KIDNEY BIOPSY

A Biopsy is a medical procedure used to diagnose various diseases. This involves removing a small piece of tissue or cells from the body that is examined under a microscope in a laboratory to see if there is an abnormal growth of cells or cancer. A Kidney biopsy also called a renal biopsy involves the extraction of a small piece of kidney tissue to determine the functioning of kidneys, to diagnose any suspected diseases, and to monitor or treat kidney problems. In this article, we will get to know about the kidney biopsy procedure and its type.

A kidney biopsy can target a specific lesion, such as a tumor that originated in the kidney (targeted kidney biopsy). More often, the biopsy is not targeted because diseases that affect the kidney generally affect all kidney tissue indiscriminately.

Types of Kidney Biopsy

Percutaneous (which means through the skin) Biopsy

  • In this a needle is inserted through the skin that usually lies on top of the kidney and is positioned towards the right place in the kidney
  • It is usually done with the help of ultrasound or computed tomography (CT scan).
  • Anesthesia is given during this procedure.
KIDNEY DISEASE

Open Biopsy 

  • In this, a sample of kidney tissues is taken directly from the kidney during surgery.
  • The sample is then sent to a pathology lab to check for any signs of disease.

A biopsy is usually performed by the following specialists 

  • A urologist
  • A nephrologist
  • A transplant surgeon
  • An interventional radiologist

Reasons for doing Kidney Biopsy

There can be various reasons to perform a kidney biopsy which may be:

  • To find out the cause of poor kidney functioning.
  • To monitor how well the kidneys are working after a kidney transplant or to find why the transplanted kidneys are not working properly.
  • To find out/diagnose a kidney problem that cannot be found any other way.
  • Hematuria (blood in urine).
  • Proteinuria (protein in urine ).
  • Abnormal hematology report.
  • Acute or chronic kidney disease with no clear cause.
  • Nephrotic syndrome (Disorder in which the kidneys produce too much protein in urine)
  • Glomerular disease (this occurs due to the damage to the filtering units of the kidneys).
  • To determine how well a treatment is working for kidney disease.
  • To determine the progression of kidney disease.
  • Patients should discuss with their doctors to explain the reason for the kidney biopsy.
  • You will then be asked to sign a declaration of consent in which you are aware of all possible risks that will be involved during the procedure.
BIOPSY PROCEDURE

Before the biopsy 

Talk to your doctor or physician 

It is important to speak with your doctor before the procedure to get all relevant information about medical conditions such as blood clotting abnormalities, infections, all prescription and over-the-counter medications, supplements, and vitamins that may include:

  • Aspirin ,clopidogrel
  • Non-steroidal anti-inflammatory medications [NSAID’s] (Ibuprofen, naproxen)
  • Blood thinners
  • Arthritis medications
  • Any allergies present 
  • To decrease the risk of bleeding, patients taking blood thinners like aspirin are advised to stop for a period of one to two weeks before the biopsy.

Kidney Biopsy Procedure

A kidney biopsy procedure usually takes an hour and consists of the following steps:

  • The patient has to lie down on their abdomen on an examination table
  • A sandbag or a firm pillow will be placed under the patient’s body to support the abdomen and help to push the kidneys up towards the patient’s back and the skin surface.
  • The individuals who have transplanted kidneys are instructed to lie down on their backs because surgeons place transplanted kidneys in the lower front part of the abdomen, next to the bladder 
  • A nurse will administer anesthesia to the patient through IV.
  • The skin at the biopsy site is prepared by cleaning with an antiseptic solution.
  • When the local anesthetic is injected, the needle stick can be felt through a short stab.

The two main types of kidney biopsy procedures performed are :

PERCUTANEOUS KIDNEY BIOPSY PROCEDURE

KIDNEY BIOPSY PROCEDURE
  • The kidney is detected using ultrasound, x-rays images, or both. 
  • Ultrasound uses a tool referred to as a transducer that bounces safe, painless sound waves off organs to obtain a picture of the internal structure.
  • At times the doctor uses an X-ray or magnetic resonance imaging to guide the needle into the kidney. 
  • An injection of dye is injected into the veins by a doctor to detect the kidney and important blood vessels.
  • Once the biopsy site is found, the skin is incised and cleaned where the needle is to be inserted.
  • A local anesthetic is administered to numb the area where the needle enters.
  • The doctor will tell you to take a deep breath and hold your breath while inserting the needle. 
  • As the needle penetrates the skin to the kidney there will be a certain pressure felt. There will be a clicking or popping noise produced by the instrument while taking the biopsy.
  • It is important to stay still and hold your breath (for about 45seconds or less).
  • At times two needle passes are required to obtain a minimal amount of kidney specimen.
  • When a sufficient amount of sample is withdrawn the needle is taken out and the bandage is placed over the needle puncture site.
  • This whole procedure usually takes about an hour.

