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How Do You Biopsy A Kidney

What Are The Risks Of A Kidney Biopsy

When Do You Need a Kidney Cancer Biopsy?

The risks of a kidney biopsy include

  • bleedingthe most common complication of a kidney biopsy. Bleeding may come from the kidney or the puncture site. Bleeding from the kidney rarely requires a blood transfusion.
  • infectiona rare complication of a kidney biopsy. Health care providers prescribe bacteria-fighting medications called antibiotics to treat infections.

Biopsy Of Renal Transplant Allograft

A survey by the United Network for Organ Sharing showed great disparities in practice across US transplant centers regarding the timing and performance of surveillance kidney transplant biopsies for diagnosing subclinical graft rejection. The most common timeframe for surveillance biopsies was 3 and 12 months post-transplant. The 1- and 3-year graft survival was similar among centers performing biopsies compared with those not performing biopsies. The survey results showed the controversies around surveillance biopsies and the management of subclinical rejection.

Rush et al from the Manitoba Adult Renal Transplant Program were the first to report the finding of subclinical rejection within the first 3 months after kidney transplantation. Subclinical rejection can be broadly defined as lymphocytic infiltration of a renal allograft with normal function.

Rush et al further classified subclinical rejection as an increase in serum creatinine by more than 10% 2 weeks before the protocol biopsy and a histologic Banff score of ai2at2 or greater. The controversy regarding this topic is whether detecting subclinical rejection from a specific biopsy protocol can guide early successful treatment of renal allograft pathology, ultimately improving long-term graft function.

In a high-risk transplant , the allograft interval biopsy schedule remains the mainstay for surveillance in this particular category of patients in whom the graft might be compromised by silent immunologic processes.

Types Of Renal Biopsy

  • Percutaneous Biopsy : It is a process in which a thin needle is inserted through the skin by your doctor. An ultrasound or computerized tomography scan guides the doctor to the exact location from where the kidney tissue needs to be extracted. It is the most frequently used technique.

  • Open Biopsy : This procedure is used when a larger kidney tissue is required. The patient is given anesthesia post which the doctor makes a small surgical incision in the skin near the kidneys. He then locates a suitable area in the kidney and removes a piece of kidney tissue and stitches the incision with sutures.

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Why Do I Need A Kidney Biopsy

You should tell your kidney doctor before the day of the biopsy if you are taking medication to thin your blood or make your blood less likely to clot.

There are lots of medications that do this, but common ones are aspirin, clopidogrel, warfarin, dabigatran, apixaban and rivaroxaban. These will need to be stopped before the day of your biopsy .

You should not stop taking these medications without consulting your kidney doctor. They will tell you if and when you need to stop taking them and when you should start taking them again.

You will usually go to the hospital on the morning of your biopsy. The kidney team will tell you where to go and at what time – this may involve attending the kidney ward. You can eat, drink and take your medication as normal . You should plan to have a light breakfast as your biopsy will involve you lying flat on your stomach or your back if you have a transplant.

You may need to have blood tests to check your blood levels and how well your blood clots, or these may have been done before the day of your biopsy.

Before you have your biopsy, a small plastic tube will be inserted into the back of your hand. Your cannula may be used to give you a medication called Desmopressin . Desmopressin reduces the risk of bleeding after your biopsy, and is given slowly over 30-60 minutes. It may not be needed in every patient but you may still need the cannula in case you need to have any treatment after the biopsy.

What Can A Person Expect After A Kidney Biopsy

Renal Biopsy: Purpose, Procedure, and Risks

After a kidney biopsy, a person can expect to

  • lie on his or her back in the clinic or hospital for a few hours. During this time, the staff will monitor the persons blood pressure, pulse, urine, and blood test results.
  • go home the same day, in most cases however, a person will need to rest at home for 12 to 24 hours after the biopsy. Sometimes a person may need to stay overnight at the hospital.
  • have some pain or soreness near the point where the needle went through the skin.
  • receive written instructions for ensuring a healthy recovery from the procedure. Most people need to wait 2 weeks before resuming strenuous activities, such as heavy lifting or participating in contact sports.

A health care provider most often receives the complete biopsy results from the pathologist in about a week. In urgent cases, a person may receive a preliminary report within 24 hours. The health care provider will review the results with the person during a follow-up visit.

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How Is It Done

Your kidneys lie just under the ribcage, towards the side and back of your upper tummy . So, you will usually be asked to lie on your front on a couch or bed. The skin over a kidney is cleaned with antiseptic. Local anaesthetic is then injected into a small area of skin and tissues just over the kidney to be sampled . This stings a little at first but then makes the skin numb.

If the biopsy is of a transplanted kidney, you will be asked to lie on your back and the local anaesthetic is put into the skin over the transplant.

