Download - Percutanous renal biopsy
Percutaneous Renal Biopsy
UROLOGY DIVISION
SURGERY DEPARTMENT,LASUTH.
Outline
• Introduction/Definition
• Indications
• Contraindications
• Pre procedural preparation
• Equipment
• Technique
• Post operative care
• Complication
Introduction/Definition• Renal biopsy is a procedure used to obtain segment
of renal tissue, usually through a needle or another
surgical instrument.
• This is done utilizing either ultrasound scan or the CT scan.
• This allows for an accurate, reliable method of
acquiring renal tissue for histopathological
assessment.
Introduction cont’d• Biopsy maybe of a native or transplanted kidney
and its divided into 2 types.
Non-focal or non-targeted
Focal or targeted
• Either type can be performed as a CT guided
biopsy or an Ultrasound guided biopsy.
• 3D cone beam CT for challenging focal lesions.
• Both patients’ and surgeons’ factors are considered.
• Transplant renal biopsy is usually undertaken with
ultrasound guidance.
• Alternative option for percutaneous CT/USS guidance
is the trans-jugular renal biopsy.
Indications• focal lesion non-characterised on diagnostic imaging
• renal failure with unknown cause (typically a
nephropathy)
• deteriorating renal function in transplant patient
• Acute nephritic syndrome
• Nephrotic syndrome
• Isolated glomerular hematuria
For focal mass lesions the established indications
include:
• known extra-renal malignancy
• suspected renal renal lymphoma
• prior to ablation therapy
• multiple or bilateral renal masses
• diagnostic dilemma of infection/malignant mass
Contraindication
The contraindications should be individualized in each
case
Absolute
• Uncontrolled bleeding diathesis
• Uncontrolled severe hypertension
• Active renal or peri-renal infection
• Skin infection at biopsy site
Relative Contraindications
• Uncooperative patient
• Anatomic abnormalities of the kidney
• Small kidney
• Solitary kidney
Pre-procedure preparations
• Assessment of patient’s cooperation
• Informed consent
• Laboratory parameters
coagulation studies (INR ≤ 1.5 )
Platelet
Equipments
• Single or co-axial needle set
• 1% lidocaine
• Midazolam
Technique
• Focal biopsy usually require a single core
• Non-focal biopsies typically requires two cores
• For native and transplanted non-focal kidney
biopsies, the core is usually taken from the
lower pole
• Both Ultrasound and CT biopsies are
performed with the patient prone or
occasionally ipsilateral side up position in the
pelvis
• Preliminary USS or single shot CT is done to
locate and map the kidney
• The skin is prepared and draped and the mapped
area infiltrated up to the capsule of the kidney.
• The specimen is taken with the needle directed
vertically.
• CT guidance is preferred for those with large
body habitus.
• After the procedure, a brief assessment for
perinephric or intra-parenchyma hemorrhage is
done.
Postoperative Care
• Bed rest is advised as well as regular observation
for 4-6hrs.
• Early complication identification improves
outcome
( > 90% of complication occur within 24hrs)
ComplicationsRisk of complication is higher in patients with advanced
renal insufficiency and also hypertension and Amyloidosis.
• Perinephric (retroperitoneal) hematoma
• Intra-renal hematoma
• Hematuria
• Ureteric obstruction
• AV fistula and pseudo-aneurysm
• Pneumothorax