40:
529:
biopsy needle. In most cases, real-time imaging will be used to guide positioning of the local anaesthetic and biopsy needles. In the case of blind biopsy, this will not be used. A loud click may be heard as the spring-loaded biopsy needle is fired into the kidney to obtain a tissue sample. The resulting core of kidney tissue is usually less than 1 mm in diameter and up to 1 cm long. This may be done more than once to obtain sufficient kidney tissue.
644:
Occasionally, a biopsy will have to be abandoned prematurely due to technical issues such as inaccessible or small kidneys, obscured kidneys, difficult to penetrate kidneys or observation of bleeding complication. Further, after the biopsy has been completed, microscopic examination of the tissue may
528:
into the skin, through the subcutaneous tissue and down to and around the kidney. There may be a sharp sting as the local anaesthetic is injected. After a few seconds, the site will be numb and only a sensation of pressure should be felt. A small 1–2 mm incision is made to allow insertion of the
567:
Post-biopsy care will differ from centre to centre. Most hospitals will observe patients who have had renal biopsy for 4–6 hours to minimise the risk of bleeding. Blood pressure and urine are frequently monitored to ensure the patient does not have any bleeding complications. Mild-moderate pain is
397:
will have to satisfy themselves that a renal biopsy is of appropriate benefit to justify the risks of the procedure before proceeding. This will include careful consideration of patient characteristics and other clinical information obtained from history, examination and other less-invasive
239:(or protein in the urine) occurs in many renal conditions. Renal biopsy is usually reserved for patients with high or increasing levels of proteinuria, or for patients who have proteinuria along with other signs of renal dysfunction. One example is the
543:
may be present at the biopsy to examine the core(s) of kidney tissue for adequacy under a low power microscope. They will inform the person performing the procedure about how much kidney tissue was obtained, specifically how of biopsy sample is
122:). More commonly, however, the biopsy is non-targeted as medical conditions affecting the kidney typically involve all kidney tissue indiscriminately. In the latter situation, any sufficiently sized piece of kidney tissue can be used.
149:
depending on the timing of the biopsy with respect to key stages of the operation. When the transplanted kidney is not working properly, biopsy may be undertaken to identify the cause of dysfunction. This is referred to as an
583:
If there are no observed complications during this period, most hospitals will discharge patients and allow them to return home. Other centres will admit patients who have had renal biopsy overnight for observation.
463:
is usually taken. Arrangements will also be made to ensure that appropriate post-biopsy care and supervision is in place. Fasting is usually not required. However, this will depend on centre preference.
213:(or blood in the urine) can occur with a number of conditions that affect the kidneys and urinary tract. While renal biopsy is not indicated in all cases of haematuria, it may be performed in those with
506:
The site of biopsy is prepared antiseptic solution and sterile drapes are applied. If real-time imaging is used, sterile coverings will be placed on the equipment. The person performing the procedure (
409:
or other imaging study of the kidney may be performed before biopsy to exclude structural problems of the kidney, which may theoretically increase the risk of the procedure. These include
141:). This is typically done at 0, 3 and 12 months post-transplant according to a transplant unit protocol. Biopsy of the transplanted kidney taken during the transplant operation is termed
161:). Alternatively, a biopsy may be performed without imaging-guidance using indirect assessments of position such as "needle-swing" to confirm appropriate placement of biopsy equipment (
137:
into the patient is biopsied. Transplant kidney biopsy can be performed when nothing is apparently wrong with the transplant kidney for the purposes of surveillance for hidden disease (
652:
As with all treatments, there is a risk of allergy to the disinfectant solution, sedation, local anaesthetic and materials (latex gloves, drapes, dressings) used for the procedure.
559:
When enough kidney tissue has been obtained, pressure will be applied to the biopsy site. After a period of time, it will be cleaned and dressed. Sutures are usually not required.
641:
Infection is rare with modern sterile operating procedures. Damage to surrounding structures, such as bowel and bladder (more likely with transplant kidney biopsy), can occur.
663:. Rarely, they may result in intermittent bleeding into the urine or may grow in size and threaten to burst. In these instances, the fistula may be closed surgically or with
424:
To decrease the risk of bleeding, patients are usually advised to avoid medicines that impair clotting for one to two weeks before the biopsy. These medications include
618:. The majority of bleeding that occurs following renal biopsy usually resolves on its own without long-term damage. Less commonly, the bleeding may be brisk (causing
847:
283:
When the transplant kidney is not working as well as expected, or when there is a deterioration in function. In these instances, biopsy is performed to exclude
595:
Serious complications of renal biopsy are uncommon. The risk of complications will vary from centre to centre based on experience and other technical factors.
