renal biopsy

Pathology

• immunofluorescence staining
  • pauci-immune staining (ANCA-associated glomerulonephritis)
  • linear staining (anti-glomerular basement membrane disease)
  • granular staining (lupus nephritis)

Indications

• to determine the etiology & prognosis of patients with > 2 grams/day non-nephrotic range proteinuria (albuminuria)
• nephrotic range proteinuria
• albuminuria (> 300 mg/g creatinine)
• microscopic hematuria*
  • glomerular hematuria, glomerulonephritis
• acute or chronic kidney disease of unclear etiology
  • progressive renal insufficiency
  • acute renal failure lasting 3-4 weeks
• atypical course of diabetic nephropathy
• undiagnosed systemic disease with renal involvement
• renal transplantation dysfunction
• 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

• bleeding disorders
  • coagulopathy
  • thrombocytopenia
• severe anemia
• uncontrolled hypertension
  • ensure blood pressure < 165/95 prior to biopsy
  • clonidine or metoprolol suggested if antihypertensive needed
• urinary tract infections (acute pyelonephritis)
• solitary kidneys other than allografts
• cystic kidney disease
• hydronephrosis
• atrophic kidney or shrunken kidneys (< 9 cm) irreversible disease
• uncooperative patients
• renal mass & renal cell carcinoma are relative contraindications due to increased risk of bleeding & spread of malignant cells through the biopsy tract

Procedure

• percutaneous kidney biopsy may be performed in the setting of direct visualization by laparoscopy

Complications

• perinephric bleeding
• small arteriovenous fistulas
• hematuria
• 1% require transfusion
• 0.1% require nephrectomy

More general terms

• tissue biopsy

Patient information

renal biopsy patient information