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renal biopsy

Indications: 1) to determine the etiology & prognosis of patients with > 2 grams/day non-nephrotic range proteinuria (albuminuria) 2) nephrotic range proteinuria 3) albuminuria (> 300 mg/g creatinine) 4) microscopic hematuria* - glomerular hematuria, glomerulonephritis 5) acute or chronic kidney disease of unclear etiology a) progressive renal insufficiency b) acute renal failure lasting 3-4 weeks 6) atypical course of diabetic nephropathy 7) undiagnosed systemic disease with renal involvement 8) renal transplantation dysfunction 9) evaluation of renal neoplasm * in the absence of acute renal failure, nephrotic syndrome, or clinical manifestations of systemic disease (i.e. vasculitis), renal biopsy seldom provides therapeutically important information in patients with unexplained hematuria Contraindications: 1) bleeding disorders a) coagulopathy b) thrombocytopenia 2) severe anemia 3) uncontrolled hypertension a) ensure blood pressure < 165/95 prior to biopsy [2] b) clonidine or metoprolol suggested if antihypertensive needed [2] 4) urinary tract infections (acute pyelonephritis) 5) solitary kidneys other than allografts 6) cystic kidney disease 7) hydronephrosis 8) atrophic kidney or shrunken kidneys (< 9 cm) irreversible disease 9) uncooperative patients 10) renal mass & renal cell carcinoma are relative contraindications due to increased risk of bleeding & spread of malignant cells through the biopsy tract [2] Procedure: - percutaneous kidney biopsy may be performed in the setting of direct visualization by laparoscopy [2] Pathology: - immunofluorescence staining - pauci-immune staining (ANCA-associated glomerulonephritis) - linear staining (anti-glomerular basement membrane disease) - granular staining (lupus nephritis) Complications: 1) perinephric bleeding 2) small arteriovenous fistulas 3) hematuria 4) 1% require transfusion 5) 0.1% require nephrectomy

General

tissue biopsy

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 604-605
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2012, 2015, 2018, 2021. - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  3. Whittier WL, Korbet SM. Renal biopsy: update. Curr Opin Nephrol Hypertens. 2004 Nov;13(6):661-5. PMID: 15483458
  4. Corapi KM, Chen JL, Balk EM, Gordon CE. Bleeding complications of native kidney biopsy: a systematic review and meta-analysis. Am J Kidney Dis. 2012 Jul;60(1):62-73. Review. PMID: 22537423
  5. Piccoli GB, Daidola G, Attini R et al Kidney biopsy in pregnancy: evidence for counselling? A systematic narrative review. BJOG. 2013 Mar;120(4):412-27. Review. PMID: 23320849 Free Article
  6. Hogan JJ, Mocanu M, Berns JS. The Native Kidney Biopsy: Update and Evidence for Best Practice. Clin J Am Soc Nephrol. 2016 Feb 5;11(2):354-62. Review. PMID: 26339068 Free PMC Article
  7. Kidney Biopsy http://kidney.niddk.nih.gov/kudiseases/pubs/biopsy/index.htm