598:
The most common complication of kidney biopsy is bleeding. This reflects the density of blood vessels within the kidney and observation that individuals with
261:). The cause of acute kidney failure can usually be determined without kidney biopsy. Biopsy is performed in those instances where the cause is uncertain.
199:. It is most commonly used when less invasive tests are insufficient. The decision on whether or not to proceed to a kidney biopsy is usually made by a
638:) or open surgery. In most cases, bleeding can be controlled and the kidneys are not lost. Rarely, a heavily damaged kidney may need to be removed.
66:
62:
614:) or bleeding from larger blood vessels that lie adjacent the kidney. If blood clots in the bladder, this can obstruct the bladder and lead to
280:
of hidden disease involving the transplant kidney, so-called protocol renal biopsy undertaken at fixed intervals post-transplantation.
176:
In 1951, Danish physicians Poul
Iversen and Claus Brun described a method involving needle biopsy which has become the new standard.
840:
634:
may be required. Surgical options to control bleeding include less invasive catheter-delivered particles to block bleeding vessels (
1168:
1203:
107:. Microscopic examination of the tissue can provide information needed to diagnose, monitor or treat problems of the kidney.
751:
Mendelssohn D, Cole E (October 1995). "Outcomes of percutaneous kidney biopsy, including those of solitary native kidneys".
39:
580:. Severe pain is usually an indication of bleeding complication, and may prompt a longer hospital stay and further tests.
587:
Most hospitals will discharge patients post-renal biopsy with written instructions on what to do if complications occur.
1026:
885:
833:
157:
Renal biopsy may be performed with the aid of "real-time" medical imaging to guide the positioning of biopsy equipment (
1031:
1118:
477:
485:
184:
491:
In the case of a native kidney biopsy, the procedure will be performed with the patient lying on their stomach (
1061:
878:
1146:
1103:
660:
481:
406:
368:
180:
1113:
917:
659:. These usually do not cause problems and close on their own. They may be monitored over time with repeat
258:
1071:
983:
656:
418:
414:
655:
Finally, the biopsy needle may join an artery and vein in the kidney, resulting in the formation of an
173:
Before 1951, the only way of obtaining kidney tissue from a live person was through an open operation.
1076:
950:
284:
254:
825:
1081:
619:
518:
218:
401:
Blood testing may be done before the biopsy to ensure that there is no evidence of infection or a
1123:
1036:
811:
313:
240:
230:
1161:
1016:
945:
803:
768:
733:
693:
627:
615:
525:
496:
96:
57:
795:
760:
725:
460:
250:
134:
1198:
1151:
1098:
1053:
970:
606:). Bleeding complications include a collection of blood adjacent to or around the kidney (
510:) will wash their hands and don a sterile gown and gloves. A mask may or may not be worn.
857:
646:
599:
549:
492:
449:
410:
292:
246:
226:
1192:
1086:
1021:
799:
764:
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577:
545:
507:
288:
815:
960:
955:
940:
664:
635:
473:
441:
394:
319:
277:
200:
488:
to visualise the location and depth of the kidneys immediately before the biopsy.
79:
1156:
1108:
1011:
1006:
912:
900:
873:
685:
573:
533:
445:
429:
402:
236:
222:
206:
The following are examples of the most common reasons for native kidney biopsy:
73:
389:
Like most invasive medical procedures, a renal biopsy is not without risk (see
221:) or when combined with features of progressive renal disease (e.g. increasing
1173:
1128:
1093:
988:
978:
922:
890:
645:
reveal heavily scarred tissue prompting recommendation for re-biopsy to avoid
210:
196:
104:
44:
552:. In some centres, this role will be performed by the proceduralist with the
17:
1066:
895:
611:
569:
553:
540:
537:
456:). Strict control of blood pressure is also sought to reduce bleeding risk.
363:
214:
48:
807:
737:
697:
772:
607:
514:
437:
353:
337:
513:
The biopsy is usually performed while the patient is awake or with mild
499:
position). For transplant renal biopsy, the patient lies on their back (
998:
716:
Iversen P, Brun C (September 1951). "Aspiration biopsy of the kidney".
