Renal Biopsy

1. Renal biopsy
Dr. Kamal Okasha MD. PhD;
Prof of Int Med & Nephrology, Tanta University,
Egypt.
Member of ESNT, ASN, ISN and ERA-EDTA.
Fellowship of Nephrology, Sask University,
Canada.

2. ESNT-CNE 1st Course Cairo Sept 10-14, 2012
 Introduction.
 Indications for renal biopsy.
 Contraindications for renal biopsy.
 Renal biopsy procedure.
 Renal biopsy complications.
 References.
Renal biopsy: Agenda

3. ESNT-CNE 1st Course Cairo Sept 10-14, 2012
 For more than 50 years, renal biopsy has been
an important diagnostic procedure in modern
nephrology.
 Increasing perfection of the biopsy technique has
made the procedure very safe, with rare
complications and few contraindications.
Ther Umsch. 2002 Mar;59(3):110-6.
INTRODUCTION

4. ESNT-CNE 1st Course Cairo Sept 10-14, 2012
 Definition: a procedure that is used to obtain
small pieces of kidney tissue to look at under a
microscope.
 It may be done to determine:
 Cause;
 Severity.
 Treatment of a kidney disorder.
 The procedure is generally safe and can provide
valuable information about kidney disease.
INTRODUCTION

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 Why?
 A renal biopsy is obtained for a number of reasons:
 Establishment of the exact diagnosis to determine the
nature of recommended therapy.
 Ascertain the degree of active (ie, potentially reversible)
and chronic (ie, irreversible) changes.
 The degree of active or chronic changes helps determine
prognosis and likelihood of response to treatment.
 In addition, kidney biopsy can be performed to help assess
genetic diseases.
INDICATIONS FOR RENAL BIOPSY

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 Four groups of patients benefit from the findings
of renal biopsy:
 Nephrotic syndrome,
 Renal disease in a context of systemic disorder,
 Acute renal failure and
 Renal transplant.
 Some patients with non-nephrotic proteinuria,
hematuria and chronic renal failure may also
benefit from the procedure.
INDICATIONS FOR RENAL
BIOPSY

7. Contraindications
Absolute contraindications
 Patient Refusal
 Bleeding diathesis
 Uncontrolled severe
hypertension
 Uncooperative patient
 Presence of a solitary
native kidney
Relative contraindications
 Azotemia
 certain anatomical
abnormalities of the kidney
 skin infection at the desired
biopsy site
 Hemostasis-altering drugs
(e.g. warfarin or heparin)
 pregnancy
 urinary tract infections
 obesity.

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 Preparation:
 Before your biopsy, patients may need testing to see
if they have a blood clotting abnormality or infection.
 To decrease the risk of bleeding, patients should be
asked to stop taking medicines that increase the risk
of bleeding (such as aspirin, aspirin-like compounds,
antiplatlets and anticoagulats) for one to two weeks
before the biopsy.
RENAL BIOPSY PROCEDURE

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 Biopsy procedure
 Renal biopsy is usually performed while patients are
awake, after a cleansing agent is applied, and local
anesthesia is given to minimize pain.
 The most common way to perform a biopsy is to use a
needle, which is inserted through the skin and into the
kidney.
 Approach is either by using an ultrasound, x-ray, or
CT scan guidance to localise the right position of the
kidney (usually the lower pole)
Biopsy procedure

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 Once the needle is in the right position, a sample
of renal tissue will be taken with the needle.
 In some cases, a different approach is used to
perform the biopsy. An open renal biopsy under
general anesthesia, and a small incision of the
skin and underlying tissue, which is opened to
obtain the kidney specimen.

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 After an open or needle biopsy, patient will be
kept in a recovery or an observation unit for
several hours to monitor for potential
complications, including pain and bleeding.
 Patients may have blood drawn for cbc or repeat
x-rays to monitor for bleeding.
 In some instances, patient will be sent home
after several hours of monitoring. Alternatively,
may be observed in the hospital overnight.
After renal biopsy

12. ESNT-CNE 1st Course Cairo Sept 10-14, 2012
 Once it is deemed safe for the patient to go
home, he is not allowed to perform any heavy
lifting or vigorous exercise for one to two weeks.
 Continue to avoid aspirin-like drugs or blood
thinning medications for at least one week or
until your physician has instructed you that it is
safe to take these.
Instructions after renal biopsy:

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 The routine evaluation of a percutaneous renal
biopsy involves examination of the tissue under
LM, IMF, and EM.
 Full clinical data and lab tests must be clearly
mentioned in the pathology request you sent to
the renal pathologist.
After renal biopsy

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 Serious complications of renal biopsy are not
common.
 Less serious complications can occur, and
can include bleeding, pain, and development of
an abnormal connection between two blood
vessels (a fistula).
 Rare complications include infection, damage
to blood vessels or other organs, or urine leaks.
RENAL BIOPSY COMPLICATIONS

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 Bleeding is the most common complication of
renal biopsy.
 Many people may notice blood in their urine for several days
after a renal biopsy.
 More severe bleeding occurring around the kidney or into
the urine is uncommon but if it occurs you may need a blood
transfusion.
 Very rarely, it may become life threatening and possibly
require a procedure or surgery to stop the bleeding.
 If the urine is bright red or brown for longer than one week
after your biopsy, FUP is needed.
Bleeding

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 Pain is a common problem after a renal biopsy.
 Patient may need pain killers to reduce pain post procedure.
 Pain usually resolves within a few hours.
 If severe or prolonged pain, most propably renal
hematoma.
Pain

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 The biopsy needle can accidentally injure the walls
of a nearby artery and vein, and this can lead to
the development of a fistula. Fistulas generally do
not cause problems and usually close on their own
over time.
Arteriovenous fistula

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 Mendelssohn D, Cole E (October 1995). "Outcomes
of percutaneous kidney biopsy, including those of
solitary native kidneys.". Am J Kidney Dis 26 (4):
580–585.
 Whittier L, Korbet S (November 2004). "Renal
biopsy: update". Current Opinion in Nephrology and
Hypertension 13 (6): 661–665.
 Iversen P, Brun C (September 1951). "Aspiration
biopsy of the kidney". Am. J. Med. 11 (3): 324–30.
References

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Tanta Nephrology Unit
Renal Biopsy Histopathology Results
2014-2015
Diagnosis No. %
Lupus nephritis 37 26.8
MCD 13 9.4
Glomerulosclerosis 13 9.4
MPGN 12 8.7
FSGS 11 8
ATN 10 7.2
MGN 9 6.5
AIN 7 5
RPGN 6 4.3
TMA 6 4.3
Amyloidosis 5 3.6
CIN 5 3.6
Post-infectious GN 2 1.4
Cast nephropathy 2 1.4
Total 138 100

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Sales
Lupus nephritis
MCD
Glomerulosclerosis
MPGN
FSGS
ATN
MGN
AIN
RPGN
TMA
Amyloidosis
Tanta Nephrology Unit
Renal Biopsy Histopathology Results
2014-2015
0 10 20 30 40
Lupus nephritis
MCD
Glomerulosclerosis
MPGN
FSGS
ATN
MGN
AIN
RPGN
TMA
Amyloidosis
CIN
Post-infectious GN
Cast nephropathy

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