A special hollow needle is then pushed through the skin and muscle into the kidney tissue to obtain a small sample. Because of the local anaesthetic, you should not feel any pain. However, you may feel some pressure as the doctor pushes on the needle. The needle is inserted and withdrawn quickly, bringing with it a small sample of kidney tissue.

You will have to hold your breath for 5-10 seconds when the needle is pushed in and out . This is because the kidneys move slightly when you breathe in and out.

During the biopsy an ultrasound scanner is often used to help the doctor. The ultrasound scan locates the kidney so the biopsy needle is inserted at exactly the right place. The scan is painless.

How Is A Kidney Biopsy Done

  • The procedure of biopsy is started by laying the patient on the bed in a position that is comfortable and suitable for the biopsy
  • Then the patient will get an intravenous placed via which the sedative will be given during the procedure if needed
  • Identification of the spot from where the needle is to be inserted in the next step. To execute this, certain procedures such as ultrasound is used.
  • After identification, that spot is marked and given local anesthesia.
  • Once the needle is inserted through that spot, the movement of the needle to go further at the kidney is again assisted by the ultrasound
  • A specialized tool at the front of the needle will collect the sample from the kidneys. Meanwhile, the patient will be asked to stay still and not get overwhelmed by the sound of removal of tissue
  • As to avoid the pain of the patient, the doctors will only take a tiny portion of kidney tissue at a time. Therefore, a needle might be inserted more than once to gather enough tissue to be studied under a microscope

As the patients who are required to get a kidney biopsy done do not suffer from the same condition, hence the above procedure is not the only method of performing a kidney biopsy.

For some patients, the method of laparoscopy is used and for some, open kidney biopsy is done.

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Technical Details And Complications

When performing a renal mass biopsy, consideration should be given to several technical factors that may affect the diagnostic and complication rates. The guidance modality that best depicts the lesion, adjacent structures and the needle-tip should be used to guide the biopsy. Each modality has its advantages and disadvantages. US provides real-time imaging without ionizing radiation but may not visualize the lesion. CT is more expensive, however, usually allows better depiction of the mass and surrounding structures. MR imaging is seldom used but may be helpful to biopsy a mass that is not seen by US or CT. Operator preference, and equipment availability will also play a part in deciding which imaging modality is chosen.

Given the lack of conclusive evidence that large needles confer a greater diagnostic effectiveness, the authors obtain fine-needle specimens initially and obtain a preliminary impression by a cytology technologist during the biopsy procedure. If the specimens are not adequate, large needle biopsies are obtained.

Needle track seeding is a potential complication of renal mass biopsy. The true incidence is difficult to ascertain. The scarcity of published reports implies that it is a rare event, and probably not more common than other percutaneous biopsy sites. To the best of our knowledge, there is no evidence to suggest that use of large needles increases the risk of needle track seeding relative to fine needles.

Why Might I Need A Kidney Biopsy

New kidney biopsy technique changes cancer diagnosis

Your kidneys are a pair of purplish-brown organs. They sit below the ribstoward the middle of the back. The kidneys:

  • Remove liquid waste from the blood in the form of urine

  • Keep a balance of salts and other substances in the blood

  • Produce erythropoietin, a hormone that aids the formation of red blood cells

  • Regulate blood pressure

When your kidney function is abnormal, a kidney biopsy may be done to:

  • Find out the reason for poor kidney function

  • Check how well a transplanted kidney is working.

There may be other reasons for your healthcare provider to advise a kidneybiopsy.

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What Are Some Of The Risks Of A Transplant Kidney Biopsy

While the risks of a biopsy are small, complications could occur. Bleeding may occur. About a third of patients have some light red color in the urine for a day or so of little consequence. About 1-3% of patients have bleeding with clots that required a bladder irrigation with a catheter to clear them. If the bleeding is severe enough, a transfusion may be needed. However, this is a very rare occurrence in less than 1% of patients. Very rarely a urine infection may occur, especially in patients with a history of frequent urine infections. Other problems to watch for include fever, pain at the site of the biopsy, dizziness, or not being able to urinate.

Last reviewed by a Cleveland Clinic medical professional on 11/05/2019.

References

How It Is Done

A kidney biopsy is done by a urologist, nephrologist, or a radiologist in a clinic or a hospital. A kidney biopsy is often done by a radiologist using ultrasound, fluoroscopy, a CT scan, or magnetic resonance imaging to help guide the biopsy needle.

You will need to take off all or most of your clothes. You will wear a gown. Before the biopsy, you may be given a sedative through an intravenous line in a vein in your arm. The sedative will help you relax and lie still during the biopsy.

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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.

What Are The Risks Of Kidney Biopsy

You Need a 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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Why Have A Kidney Biopsy

Your doctor may need to do a kidney biopsy to find out why your kidneys are not working well or why there is blood or protein in your urine. While a blood test and a urine test are the most common ways to test for kidney disease, a kidney biopsy can tell your doctor if you have other rare conditions that are damaging your kidneys, such as focal segmental glomerular sclerosis .

Doctors also use kidney biopsies to:

  • Monitor how quickly kidney damage is getting worse
  • Check how well your transplanted kidney is working
  • Find out why your transplanted kidney is not working properly
  • Create treatment plans based on the condition of your kidneys
  • Find out how well treatments are working
  • Diagnose cancer

Imaging Tests To Look For Kidney Cancer

Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. Imaging tests are done for a number of reasons, such as:

  • To look at suspicious areas that might be cancer
  • To learn how far cancer might have spread
  • To help determine if treatment is working
  • To look for possible signs of cancer coming back after treatment

Unlike most other cancers, doctors can often diagnose kidney cancer with fair certainty based on imaging tests without doing a biopsy . Some patients, however, may need a biopsy.

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Tell A Healthcare Provider About:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eyedrops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anestheticmedicines.
  • Any blood disorders you have.
  • Any surgeries you have had.
  • Any medical conditions you have.
  • Whether you are pregnant or may be pregnant.

What Can I Expect After A Kidney Biopsy

Kidney Biopsy!! Is it Painful ??

After the biopsy, you may feel some pain or soreness near the cut. In most cases, you will be able to go home a few hours after the procedure is finished. Occasionally, patients may have to stay at the hospital overnight. You should be able to return to most of your normal daily activities after 24 hours of rest. Your doctor will have the results from your biopsy within a week.

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What Happens Afterwards

Biopsy results take at least 2 weeks. Very specialist tests from the biopsy take several months. Results will be discussed at your next clinic appointment.

If you get any discomfort from the biopsy site, you should take paracetamol for 24 48 hours after the biopsy such as ibuprofen should be avoided).

You should not drive for 2 days and should avoid any heavy lifting or strenuous exertion for 10 days. You can shower or bathe as normal. If you notice any blood or clots in your urine, feel any new or severe back pain, or become faint after you have gone home you should attend your local Emergency Department immediately.

The slides that are made from the biopsy are kept indefinitely in the Pathology Department in case we need to refer to them for comparison with other biopsies in future years. Biopsy tissue samples may also be used for research into understanding various diseases and improving treatment of these.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Renal Department on telephone: 675050 or ask to speak to the doctor who referred you.

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 during the first 24 hours after the test. If the bleeding lasts longer, tell your provider.

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What Affects The Test

Reasons you may not be able to have the test or why the results may not be helpful include:

  • Having an untreated bleeding or blood clotting disorder.
  • Not being able to lie still.
  • Having advanced kidney disease, uncontrolled high blood pressure, or only one kidney.
  • Being obese.
  • Having a severely deformed spine.
  • Having a urinary tract infection.

Monoclonal Gammopathies And Paraprotein Diseases

Kidney Biopsy

Patients with monoclonal gammopathies may require a kidney biopsy to document end organ damage from the offending paraprotein. Although it has been suggested that patients with monoclonal gammopathies and amyloidosis have a higher risk of complications from bleeding diathesis , there is no evidence that this translates to a higher clinical risk with PRBs. One series found a statistically increased risk of bleeding in patients who had renal amyloidosis , but the definition of bleeding was a hemoglobin decrease > 1 g/dl and did not include need for transfusion or intervention. A second series found no difference in overall or major bleeding complications after PRB in patients with systemic amyloidosis versus controls . Another series found no increased risk of PRB complications for patients with monoclonal gammopathies versus controls .

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What To Think About

  • A kidney biopsy is done after other tests for kidney disease have not been able to tell what kind of kidney problem is present. A kidney biopsy has more risk for problems than these other tests and a chance of false-negative results. More than one biopsy may be needed.
  • CT Scan of the Body
  • Open kidney biopsy and ureteroscopy are two other methods that may be used to take kidney tissue samples. You will stay overnight in the hospital for these biopsies.
  • An open kidney biopsy is a surgery done in an operating room while you are asleep . A cut is made through the back or the side and a small piece of kidney tissue is taken out. Open biopsy is often done when the doctor needs to remove a larger piece of tissue .
  • Ureteroscopy with biopsy is often done if there is a mass in the renal pelvis or ureter. Ureteroscopy is a surgery done in an operating room under spinal or general anesthesia. A long thin flexible tube is used to look inside the ureter and lower part of the kidney . Once the mass is found, a biopsy is done through the ureteroscope.
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