renal biopsy
TRANSCRIPT
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.
ESNT-CNE 1st Course Cairo Sept 10-14, 2012
Introduction. Indications for renal biopsy. Contraindications for renal biopsy. Renal biopsy procedure. Renal biopsy complications. References.
Renal biopsy: Agenda
ESNT-CNE 1st Course Cairo Sept 10-14, 2012
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
ESNT-CNE 1st Course Cairo Sept 10-14, 2012
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
ESNT-CNE 1st Course Cairo Sept 10-14, 2012
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
ESNT-CNE 1st Course Cairo Sept 10-14, 2012
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
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.
ESNT-CNE 1st Course Cairo Sept 10-14, 2012
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
ESNT-CNE 1st Course Cairo Sept 10-14, 2012
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
ESNT-CNE 1st Course Cairo Sept 10-14, 2012
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.
ESNT-CNE 1st Course Cairo Sept 10-14, 2012
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.
Patients 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
ESNT-CNE 1st Course Cairo Sept 10-14, 2012
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 :
ESNT-CNE 1st Course Cairo Sept 10-14, 2012
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
ESNT-CNE 1st Course Cairo Sept 10-14, 2012
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
ESNT-CNE 1st Course Cairo Sept 10-14, 2012
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
ESNT-CNE 1st Course Cairo Sept 10-14, 2012
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
ESNT-CNE 1st Course Cairo Sept 10-14, 2012
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
ESNT-CNE 1st Course Cairo Sept 10-14, 2012
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
ESNT-CNE 1st Course Cairo Sept 10-14, 2012
Tanta Nephrology Unit Renal Biopsy Histopathology Results
2014-2015
Diagnosis No. %Lupus nephritis 37 26.8MCD 13 9.4Glomerulosclerosis 13 9.4MPGN 12 8.7FSGS 11 8ATN 10 7.2MGN 9 6.5AIN 7 5RPGN 6 4.3TMA 6 4.3Amyloidosis 5 3.6CIN 5 3.6Post-infectious GN 2 1.4Cast nephropathy 2 1.4Total 138 100
ESNT-CNE 1st Course Cairo Sept 10-14, 2012
Sales
Lupus nephritis MCDGlomerulosclerosis MPGNFSGS ATNMGN AINRPGN TMAAmyloidosis CINPost-infectious GN Cast nephropathy
Tanta Nephrology Unit Renal Biopsy Histopathology Results
2014-2015
Lupus nephritisMCD
GlomerulosclerosisMPGNFSGS
ATNMGN
AINRPGN
TMAAmyloidosis
CINPost-infectious GN
Cast nephropathy
0 5 10 15 20 25 30 35 40
ESNT-CNE 1st Course Cairo Sept 10-14, 2012
Thank You