Renal biopsy is an informative diagnostic procedure that involves obtaining a biomaterial from the kidneys using a special syringe.
As a result of histological examination of tissues, specialists get a complete picture of the disease, an accurate diagnosis and the necessary treatment plan.
A diagnostic procedure like renal biopsy is indicated in the following cases:
- Complex urinary tract infections;
- Chronic or acute pathological processes in the kidneys that have an unclear etiology;
- The presence of protein and blood in the urine;
- Rapidly developing glomerulonephritis;
- The presence in the blood of slags of nitrogen origin like creatinine, urea or uric acid;
- For the specification of various kinds of renal pathologies, detected by ultrasound examination or computed tomography;
- If there is a suspicion of nephrotic syndrome or kidney cancer;
- In order to establish the stage of development and severity of renal pathological processes;
- Unstable, impaired a
ctivity of the implanted kidney;
- In order to evaluate the therapeutic efficacy of a prescribed treatment.
But even such a procedure, useful in all respects, having the highest informativeness, has specific contraindications.
It is strictly forbidden to perform renal biopsy if:
- There is only one functioning kidney;
- Blood flow problems;
- Allergic reaction to novocaine and preparations based on it;
- Renal tumor detected;
- An aneurysm of the artery of the kidney has been identified;
- Renal cavernous tuberculosis, venous thrombosis or hydronephrosis.
In addition, renal biopsy is relatively contraindicated in myeloma processes, severe forms of diastolic hypertension, late stages of atherosclerosis, renal failure, nephroptosis or pathological renal mobility, nodular periarteritis, etc.
There are several methods of conducting renal biopsy:
- Open form. This technique involves performing an operation with a cut above the location of the kidney, during which a piece of tissue is taken from the organ. Usually an open technique is used when it is necessary to remove the bulk part of the tissue. To date, an open biopsy is often performed in a laparoscopic way, which is less traumatic.
- Transcutaneous biopsy is performed by means of a specialized needle that is inserted through the skin layer above the kidney under X-ray or ultrasound control. Sometimes this procedure is accompanied by the use of a contrast medium to visualize the kidney and the vasculature at the puncture site.
- Transplant biopsy. This procedure is performed using a catheter that is triggered into the renal vein. This method of obtaining a biopsy is recommended for people who have blood flow disorders, obesity or respiratory failure.
- Urethroscopy with a biopsy fence is usually performed in patients with calculi in the ureters or renal pelvis. Urethroscopy is performed under operating conditions using general or spinal anesthesia. Through the urethra, a long, flexible, thin tube is inserted, passes through the urinary tract to the kidneys, where the biopsy sampling takes place.
A specific method is selected individually in the case of each patient. The specialist takes into account the patient's condition, biopsy goals, clinic capabilities and other factors.
procedure The doctor preliminarily reports the suspicions that caused the biopsy, and necessarily informs the patient of the likely risks and complications.
Between the medical institution and the patient the agreement on the consent for conducting the diagnostic procedure is concluded, which says about the patient's awareness of the possible consequences.
Then the doctor finds out the presence of pathologies, allergic reactions and intolerance to medications, and also asks the patient about the medications he takes.
In general, the preparation for diagnosis involves the following:
- 1-2 weeks before the procedure, it is necessary to stop using drugs like Rivaroxaban, Aspirin, Dabigatran and other drugs that have a blood thinning effect;
- Undergo a laboratory examination of blood and urine to exclude infectious lesions and determine contraindications;
- 8 hours before the procedure, stop eating, and before the procedure do not consume liquid;
- Discontinue the use of analgesic medicines such as Naproxen, Ibuprofen, as these drugs affect blood flow and increase the likelihood of bleeding.
How is kidney biopsy done?
The diagnostic procedure is performed in a stationary setting in an operating room or treatment room.
The total duration of the procedure is about 30 minutes.
The patient is placed on the couch with the abdomen down, the equipment for controlling the pulse and pressure is connected. All manipulations are monitored by a magnetic resonance or computer tomograph, X-ray or ultrasound device.
