What To Expect From Your Biopsy
Biopsies vary greatly according to how difficult the tissue is to obtain. The medical term for this is “invasiveness.”
A minimally invasive biopsy may be done in the doctor’s office during the same visit the lesion is discovered. A small injection of numbing medicine can make the procedure almost painless.
More invasive biopsies may be done in a hospital, a surgery center, or a specialized doctor’s office. You would make a separate appointment for the biopsy. In most cases, sedating and pain relief medicines are given, reducing any discomfort. You likely won’t be able to drive after receiving these medicines.
You may feel sore at the area of the biopsy for a few days. Your doctor can prescribe appropriate pain relief medicines if you have significant pain from the biopsy.
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:
- anticoagulants
- 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.
How Will I Recover From A Kidney Biopsy
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
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Your healthcare provider will tell you about the procedure and can ask questions.
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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.
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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.
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Tell your healthcare provider if you are sensitive to or are allergic to any medicines, latex, tape, and anesthesia.
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Tell your healthcare provider of all medicines and herbal supplements that you are taking.
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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.
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If you are pregnant or think you might be, tell your healthcare provider before the procedure.
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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.
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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.
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Based on your medical condition, your healthcare team may request other specific preparation.
What Are The Chances Of Bleeding After A Kidney Biopsy
After a kidney biopsy, 13 to 34 percent of patients have a chance of bleeding. Percutaneous kidney biopsy was linked to bleeding events such macroscopic hematuria , post-biopsy hematoma , erythrocyte transfusion , and rarely nephrectomy or mortality . Patients who get a kidney biopsy for AKD are more likely to need a blood transfusion afterward. After a kidney biopsy using the NPS technique, AKD was linked to more post-biopsy hemorrhages. Despite the unclear mechanism, we recommend that patients with AKD who had a kidney biopsy be closely followed afterward.
FAQ
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How The Test Is Performed
A kidney biopsy is done in the hospital. The;two most common ways to do a kidney biopsy are percutaneous and open. These are described below.
Percutaneous biopsy
Percutaneous means through the skin. Most kidney biopsies are done this way. The procedure is usually done in the following way:
- You may receive medicine to make you drowsy.
- You lie on your stomach. If you have a transplanted kidney, you lie on your back.
- The doctor marks the spot on the skin where the biopsy needle is inserted.
- The skin is cleaned.
- Numbing medicine is injected under the skin near the kidney area.
- The doctor makes a tiny cut in the skin. Ultrasound images are used to find the proper location. Sometimes another imaging method, such as CT, is used.
- The doctor inserts a biopsy needle through the skin to the surface of the kidney. You are asked to take and hold a deep breath as the needle goes into the kidney.
- If the doctor is not using ultrasound guidance, you may be asked to take several deep breaths. This allows the doctor to know the needle is in place.
- The needle may be inserted more than once if more than one tissue sample is needed.
- The needle is removed. Pressure is applied to the biopsy site to stop any bleeding.
- After the procedure, a bandage is applied to the biopsy site.
Open biopsy
In some cases, your doctor may recommend a surgical biopsy. This method is used when a larger piece of tissue is needed.
Types Of Renal Biopsy
A native renal biopsy is commonly performed percutaneously through the patients back. The biopsy needle is typically guided using ultrasound.
Other possible approaches are the transjugular kidney biopsy and laparoscopic/open kidney biopsy. For a kidney transplant, the graft biopsy is percutaneous and ultrasound guided.
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What Is A Kidney Biopsy
A kidney biopsy is a test doctors use to help diagnose kidney disease. During this test, a doctor takes a sample of kidney tissue and sends it to a laboratory for examination.
Most kidney biopsies are performed at a hospital or outpatient clinic, either in radiology or a procedure room. A kidney biopsy is also called a renal biopsy.
During An Open Biopsy
- Youre given general anesthesia, so you dont feel anything during the procedure.
- Your surgeon makes a small incision above your kidney.
- Your surgeon identifies the area of your kidney thats of concern and removes a small sample.
- Your surgeon closes the incision with sutures.
Afterward, youll likely be given medicine to help alleviate any pain from the surgery, and you also may be given fluids by mouth or an IV.
The staff will monitor your urine for heavy bleeding.
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Availability Of Data And Materials
The data that support the findings of this study are available from Universidade Federal de São Paulo , but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of Universidade Federal de São Paulo .
