Renal Biopsy

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. Introduction. Indications for renal biopsy. Contraindications for renal biopsy . Renal biopsy procedure. Renal biopsy complications. References . Renal biopsy: Agenda

3. 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. 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

5. 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

6. 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 .

8. 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

9.   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

10. 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.

11. 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. P atients 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. 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:

13. 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

14. 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

15. 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

16. 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 

17. 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 

18. 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

19. 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

20. Tanta Nephrology Unit Renal Biopsy Histopathology Results 2014-2015

21. Thank You