Medihub - Medical Information - Renal Medicine

A renal biopsy is a procedure that aims to remove small amounts of kidney tissue through a small needle for microscopic examination. The information gives doctors more information on how to prognosticate the renal disease and guide further therapy. It can be done in both patients with native kidneys (ie their original kidneys) or in transplanted kidneys.

Native kidney biopsies require the patient to lie down prone as the kidneys are at the back. Under local anesthesia as well as real-time ultrasound guidance, the operator will insert a needle into the substance of the kidney.

In Transplant kidney biopsies, the patient lies face upward, as the transplanted kidney would have been placed not in the back but in the more anterior (or front) portion of the abdomen. The rest of the procedure is relative similar between native and transplant biopsies.

Complications in kidney biopsies:

1. Bleeding

Bleeding is the major complication associated with this procedure. Transient microscopic haematuria occurs in most patients, but will usually resolve in 48 hrs.

Occasionally, transient gross haematuria can occur days after biopsy which should resolve with rest.

Perinephric haematoma (bleeding around and localised to the kidney) is usually occult(hidden) and is associated with a fall in haemaglobin (colored pigments inside red blood cells that carries oxygen round the body) and sometimes manifested by flank pain and swelling.

Very rarely surgery (nephrectomy) may be required to control the bleeding (0.06%)

To avoid the risk of bleeding, please inform the doctor whether you have a bleeding abnormality, on aspirin or other non-steroidal anti-inflammatory drugs for the last 7 days or take any medication to thin your blood.

2. Pain

Pain lasting more than 12 hours may be due to ureteral obstruction from a blood clot in patients with gross haematuria or may be due to a subcapsular haematoma stretching the renal capsule

3. Infections

- Urinary tract infection can occur in a minority of patients but most often in patient active renal infection

- The development of sepsis and bacteraemia can occur but is uncommon

Post-Biopsy Care

1. Remain in a prone position for at least 1 hour following the biopsy.

2. Have strict bed rest until next morning

3. Activity following discharge should be restricted for several days and intensive physical exercise should be avoided for at least 4 weeks.

4. Drink plenty of fluid to increase urine flow rate which may help in preventing ureteral obstruction due to blood clots