Types of Percutaneous Biopsies

There are two types of percutaneous Kidney biopsy, and the procedure your doctor chooses depends on the tissue removal instrument:

Fine Needle Aspiration Biopsy 

During this procedure, the doctor takes a tissue sample from the kidney with the help of a small, thin needle attached to a syringe.

Needle Core Biopsy 

For larger tissue samples, the doctor might use a needle core biopsy in which the doctor removes a large sample of kidney tissue with a spring-loaded needle. When using a needle core biopsy, a loud clicking or popping sound is heard once the tissue sample is extracted.

OPEN KIDNEY BIOPSY PROCEDURE

  • After evaluating the patient’s medical history and health condition doctors suggest an open biopsy.
  • Usually, this type of biopsy is done when there are bleeding issues or blood clotting in the past or when there is only one kidney.
  • In open biopsy general anesthesia is administered where the doctor makes an incision and surgically removes a large tissue sample from kidneys.
  • Some surgical biopsies need an incision up to 5 inches long.
  • This procedure may also be performed laparoscopically.
  • In this procedure, the doctor makes a small incision and uses an endoscope, a thin lighted tube to perform a biopsy. 
  • The end of the laparoscope contains a video camera that creates images of the kidney and sends them to a video monitor. 
  • With the help of a laparoscope, the doctor looks at the kidney and removes the larger tissue sample through a small incision.
  • If any bleeding is present the surgeon can watch through the video monitor which can then be resolved.

After the Kidney Biopsy Procedure

  • After the biopsy, the patient will be kept in recovery or observation, where the patient is made to lie on their back for 6 to 8 hours while transplant patients lie on their stomach.
  • During this time, blood pressure, pulse rate, temperature, and breathing will be closely monitored by the nurse present
  • Urine analysis and complete blood count tests are done to check for bleeding and other complications present.
  • Rest is required for about four to six hours.
  • There may be a presence of some soreness or pain at the biopsy site for a few hours which is relieved by taking prescribed pain medications.
  • The majority of people can leave the hospital the same day in about 12 to 24 hours once the procedure is done.
  • Once home, your doctor can advise you to rest for one more day or two.
  • Your doctor will advise you on any activity restrictions, work, and strenuous exercise to avoid any complications.
  • In case of open surgery make sure to ask your doctor about any necessary precautions to be taken.
KIDNEY BIOPSY

After leaving the hospital, patients should tell their doctors or nurses if they have any of these problems: 

  • Blood in urine more than 24hrs after the test 
  • Inability to urinate
  • Frequent urination
  • Burning sensation while urinating
  • Fever over 100.4 F (38 C)
  • Worsening pain in the biopsy site
  • Faintness or dizziness 
  • Blood or pus at the biopsy site that saturates the dressing.
  •  Patients should have a week off work, and avoid strenuous exercise for that week.

Results of Kidney Biopsy Procedure

  • The tissue or cell sample taken during the kidney biopsy is sent to a laboratory for examination.
  • A pathologist, a doctor who specializes in diagnosing disease, examines the tissue.
  • Then the tissue sample from the biopsy is analyzed with light microscopy (LM), immunofluorescence(IF), electron microscopy (EM), and reactive dyes.
  • The pathologist identifies and evaluates the deposits or scars that are present.
  • Infections and alternative abnormal conditions also can be detected.
  • The pathologist compiles the results and reports them to the doctor. Sometimes results take a few weeks but a preliminary report can be available in 24 hours.
  • If the kidney tissue is normal in structure with no deposits or other defects, the results are said to be normal.
  • The results of a kidney biopsy are considered abnormal if there are tissue changes in the urinary organ.
  • There are several reasons for this result. Sometimes diseases that start in other parts of the body can cause kidney damage. 

