What Does The Biopsy Involve
Once your child is under general anaesthetic or has had Entonox®, they will lay on their left side if their own kidney is being biopsied. When a child has two kidneys, we usually take a biopsy from the one on the right hand side. If the biopsy is on a transplanted kidney, your child will lie on their back, as this makes it easier to reach the transplanted kidney. The exact position of the kidney is confirmed using an ultrasound scan, which also identifies the best place to take the biopsy. This is usually at the lower and outer part of the kidney.
Local anaesthetic is injected under the skin at the biopsy site and along the path between the skin and the kidney. The only cut that is made is a tiny nick in the skin to allow the biopsy needle to enter more easily. This nick is 2mm to 3mm long and is so small that it does not need a stitch afterwards.
The biopsy needle has a hollow centre, and when it is removed, it brings a very fine core of kidney with it. This is about the size of a grain of rice and is approximately 1cm to 2cm long. This tiny piece of kidney will contain between 10 and 50 glomeruli, which are the little filtering units within the kidney. This will not affect kidney function as each kidney contains about a million glomeruli. Usually two or three samples are taken so that enough tissue is available for testing in our laboratories.
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 The needle is inserted and withdrawn quickly, bringing with it a small sample of kidney tissue.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 To Prepare For A Bladder Biopsy
Before your biopsy, your doctor will take your medical history and do a physical examination. During this time, inform your doctor of any medicines youre taking, including OTC drugs, prescription medications, and supplements.
Your doctor may instruct you to avoid liquids for a certain amount of time before your procedure. Be sure to follow these instructions and any others your doctor gives you.
When you arrive for your biopsy, youll change into a hospital gown. Your doctor will also ask you to urinate before 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.
Is A Kidney Transplant An Option
If kidney failure occurs and is non-reversible, kidney transplantation is an alternative option to dialysis. If the patient is an appropriate candidate, the healthcare professional and nephrologist will contact an organ transplant center to arrange an evaluation to see whether the patient is suitable for this treatment. If so, the search for a donor begins. Sometimes, family members have compatible tissue types and, if they are willing, may donate a kidney. Otherwise, the patient will be placed on the organ transplant list that is maintained by the United Network of Organ Sharing.
Not all hospitals are capable of performing kidney transplants. The patient may have to travel to undergo their operation. The most successful programs are those that do many transplants every year.
While kidney transplants have become routine, they still carry some risks. The patient will need to take anti-rejection medications that reduce the ability of the immune system to fight infection. The body can try to reject the kidney or the transplanted kidney may fail to work. As with any operation, there is a risk of bleeding and infection.
Kidney transplants may provide a better quality of life than dialysis. After one year, 95% of transplanted kidneys are still functioning and after five years, the number is 80%. It seems that the longer a patient is on dialysis, the shorter the life of the transplanted kidney.
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When Will I Get The Results
The biopsy is processed in three different ways. First of all, we look at it under a microscope. This may give us some information within a day or two. We then do special stains on the sample, which takes a bit longer, and electron microscopy, which takes longer again. We may have some results available while you are still in hospital, but would need to allow six weeks to be sure that the others are back. You need to make sure that when you leave the hospital, you have an appointment for six weeks or sooner if you are asked to do so.
Biopsy For Kidney Cancer Communicating Changes In Practice
One question that is routinely posted in our kidney cancer patient communities is: should I have a biopsy of my kidney tumor? The resounding chorus from others is almost always an emphatic: NO! its too dangerous youll spread the cancer.
For more than two decades, the use of biopsy in managing renal cell carcinoma has been shifting dramatically. Advances in cytological techniques as well as increases in the number of unnecessary surgeries have expanded the role of renal mass biopsy. The myth that renal mass biopsy is dangerous has also largely been dispelled by multiple studies.
Despite the fact that biopsy rates are increasing, that the procedure is known to be safe, and that it can result in a reduction in unnecessary surgeries, the shared view in patient communities remains resoundingly negative.
Why do we think that biopsy is so dangerous?
In short? Because we were told that by doctors. If you or a loved one was diagnosed with kidney cancer in the last few decades, you might have been told that renal biopsies are never done and/or are not safe.
The reality is that biopsy is done in kidney cancer its just not always done. If a patient has a large tumor, imaging is generally sufficient to make a recommendation for surgery. It is not that it is dangerous to do a biopsy of the kidney, rather, it is just not necessary and there is no reason to put a patient through an additional invasive procedure.
What is tumor seeding?
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Why Might I Need A Kidney Biopsy
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.
What Problems Can A Transplant Kidney Biopsy Show
The procedure can verify if the donor kidney is working well. Examples of abnormalities detected by the biopsy include rejection-both from antibodies or cells. Rejections can be rapid and aggressive or slow and subtle. Over time damage to the kidney from the following may occur:
- Poor blood flow or scarring
- Viral or bacterial infections
- Evidence of kidney injury from certain drugs
- Evidence that a prior kidney disease has returned
- Evidence that a new kidney disease has begun
- Occasionally, kidney tumors or tumors from other sites in the body
Very often biopsy findings lead to changes or adjustments in treatment by your transplant doctor.
