insulin dose, following your usual fasting rules. If you require help with this then please ask your kidney doctor or diabetes team. On the morning of the biopsy, you will be booked into the daycase unit or renal ward. We will check your blood pressure and take some blood tests to ensure that it is safe to go ahead with the biopsy.

    Follow Your Health Care Professionals Instructions

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    As your health care professional advises

    • make any needed changes to the medicines and supplements you take
    • have blood tests and imaging testssuch as a computed tomography scan or ultrasoundto prepare for the procedure
    • make plans to get a ride home after the kidney biopsy
    • fast for several hours before the procedure
    • arrive 90 minutes to 2 hours before the procedure to sign a consent form and have any needed tests

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    How Does The Procedure Work

    The type of procedure used to perform the biopsy depends on the location of the tissue that needs to be examined.

    Most areas of the body can be biopsied with a needle device. This is the least invasive option, and usually allows for the patient to return home the same day. Imaging guidance with x-ray, ultrasound, CT or MRI allows for accurate placement of the needle to locate the best place to take a tissue sample.

    In hard to reach places, biopsies using surgery in a hospital operating room may sometimes be necessary. A surgeon will perform surgery to remove the tissue needed for the biopsy. The surgeon may use an instrument with a camera to help locate the best place to biopsy and remove the tissue sample.

    Using imaging guidance, the doctor inserts the needle through the skin and advances it into the lesion.

    They will remove tissue samples using one of several methods.

    How Do I Prepare For A Kidney Biopsy

    Some medications can decrease blood clotting and increase the risk of bleeding during the procedure. You should stop taking these medications, including aspirin, warfarin, apixaban, ibuprofen, and other blood thinners and anti-inflammatory drugs at least one week before a kidney biopsy. Your doctor will ask about any other medicines or supplements you take and recommend any needed changes to your medication regimen.

    Your doctor will take urine and blood samples before the biopsy to make sure you do not have any infections or other conditions that could cause complications. In most cases, doctors tell people not to drink or eat anything after midnight prior to the biopsy.

    Itâs important to take other medication as usual on the day of biopsy. Blood pressure medication should be taken to avoid high blood pressure at the time of biopsy, and medicine may be taken with sips of water.

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    How Is The Procedure Performed

    Imaging-guided, minimally invasive procedures, such as needle biopsies, are most often performed by a specially trained radiologist, an interventional radiologist or a neuroradiologist.

    Doctors usually perform needle biopsies on an outpatient basis.

    A nurse or technologist may insert an intravenous line into a vein in your hand or arm. This will allow them to provide sedation or relaxation medication intravenously during the procedure. You may also receive a mild sedative prior to the biopsy.

    The doctor will use a local anesthetic to numb the path of the needle.

    Some biopsies, such as breast or thyroid biopsies, may be performed without sedation. The nurse or technologist will advise you at the time of the procedure regarding the sedation.

    When a biopsy is performed on a child, it is more likely that general anesthesia will be required to keep them comfortable during the procedure.

    If the doctor is using fluoroscopy guidance, you will lie down or stand for the procedure.

    If the doctor is using CT or MRI guidance, you will lie down during the procedure. They will use a limited CT or MRI scan to confirm the location of the nodule and the safest approach for the targeted area. Once they confirm the nodules location, they will mark the entry site on the skin. The doctor will clean and disinfect the skin around the insertion site and cover it with a clean and sterile drape.

    The doctor will make a very small nick in the skin at the site where the biopsy needle will be inserted.


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