In case of abnormal results, it could indicate:

  • Kidney infection
  • Restrictions or weaknesses in blood flow to the kidneys
  • Connective tissue diseases
  • Rejection of a kidney transplant
  • kidney cancer
  • Complicated urinary tract infection
  • Numerous different diseases have a negative effect on kidney function.
  • Usually, the doctor will discuss the results with you at a follow-up visit.
  • Further, the result may explain the reason for the kidney problem or maybe used to plan or change the treatment. 

Risks of Kidney Biopsy

Pain

  • Pain at the biopsy site is common after a kidney biopsy
  • It usually goes away within a few hours.

Bleeding

  • Bleeding is the commonest complication seen, it can occur at the site of injury, in kidneys, or as blood in the urine. 
  • In case of blood clots present in the bladder can cause obstruction in the bladder and lead to urinary retention.
  • Bleeding from kidneys rarely needs a blood transfusion and embolization (keyhole surgery).
  • Less than 0.2% of patients undergo surgery for persistent or massive bleeding.
  • In extreme cases, bleeding can lead to kidney loss or death (both probably in <0.1%, that is 1 in 1000 patients).
KIDNEY BIOPSY PROCEDURE

Arteriovenous fistulas

  • When a biopsy needle accidentally injures a nearby artery or vein, an abnormal connection between two blood vessels can form known as a fistula.
  • Apparently, this type of fistula usually occurs without symptoms and resolves on its own.
  • These are monitored by repeated doppler ultrasound. In some cases, they can cause intermittent bleeding in the urine or an increase in size, which may burst and require surgical closure or Angio embolism.

Infection 

  • Infection is a rare complication with modern sterile surgical procedures.
  • Infection can occur after a biopsy in which the collection of blood (hematoma) around the kidneys becomes infected, is treated with antibiotics and surgical drainage is performed to remove the collected blood.

Others 

  • This includes an uncommon risk of a high rise in blood pressure which is usually due to the presence of a large hematoma.
  • As with all treatments, there’s a risk of hypersensitivity reaction to the disinfectant solution, sedation, local anesthetic, and materials (latex gloves, drapes, dressings) used for the procedure.
  • Around 30 percent of serious complications occur more than eight hours after kidney biopsy.

Contraindications in Kidney Biopsy

The safety of kidney biopsy is influenced by the following conditions:

ABSOLUTE

  • Severe uncontrolled hypertension
  • Bleeding diathesis (the tendency of bleeding or bruising easily)
  • Uncooperative patient
  • Presence of a single native kidney

RELATIVE

  • Azotemia or uremia (build up toxins in blood when kidneys stop filtering out of urine)
  • Some anatomical abnormalities of kidney
  • Skin infection at the site of biopsy
  • Drugs that interfere with clotting (such as warfarin, heparin)
  • Pregnancy
  • Urinary tract infections (UTI’s)
  • Obesity

Kidney Biopsy | When-How-Sign & Infection-Side Effect

kidney biopsy | Nephrologist in Delhi

Table of Contents

Kidney Biopsy

Kidney biopsy (renal biopsy) is an invasive test. The kidney biopsy is a complex procedure and needs to be critically performed only by a nephrologist. It is a minor procedure and is done under the effect of local anesthesia. In this medical procedure, a small piece of kidney is taken and then examined under a microscope. It is done for native kidney (patient’s own kidney) or transplanted kidney (graft) biopsy.
Generally, a biopsy sample is examined under the light microscope, electron microscope, and an immunofluorescence study is done.

When to get a Kidney Biopsy?

Reasons to get a kidney Biopsy-

  • A kidney biopsy may be recommended by your nephrologist to diagnose suspected kidney disease. 
  • It can also be used to determine the severity of a kidney problem or to track the progress of kidney disease therapy. 
  • If you have a kidney transplant that isn’t operating correctly or has negative blood tests or a large amount of protein present in proteinuria or suffering from glomerular damage, or renal disease with no apparent cause.

How is a Kidney Biopsy done?

Percutaneous biopsy is the most common form of biopsy. A small incision in your back and removes tiny specimens of kidney tissue using a thin, hollow needle. You will be conscious during the operation, but your nephrologist will sedate the area so that you do not experience unbearable pain.