What Will A Kidney Biopsy Reveal
Inflammation, scarring, infection, or atypical immunoglobulin deposits can all be seen in kidney tissue samples if a person has chronic kidney disease, which is defined as any illness that results in decreased kidney function over time. A biopsy may reveal how rapidly the disease is progressing. A biopsy can further reveal why a transplanted kidney isnt functioning well. While the most frequent tests for kidney illness are a blood test and a urine test, a kidney biopsy can provide your nephrologist with the data on whether you have other uncommon disorders that are causing your kidneys to fail, such as focal segmental glomerulosclerosis .
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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
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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Four Key Concepts And Talking Points
1. Talk to patients about their kidneys, CKD, and their risk.
What is CKD? CKD means the kidneys are damaged and may no longer filter blood well. This damage happens over many years. As more damage occurs, the kidneys are unable to keep the body healthy – then dialysis or a kidney transplant may be needed to maintain health.
How can I lower my risk for CKD? The steps you take to manage your diabetes and high blood pressure also help protect your kidneys. Choosing healthy foods, quitting smoking, and being more physically active are all important steps.
2. Communicate the importance of testing and how CKD is diagnosed.
What are the symptoms of CKD? Most people with CKD have no symptoms until their kidneys are about to fail. The only way to know if you have kidney disease is to get tested. The sooner kidney disease is found, the sooner you can take steps to begin treatment and keep your kidneys healthier longer.
How do you check for CKD? A blood test and a urine test are used to find kidney disease. Because you are at risk, you should get these tests regularly:
- GFR – A blood test measures how much blood your kidneys filter each minute, which is known as your glomerular filtration rate .
- Urine Albumin – A urine test checks for albumin in your urine. Albumin is a protein that can pass into the urine when the filters in the kidneys are damaged.
3. Explain the progressive nature of CKD and the basics of treatment.
4. Begin to speak about dialysis and transplantation.
How Long Does It Take To Recover From A Kidney Biopsy
As far as the recovery is concerned, the patient will be kept under monitoring after the biopsy is done. The time it takes for the final release will depend on the overall health of the patient, the nephrologists procedures, and his/her reaction to the treatment. In most cases, the patient is transported to a recovery room to relax and be observed. Youll spend around six to eight hours lying on your back throughout this period.
Your vital indicators, such as sugar levels, temperature, pulse, and respiratory rate, are monitored. Youll be released from the hospital after. This often occurs 12 to 24 hours following the kidney biopsy. Up to 24 hours following the biopsy, its usual to see bright red blood in your urine. Your nephrologist may advise you to stay in bed for 12 to 24 hours and avoid intense exercise and forceful liftings for two weeks.
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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.
Why Is A Kidney Biopsy Done
A kidney biopsy helps doctors identify the cause of kidney problems so they can treat the condition effectively. It can reveal scarring, inflammation , and protein deposits that cannot be identified with other tests, such as ultrasounds or blood and urine tests.
The test can also enable a doctor to see how well a transplanted kidney is working and monitor the progression of kidney disease.
Your doctor may recommend a kidney biopsy if you have:
- A transplanted kidney.
- Abnormal results from a blood test.
- Glomerular disease or glomerulonephritis.
- Hematuria .
- Kidney disease with no known cause.
- Proteinuria .
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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
After A Kidney Biopsy
You will need to lie on a bed and be observed for several hours to check that you have no bleeding. So, you may wish to bring in a book or a music player for this time. If you come into hospital for the test, you may need to stay in overnight. However, if the sample was done early in the morning, you may be able to go home later in the day. You may have some discomfort which is usually eased by painkillers. The result of the biopsy may take a week or so to come back.
Your doctor may advise you not to take part in contact sports such as rugby for a certain length of time after the procedure. This is to make sure the kidney has a chance to heal properly.
You should seek medical advice if:
- Your urine appears blood-stained.
- You develop tummy pain.
- The biopsy site becomes red or angry looking.
- You develop a high temperature .
- The biopsy site is still painful three days later and painkillers do not help.
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Risks Of A Renal Biopsy
A renal biopsy can provide valuable information that allows your doctor to diagnose kidney abnormalities and decide on appropriate treatments.
Developing an infection after the procedure is a serious risk. However, this rarely occurs. Always be on the lookout for symptoms that could indicate an infection after your renal biopsy. Contact your doctor if you:
- have bright red blood or blood clots in your urine for longer than 24 hours after your biopsy
- cant urinate
- have chills or a fever
- experience pain at the biopsy site that increases in intensity
- have redness, swelling, bleeding, or any other discharge from the biopsy site
- feel faint or weak
In addition to infection, a renal biopsy like any invasive procedure carries the risk of potential internal damage to the targeted organ or nearby areas.
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.
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