631:
623:
603:
433:
425:
373:
357:
341:
272:
Transplant kidney biopsy is performed in the following circumstances:
932:
865:
500:
453:
265:
115:
111:
100:
304:
The safety of renal biopsy is affected by the following conditions:
448:
in the hope of reversing the clotting disturbance that accompanies
179:
Recent widespread availability of real-time imaging guidance using
610:), bleeding into the urine with passage of blood stained urine (
154:, because something has prompted the performance of the biopsy.
829:
786:
Whittier L, Korbet S (November 2004). "Renal biopsy: update".
129:
is one in which the patient's own kidneys are biopsied. In a
264:
Targeted kidney biopsy can be used to obtain tissue from a
103:
is removed from the body for examination, usually under a
291:, drug-toxicity or recurrence of the disease that caused
503:). The biopsy procedure usually takes about 15 minutes.
524:
After the site is prepared, the proceduralist injects
195:
Kidney biopsy is performed on selected patients with
1139:
1052:
1045:
997:
969:
931:
864:
187:having improved perceived safety of the procedure.
72:
56:
32:
626:) or both. In these circumstances, treatment with
217:(blood that is thought to come from damage to the
27:Removal of kidney tissue for medical examination
692:, Treasure Island (FL): StatPearls Publishing,
480:. The biopsy is planned with the assistance of
352:medications that interfere with clotting (e.g.
110:A renal biopsy can be targeted to a particular
788:Current Opinion in Nephrology and Hypertension
346:certain anatomical abnormalities of the kidney
841:
133:, the kidney of another person that has been
8:
602:take longer to stop bleeding after trauma (
1049:
848:
834:
826:
253:due to kidney injury) can occur abruptly (
38:
472:Renal biopsy is typically performed by a
684:Young, Michael; Leslie, Stephen (2022),
676:
29:
257:) or progress over a period of time (
7:
327:presence of a solitary native kidney
268:arising from or adjacent the kidney.
856:Tests and procedures involving the
390:
25:
349:skin infection at the biopsy site
1169:Extracorporeal shockwave therapy
800:10.1097/00041552-200411000-00013
147:post-perfusion transplant biopsy
225:, elevated blood pressure and
143:implantation transplant biopsy
1:
421:and small, shrunken kidneys.
47:showing a renal core biopsy.
1027:Artificial urinary sphincter
886:Percutaneous nephrolithotomy
765:10.1016/0272-6386(95)90592-8
730:10.1016/0002-9343(51)90169-6
152:indication transplant biopsy
1032:Urethral bulking injections
521:is typically not required.
159:imaging-guided renal biopsy
1220:
1119:Voiding cystourethrography
478:interventional radiologist
139:protocol transplant biopsy
99:in which a small piece of
622:) or persistent (causing
405:abnormality. Further, an
118:arising from the kidney (
37:
1062:Urinary tract ultrasound
459:Prior to the procedure,
1147:Urinary catheterization
1104:Radioisotope renography
661:Doppler ultrasonography
369:urinary tract infection
131:transplant renal biopsy
1114:Retrograde urethrogram
918:Kidney transplantation
612:macroscopic haematuria
259:chronic kidney disease
229:). One example is the
1204:Diagnostic nephrology
984:Suprapubic cystostomy
657:arteriovenous fistula
608:perinephric haematoma
419:cystic kidney disease
415:arteriovenous fistula
324:uncooperative patient
215:glomerular haematuria
120:targeted renal biopsy
951:Ureterosigmoidostomy
604:uraemic coagulopathy
568:managed with simple
495:) or on their side (
454:uraemic coagulopathy
444:may be administered
318:uncontrolled severe
255:acute kidney failure
519:general anaesthetic
320:high blood pressure
295:in the first place.
127:native renal biopsy
1124:Urodynamic testing
1037:Cystourethrography
314:bleeding diathesis
241:nephrotic syndrome
231:nephritic syndrome
163:blind renal biopsy
1186:
1185:
1182:
1181:
1162:Laser lithotripsy
1017:Urethral sounding
946:Urinary diversion
665:angioembolisation
636:angioembolisation
628:blood transfusion
616:urinary retention
526:local anaesthetic
497:lateral decubitus
300:Contraindications
97:medical procedure
86:
85:
16:(Redirected from
1211:
1050:
850:
843:
836:
827:
820:
819:
783:
777:
776:
748:
742:
741:
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707:
706:
705:
704:
681:
548:and how much is
461:informed consent
398:investigations.
114:, for example a
82:
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1219:
1218:
1214:
1213:
1212:
1210:
1209:
1208:
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1152:Kidney dialysis
1135:
1099:Abdominal x-ray
1041:
993:
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860:
854:
824:
823:
785:
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780:
753:Am J Kidney Dis
750:
749:
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714:
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700:
683:
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565:
470:
417:in the kidney,
413:, pre-existing
387:
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251:kidney function
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861:
858:urinary system
855:
853:
852:
845:
838:
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822:
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794:(6): 661–665.
778:
759:(4): 580–585.
743:
708:
686:"Renal Biopsy"
675:
674:
672:
669:
647:sampling error
600:kidney failure
592:
589:
564:
561:
550:kidney medulla
469:
466:
450:kidney failure
411:hydronephrosis
403:blood clotting
386:
383:
381:
378:
377:
376:
371:
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350:
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344:
333:
330:
329:
328:
325:
322:
316:
309:
306:
301:
298:
297:
296:
293:kidney failure
289:BK nephropathy
281:
270:
269:
262:
247:Kidney failure
244:
234:
227:kidney failure
197:kidney disease
192:
189:
170:
167:
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591:Complications
590:
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579:
578:acetaminophen
575:
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555:
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547:
546:kidney cortex
542:
539:
535:
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520:
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511:
509:
508:proceduralist
504:
502:
498:
494:
489:
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483:
479:
475:
468:During biopsy
467:
465:
462:
457:
455:
451:
447:
446:intravenously
443:
439:
435:
431:
427:
422:
420:
416:
412:
408:
404:
399:
396:
392:
391:Complications
385:Before biopsy
384:
379:
375:
372:
370:
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365:
362:
359:
355:
351:
348:
345:
343:
339:
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117:
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106:
102:
98:
94:
93:kidney biopsy
90:
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61:
59:
55:
50:
46:
41:
36:
31:
19:
18:Kidney biopsy
961:Ureteroscopy
956:Ureterolysis
941:Ureterostomy
908:Renal biopsy
907:
879:percutaneous
791:
787:
781:
756:
752:
746:
721:
717:
711:
701:, retrieved
689:
679:
654:
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643:
640:
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594:
586:
582:
566:
563:After biopsy
558:
531:
523:
512:
505:
490:
474:nephrologist
471:
458:
442:Desmopressin
423:
400:
395:nephrologist
388:
303:
278:surveillance
271:
205:
201:nephrologist
194:
178:
175:
172:
162:
158:
156:
151:
146:
142:
138:
135:transplanted
130:
126:
124:
119:
109:
92:
89:Renal biopsy
88:
87:
33:Renal biopsy
1157:Lithotripsy
1109:Cystography
1072:Intravenous
1012:Urethrotomy
1007:Urethropexy
913:Nephrectomy
901:Nephroscopy
874:Nephrostomy
574:paracetamol
534:pathologist
517:. Use of a
486:CT scanning
430:clopidogrel
237:Proteinuria
223:proteinuria
191:Indications
185:CT scanning
74:MedlinePlus
1193:Categories
1174:Urinalysis
1129:Cystometry
1094:CT urogram
1077:Retrograde
989:Cystoscopy
979:Cystectomy
923:Nephropexy
891:Nephrotomy
718:Am. J. Med
703:2023-11-24
690:StatPearls
671:References
570:analgesics
482:ultrasound
407:ultrasound
219:glomerulus
211:Haematuria
181:ultrasound
105:microscope
45:Micrograph
1082:Antegrade
1067:Pyelogram
896:Endoscopy
554:naked eye
541:scientist
538:pathology
380:Procedure
364:pregnancy
285:rejection
49:PAS stain
816:40898162
808:15483458
738:14877837
698:29262196
572:such as
515:sedation
438:warfarin
354:warfarin
338:azotemia
332:Relative
308:Absolute
58:ICD-9-CM
1054:Imaging
1046:General
999:Urethra
971:Bladder
773:7573010
632:surgery
624:anaemia
434:heparin
426:aspirin
374:obesity
358:heparin
342:uraemia
169:History
95:) is a
1199:Biopsy
933:Ureter
866:Kidney
814:
806:
771:
736:
696:
501:supine
266:tumour
116:tumour
112:lesion
101:kidney
91:(also
80:003907
1140:Other
812:S2CID
620:shock
493:prone
393:). A
67:55.24
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804:PMID
769:PMID
734:PMID
694:PMID
436:and
276:For
1087:Gas
796:doi
761:doi
726:doi
630:or
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Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.