Your nephrologist may do a laparoscopic biopsy if you have bleeding issues, a blood clot issue, or only have one kidney. Your nephrologist will be making a small cut in your abdomen and inserting a thin tube with a video camera at the tip, known as a laparoscope, to examine your kidney. During the operation, your nephrologist might use the laparoscope to check for bleeding and halt it if necessary. Through the catheter, your nephrologist can also collect tiny samples of your kidney. Anesthesia is required for a laparoscopic biopsy, which implies you will not be conscious and will not feel anything during the entire process.

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 nephrologist’s procedures, and his/her reaction to the treatment. In most cases, the patient is transported to a recovery room to relax and be observed. You’ll 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. You’ll be released from the hospital after. This often occurs 12 to 24 hours following the kidney biopsy. Up to 24 hours following the biopsy, it’s 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.

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 isn’t 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 (FSGS).

What are the Side Effects of a Kidney Biopsy?

The whole procedure is prone to certain severity, such as bleeding(requiring blood transfusion) and pain. If during the biopsy, the operation needle mistakenly harms the nearby walls of the artery and vein, the complication of the Arteriovenous fistula may rise, which is an abnormal link formed between the two blood vessels. Again, if the biopsy is not done properly, a hematoma can be infected around the kidneys. 

Longer than a day after your biopsy, you find blood or blood clots in your urine. Frequent urination is quite common. Other complications are-

  1. Urinating causes a burning feeling.
  2. Suffering from high fevers
  3. Pain at the biopsy site is becoming worse.
  4. The bandage is saturated with blood or pus seeping from the biopsy site.
  5. Feel dizzy, feeble, or becoming pale

Internal injury to the targeted organ or surrounding regions like a liver injury can sometimes occur during a renal biopsy. The most prevalent post-biopsy complexities are macroscopic hematuria, arteriovenous fistulas, and perirenal hematomas.

Signs of Infection

If you are experiencing any of the following symptoms, see your nephrologist right away:

  1. More than 24 hours after your biopsy, you have bright red blood or blood clots in your urine
  2. Inability to urinate for a longer time
  3. Undergoing intense fever and chilling sensations
  4. Extreme swelling, bleeding, and abnormal fluid discharge from the operated site
  5. Constant dizziness and weakness

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-

You’ll take off your clothes and change into a hospital gown.

  1. An intravenous (IV) line will be inserted.
  2. 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.
  3. An antibacterial liquid will be used to clean the skin around the biopsy site.
  4. When the local anesthetic is given, you will feel a syringe stick. There may be a short stinging sensation as a result of this.
  5. The needle may be guided into the kidney using ultrasound or X-ray.
  6. 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 needle’s insertion.
  7. When the nephrologist takes the sample, you may feel uncomfortable or pressed.
  8. If the nephrologist requires more than one tissue sample, there may be several punctures. If that’s the case, the puncture will be repeated.
  9. To halt bleeding, strong pressure will be administered to the biopsy site once the needle is removed.
  10. A sterile dressing or bandage will be applied.
  11. A sample of kidney tissue will be submitted to a lab for examination.
  12. Consult your nephrologist about the procedures that will be performed during your kidney biopsy.

 

You will be required to sign a form granting consent for the kidney biopsy to be performed. If something isn’t understood, read the form again and discuss the matter. A physical exam may be performed by your provider to ensure that you are in otherwise excellent health. You may be subjected to blood testing or other diagnostic procedures.

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 (3.5%), post-biopsy hematoma (11.6%), erythrocyte transfusion (0.9%), and rarely nephrectomy (0.01 percent) or mortality (0.02 percent). Patients who get a kidney biopsy for AKD are more likely to need a blood transfusion afterward. After a 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

Most frequent questions and answers

After Biopsy, Soreness and pain in the biopsy area are common, but it generally only lasts a few hours. For a few hours after the biopsy, you may have some stiffness or pain at the biopsy site. Painkillers will be prescribed for pain relief.

A kidney biopsy is a procedure in which a tiny sample of tissue is taken from a bodily component. The material is examined under a microscope or put through additional tests. Generally, the cost of a kidney biopsy in Delhi NCR ranges from INR 10,000 to 50,000.

Depending on the severity of the condition (varies from patient to patient), only a nephrologist can advise whether the person would need dialysis before  biopsy or not.

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