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What Do The Stages Of Chronic Kidney Disease Refer To
The five stages of CKD refer to how well your kidneys are working. Kidney disease can get worse in time. In the early stages , your kidneys are still able to filter waste out of your blood. In the later stages , your kidneys must work harder to filter your blood and may stop working altogether.
The goal at each stage of CKD is to take steps to slow down the damage to your kidneys and keep your kidneys working as long as possible.
Following Up After A Bladder Biopsy
It usually takes a few days for the results to be ready. Afterward, your doctor will want to discuss your test results with you.
Your doctor will be looking for cancer cells in the biopsy sample. If you have bladder cancer, the biopsy helps determine two things:
- invasiveness, which is how deeply the cancer has progressed into the bladder wall
- grade, which is how closely the cancer cells look like bladder cells
Low-grade cancer is easier to treat than high-grade cancer, which occurs when the cells have reached the point where they no longer look like normal cells.
The number of cancer cells and the extent of their presence in your body will help determine the stage of cancer. You may need other tests to help your doctor confirm the biopsys finding.
When your doctor knows the grade and invasiveness of your cancer, they can better plan for your treatment.
Remember, not all abnormalities in the bladder are cancerous. If your biopsy doesnt show cancer, it can help determine if another complication is causing your symptoms, such as:
- an infection
- bladder diverticula, or balloon-like growths on the bladder
- a burning sensation when you urinate after the second day
- a fever
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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.
What Is A Transplant Kidney Biopsy
While a kidney biopsy is a procedure where small samples of the kidney are removed in order to be examined by a pathologist under a microscope. A transplant kidney biopsy is done either as a screening test or to see what is happening with a kidney that is not working properly. It provides more information than can be obtained from a noninvasive procedure . Biopsy is considered the best option to diagnose problems with transplanted kidneys.
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How Is The Sample Obtained In A Transplant Kidney Biopsy
There are two ways to obtain the sample during a transplant kidney biopsy. A needle can be used that will go through the skin and into the kidney. The needle then is used to collect the sample. An ultrasound image is used to help guide the needle to the correct spot. This process is called a percutaneous biopsy. The second method would be to take a sample during surgery, this is much less common. Ultrasound guided transplant kidney biopsies are most often done under local anesthesia.
The Benefits From The Kidney Disease Solution
Through this program, here are the advantages you are likely to see with your kidney health and function:
- A comprehensive and holistic treatment for kidney disease
- An all-natural treatment plan that does not rely on medications, supplements or any other methods.
- Lowering kidney load and relieving the build-up of toxin in the kidneys
- Improved overall health through simple lifestyle modifications
- Improved diet through knowing the foods to eat, and what you should avoid to ensure healthy kidneys
- Reduced stress and improved sleep through guided meditation and yoga exercises
- Greater vitality throughout the day
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Preparation For A Renal Biopsy
Typically, you dont need to do much to prepare for a renal biopsy.
Be sure to tell your doctor about any prescription drugs, over-the-counter medications, and herbal supplements youre taking. You should discuss with them whether you should stop taking them before and during the test, or if you should change the dosage.
Your doctor may provide special instructions if youre taking medications that could affect the results of the renal biopsy. These medications include:
- nonsteroidal anti-inflammatory drugs, including aspirin or ibuprofen
- any medications that affect blood clotting
- herbal or dietary supplements
Tell your doctor if youre pregnant or think you might be pregnant. Also, before your renal biopsy, youll have a blood test and provide a urine sample. This ensures that you dont have any preexisting infections.
You need to fast from food and drink for at least eight hours prior to your kidney biopsy.
If youre given a sedative to take at home before the biopsy, you wont be able to drive yourself to the procedure and need to arrange for transportation.
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.
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What Is Kidney Failure
Kidney failure means one or both kidneys can no longer function well on their own. Sometimes, kidney failure is temporary and comes on quickly. Other times, it is a chronic condition that can get worse slowly over a long time.
Kidney failure may sound serious, and it is. But treatments such as dialysis and kidney transplant help many people with limited kidney function continue to live fulfilling lives.
What Happens During A Kidney Biopsy
During a kidney biopsy, a doctor collects a sample of tissue from your kidney. Most biopsies are done through your back, although people with a transplanted kidney have the biopsy through their lower abdomen .
Your doctor will use one of these methods to take the sample:
- Percutaneous biopsy: In this more common type of kidney biopsy, a doctor numbs the skin located over the kidney and inserts a needle to take a small tissue sample from the kidney. Your doctor may use ultrasound imaging to guide the needle to the best location in the kidney.
- Open biopsy: In an open biopsy, a doctor makes an incision , removes tissue from the kidney, and closes the incision with stitches. Your doctor will give you anesthesia so you do not feel pain during the procedure. This type of biopsy is rare except at the time of kidney transplant.
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