29:
518:
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.
633:
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
517:
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
556:
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
386:
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
228:(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
532:
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
111:). 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.
138:
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
572:
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.
452:
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.
202:(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
495:
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 (
398:
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
130:). 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
150:). 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 (
126:
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 (
641:
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.
548:
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.
630:
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.
652:. 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
413:
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
607:. 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
272:
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
584:
Serious complications of renal biopsy are uncommon. The risk of complications will vary from centre to centre based on experience and other technical factors.
587:
The most common complication of kidney biopsy is bleeding. This reflects the density of blood vessels within the kidney and observation that individuals with
250:). The cause of acute kidney failure can usually be determined without kidney biopsy. Biopsy is performed in those instances where the cause is uncertain.
188:. 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
627:) 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.
55:
51:
603:) 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
836:
269:
of hidden disease involving the transplant kidney, so-called protocol renal biopsy undertaken at fixed intervals post-transplantation.
165:
In 1951, Danish physicians Poul
Iversen and Claus Brun described a method involving needle biopsy which has become the new standard.
623:
may be required. Surgical options to control bleeding include less invasive catheter-delivered particles to block bleeding vessels (
96:. Microscopic examination of the tissue can provide information needed to diagnose, monitor or treat problems of the kidney.
740:
Mendelssohn D, Cole E (October 1995). "Outcomes of percutaneous kidney biopsy, including those of solitary native kidneys".
569:. Severe pain is usually an indication of bleeding complication, and may prompt a longer hospital stay and further tests.
576:
Most hospitals will discharge patients post-renal biopsy with written instructions on what to do if complications occur.
146:
Renal biopsy may be performed with the aid of "real-time" medical imaging to guide the positioning of biopsy equipment (
829:
1157:
480:
In the case of a native kidney biopsy, the procedure will be performed with the patient lying on their stomach (
1192:
1015:
874:
822:
648:. These usually do not cause problems and close on their own. They may be monitored over time with repeat
1020:
1107:
644:
Finally, the biopsy needle may join an artery and vein in the kidney, resulting in the formation of an
466:
162:
Before 1951, the only way of obtaining kidney tissue from a live person was through an open operation.
474:
173:
814:
28:
1050:
867:
390:
Blood testing may be done before the biopsy to ensure that there is no evidence of infection or a
1135:
1092:
649:
470:
395:
357:
169:
1102:
906:
247:
1060:
972:
645:
407:
403:
1065:
939:
273:
243:
595:). Bleeding complications include a collection of blood adjacent to or around the kidney (
499:) will wash their hands and don a sterile gown and gloves. A mask may or may not be worn.
8:
1070:
608:
507:
207:
1112:
1025:
800:
302:
229:
219:
1150:
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792:
788:
757:
753:
722:
718:
682:
616:
604:
514:
485:
85:
46:
804:
784:
749:
714:
449:
239:
123:
477:
to visualise the location and depth of the kidneys immediately before the biopsy.
68:
1187:
1140:
1087:
1042:
959:
674:
195:
The following are examples of the most common reasons for native kidney biopsy:
846:
635:
588:
538:
481:
438:
399:
378:
Like most invasive medical procedures, a renal biopsy is not without risk (see
281:
235:
215:
210:) or when combined with features of progressive renal disease (e.g. increasing
634:
reveal heavily scarred tissue prompting recommendation for re-biopsy to avoid
1181:
1075:
1010:
566:
541:. In some centres, this role will be performed by the proceduralist with the
534:
496:
277:
445:). Strict control of blood pressure is also sought to reduce bleeding risk.
949:
944:
929:
796:
726:
686:
653:
624:
462:
430:
383:
308:
266:
189:
761:
1145:
1097:
1000:
995:
901:
889:
862:
562:
522:
434:
418:
391:
225:
211:
62:
502:
The biopsy is usually performed while the patient is awake or with mild
488:
position). For transplant renal biopsy, the patient lies on their back (
1162:
1117:
1082:
977:
967:
911:
879:
705:
Iversen P, Brun C (September 1951). "Aspiration biopsy of the kidney".
199:
185:
93:
33:
261:
Transplant kidney biopsy is performed in the following circumstances:
1055:
884:
844:
600:
558:
542:
529:
526:
352:
203:
37:
293:
The safety of renal biopsy is affected by the following conditions:
596:
503:
437:
in the hope of reversing the clotting disturbance that accompanies
426:
342:
326:
168:
Recent widespread availability of real-time imaging guidance using
987:
620:
612:
592:
422:
414:
362:
346:
330:
599:), bleeding into the urine with passage of blood stained urine (
143:, because something has prompted the performance of the biopsy.
921:
854:
489:
442:
254:
104:
100:
89:
775:
Whittier L, Korbet S (November 2004). "Renal biopsy: update".
118:
is one in which the patient's own kidneys are biopsied. In a
253:
Targeted kidney biopsy can be used to obtain tissue from a
92:
is removed from the body for examination, usually under a
280:, drug-toxicity or recurrence of the disease that caused
492:). The biopsy procedure usually takes about 15 minutes.
513:
After the site is prepared, the proceduralist injects
184:
Kidney biopsy is performed on selected patients with
176:having improved perceived safety of the procedure.
615:) or both. In these circumstances, treatment with
206:(blood that is thought to come from damage to the
1179:
16:Removal of kidney tissue for medical examination
739:
681:, Treasure Island (FL): StatPearls Publishing,
469:. The biopsy is planned with the assistance of
341:medications that interfere with clotting (e.g.
99:A renal biopsy can be targeted to a particular
777:Current Opinion in Nephrology and Hypertension
774:
335:certain anatomical abnormalities of the kidney
830:
122:, the kidney of another person that has been
704:
672:
591:take longer to stop bleeding after trauma (
837:
823:
242:due to kidney injury) can occur abruptly (
27:
461:Renal biopsy is typically performed by a
673:Young, Michael; Leslie, Stephen (2022),
1180:
818:
246:) or progress over a period of time (
316:presence of a solitary native kidney
288:
257:arising from or adjacent the kidney.
845:Tests and procedures involving the
13:
379:
14:
1204:
338:skin infection at the biopsy site
1158:Extracorporeal shockwave therapy
789:10.1097/00041552-200411000-00013
579:
456:
373:
136:post-perfusion transplant biopsy
551:
768:
733:
698:
666:
214:, elevated blood pressure and
179:
132:implantation transplant biopsy
1:
659:
410:and small, shrunken kidneys.
36:showing a renal core biopsy.
1016:Artificial urinary sphincter
875:Percutaneous nephrolithotomy
754:10.1016/0272-6386(95)90592-8
719:10.1016/0002-9343(51)90169-6
368:
141:indication transplant biopsy
7:
1021:Urethral bulking injections
510:is typically not required.
320:
296:
148:imaging-guided renal biopsy
10:
1209:
1108:Voiding cystourethrography
467:interventional radiologist
157:
128:protocol transplant biopsy
88:in which a small piece of
1128:
1041:
1034:
986:
958:
920:
853:
611:) or persistent (causing
394:abnormality. Further, an
107:arising from the kidney (
61:
45:
26:
21:
1051:Urinary tract ultrasound
448:Prior to the procedure,
1136:Urinary catheterization
1093:Radioisotope renography
650:Doppler ultrasonography
358:urinary tract infection
120:transplant renal biopsy
1103:Retrograde urethrogram
907:Kidney transplantation
601:macroscopic haematuria
248:chronic kidney disease
218:). One example is the
1193:Diagnostic nephrology
973:Suprapubic cystostomy
646:arteriovenous fistula
597:perinephric haematoma
408:cystic kidney disease
404:arteriovenous fistula
313:uncooperative patient
204:glomerular haematuria
109:targeted renal biopsy
940:Ureterosigmoidostomy
593:uraemic coagulopathy
557:managed with simple
484:) or on their side (
443:uraemic coagulopathy
433:may be administered
307:uncontrolled severe
244:acute kidney failure
508:general anaesthetic
309:high blood pressure
284:in the first place.
116:native renal biopsy
1113:Urodynamic testing
1026:Cystourethrography
303:bleeding diathesis
230:nephrotic syndrome
220:nephritic syndrome
152:blind renal biopsy
1175:
1174:
1171:
1170:
1151:Laser lithotripsy
1006:Urethral sounding
935:Urinary diversion
654:angioembolisation
625:angioembolisation
617:blood transfusion
605:urinary retention
515:local anaesthetic
486:lateral decubitus
289:Contraindications
86:medical procedure
75:
74:
1200:
1039:
1038:
839:
832:
825:
816:
815:
809:
808:
772:
766:
765:
737:
731:
730:
702:
696:
695:
694:
693:
670:
537:and how much is
450:informed consent
387:investigations.
103:, for example a
71:
31:
19:
18:
1208:
1207:
1203:
1202:
1201:
1199:
1198:
1197:
1178:
1177:
1176:
1167:
1141:Kidney dialysis
1124:
1088:Abdominal x-ray
1030:
982:
954:
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849:
843:
813:
812:
773:
769:
742:Am J Kidney Dis
738:
734:
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691:
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671:
667:
662:
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554:
459:
406:in the kidney,
402:, pre-existing
376:
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240:kidney function
182:
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1100:
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1080:
1079:
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1073:
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870:
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851:
850:
847:urinary system
842:
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834:
827:
819:
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810:
783:(6): 661–665.
767:
748:(4): 580–585.
732:
697:
675:"Renal Biopsy"
664:
663:
661:
658:
636:sampling error
589:kidney failure
581:
578:
553:
550:
539:kidney medulla
458:
455:
439:kidney failure
400:hydronephrosis
392:blood clotting
375:
372:
370:
367:
366:
365:
360:
355:
350:
339:
336:
333:
322:
319:
318:
317:
314:
311:
305:
298:
295:
290:
287:
286:
285:
282:kidney failure
278:BK nephropathy
270:
259:
258:
251:
236:Kidney failure
233:
223:
216:kidney failure
186:kidney disease
181:
178:
159:
156:
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1009:
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979:
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639:
637:
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626:
622:
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602:
598:
594:
590:
585:
580:Complications
577:
574:
570:
568:
567:acetaminophen
564:
560:
549:
546:
544:
540:
536:
535:kidney cortex
531:
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524:
519:
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511:
509:
505:
500:
498:
497:proceduralist
493:
491:
487:
483:
478:
476:
472:
468:
464:
457:During biopsy
454:
451:
446:
444:
440:
436:
435:intravenously
432:
428:
424:
420:
416:
411:
409:
405:
401:
397:
393:
388:
385:
381:
380:Complications
374:Before biopsy
364:
361:
359:
356:
354:
351:
348:
344:
340:
337:
334:
332:
328:
325:
324:
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249:
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238:(or impaired
237:
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129:
125:
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112:
110:
106:
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97:
95:
91:
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83:
82:kidney biopsy
79:
70:
66:
64:
60:
57:
53:
50:
48:
44:
39:
35:
30:
25:
20:
950:Ureteroscopy
945:Ureterolysis
930:Ureterostomy
897:Renal biopsy
896:
868:percutaneous
780:
776:
770:
745:
741:
735:
710:
706:
700:
690:, retrieved
678:
668:
643:
640:
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586:
583:
575:
571:
555:
552:After biopsy
547:
520:
512:
501:
494:
479:
463:nephrologist
460:
447:
431:Desmopressin
412:
389:
384:nephrologist
377:
292:
267:surveillance
260:
194:
190:nephrologist
183:
167:
164:
161:
151:
147:
145:
140:
135:
131:
127:
124:transplanted
119:
115:
113:
108:
98:
81:
78:Renal biopsy
77:
76:
22:Renal biopsy
1146:Lithotripsy
1098:Cystography
1061:Intravenous
1001:Urethrotomy
996:Urethropexy
902:Nephrectomy
890:Nephroscopy
863:Nephrostomy
563:paracetamol
523:pathologist
506:. Use of a
475:CT scanning
419:clopidogrel
226:Proteinuria
212:proteinuria
180:Indications
174:CT scanning
63:MedlinePlus
1182:Categories
1163:Urinalysis
1118:Cystometry
1083:CT urogram
1066:Retrograde
978:Cystoscopy
968:Cystectomy
912:Nephropexy
880:Nephrotomy
707:Am. J. Med
692:2023-11-24
679:StatPearls
660:References
559:analgesics
471:ultrasound
396:ultrasound
208:glomerulus
200:Haematuria
170:ultrasound
94:microscope
34:Micrograph
1071:Antegrade
1056:Pyelogram
885:Endoscopy
543:naked eye
530:scientist
527:pathology
369:Procedure
353:pregnancy
274:rejection
38:PAS stain
805:40898162
797:15483458
727:14877837
687:29262196
561:such as
504:sedation
427:warfarin
343:warfarin
327:azotemia
321:Relative
297:Absolute
47:ICD-9-CM
1043:Imaging
1035:General
988:Urethra
960:Bladder
762:7573010
621:surgery
613:anaemia
423:heparin
415:aspirin
363:obesity
347:heparin
331:uraemia
158:History
84:) is a
1188:Biopsy
922:Ureter
855:Kidney
803:
795:
760:
725:
685:
490:supine
255:tumour
105:tumour
101:lesion
90:kidney
80:(also
69:003907
1129:Other
801:S2CID
609:shock
482:prone
382:). A
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793:PMID
758:PMID
723:PMID
683:PMID
425:and
265:For
1076:Gas
785:doi
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619:or
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Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.