- First, the specialist determines the place of insertion of the biopsy needle, the area around which is cut with anesthetics.
- The patient is then asked to take a deep breath, holding his breath for almost a minute( 45 seconds).
- When the needle is inserted, the patients notice a pressing feeling, after which they clearly hear the click sound, which indicates the puncture of the kidney membrane and the fence of the material. It is simple when taking a biopsy specimen, a special device is used which, at the moment of tightening the biomaterial, produces a clicking sound.
- When the doctor has collected the required amount of a biopsy, the needle is carefully removed.
- The puncture site is treated with an antiseptic and covered with a bandage.
When the action of anesthetics ceases, painful discomfort arises at the puncture site. A few hours after taking the biopsy specimen, the patient is examined for urine to detect blood impurities.
Renal biopsy with glomerulonephritis
A biopsy is widely used when suspicion of glomerulonephritis appears.
Only a biopsy can clarify the picture of the kidney condition and determine the exact nature of the changes that have occurred in the tissues of the organ.
Microscopic, immunofluorescent and morphological study of the biopsy allows to determine the presence of lesions of different classification:
- The presence of minor changes with minimal tissue destruction;
- Membrane-type nephritis, which is characterized by epithelial renal tubular dystrophy;
- Glomerulonephritis of a proliferative nature, accompanied by intracapillary proliferation;
- Chronic progressive glomerulonephritis, which is considered the final stage of pathology.
Usually, the reason for renal biopsy are changes in the qualitative or quantitative characteristics of urine and its structure. By results of a biopsy to the doctor it is easier to choose the most effective scheme of treatment, contributing to the patient's quick recovery.
Results are usually ready in a few days, however, if the purpose of the biopsy was to identify an infectious inflammatory process, the patient will have to wait for results up to 10-14 days.
The results are considered normal, when there are no manifestations of tumors, infectious lesions, scarring and inflammation.
If cicatricial changes were detected during a biopsy, this could indicate systemic lesions, pyelonephritis, glomerulonephritis, and other pathologies.
Among the most common complications in renal biopsy, specialists identify:
- Internal bleeding, which in time passes by itself( in 10%);
- Serious hemorrhages requiring transfusion( less than 2%);
- Severe bleeding, which requires surgery to eliminate( probability 0.0006%);
- Kidney loss( less than 0.0003%);
- Paranoide of purulent nature, accompanied by inflammatory lesions of the perineal lipid tissues;
- Muscular bleeding;
- Breakthrough in the lower part of the kidney;
- Infectious complications.
According to medical recommendations, when a patient is released home, he must adhere to a certain regime:
- During 2-3 days to comply with bed rest;
- Drink more drink;
- For two days, exclude physical activity;
- To prevent the use of antibiotics and hemostatics;
- For a couple of months, give up playing sports and lifting weights.
It happened in my life that my kidney became ill. A lot of doctors passed, reached an oncologist who had found a kidney in the kidney, and then he prescribed a biopsy. I went to the clinic, I was taken to the ward, where I undressed and put on an operating gown. Then the operating room, anesthesia and nothing more I do not remember. Because they did with general anesthesia, there was no pain. But at me under indications it was possible to spend only an open biopsy. Everything went well, no complications.
I was very scared when I was assigned a biopsy, and I heard that this procedure was very painful. A friend of mine said that after a kidney biopsy a week later she felt bad and the kidney was ill. But in reality everything turned out completely different. They injected a vein and I fell asleep. When she came to herself, all the manipulations had already been completed. Therefore, not everything is as scary as they describe.
Price analysis and where it can be passed?
Renal biopsy procedure can be performed in highly qualified clinics, republican specialized medical centers and metropolitan multidisciplinary hospitals with professional and trained personnel.
The average cost of a percutaneous transcutaneous biopsy is about 2300-24000 rubles.
Video on how and when a biopsy of kidney neoplasms is applied: