06 Mar, 2024
06 Mar, 2024
Kidney biopsy, also called renal biopsy, is a technique that involves obtaining a small tissue of the kidney and examining it under the microscope to determine the presence of kidney disease or damage. Kidney biopsy provides vital information about the overall health of the kidney, severity, and progression of kidney disease, response to treatment in kidney diseases, and reasons for the kidney not working after a renal transplant. Kidney biopsy is considered the confirmatory test for kidney cancer.
Some of the renal biopsy indications include:
Patients with rapidly progressing glomerulonephritis have a rapid reduction in kidney function along with active urine sediments. Nephrologists may recommend a kidney biopsy in such cases, as delayed diagnosis results in irreversible kidney damage. Renal biopsy is usually a diagnostic procedure when proteinuria is associated with urinary sediment abnormalities rather than isolated hematuria or proteinuria.
Hematuria is a condition in which patients have blood in their urine. Several reasons exist for this condition. It is important to differentiate between the urological and renal causes of hematuria. Early diagnosis and treatment improve the renal prognosis of hematuria. If the blood and imaging tests do not provide adequate information about the cause of hematuria, nephrologists may recommend a kidney biopsy.
Proteinuria is a condition that involves the presence of protein in the urine. Nephrologists recommend kidney biopsy in adult patients with persistent proteinuria (generally >1 g/day). Appropriate diagnostic and prognostic information assists nephrologists in developing an optimal management strategy.
Diabetic kidney disease is a common complication in patients with diabetes and may cause kidney failure. Although a kidney biopsy is not usually necessary for diagnosing diabetic nephropathy, patients who present with atypical features of diabetic nephropathy and are suspected to have non-diabetic renal disease are recommended for a kidney biopsy.
A kidney biopsy is considered the gold standard for the detection of lupus nephritis. It offers vital information to nephrologists in the management of lupus nephritis. The doctors recommend a kidney biopsy for patients with systemic lupus erythematosus who present with active nephritis symptoms.
Myeloma kidney or Bence Jones cast nephropathy, is a common renal disease in patients with multiple myeloma. Myeloma patients with a high degree of albuminuria may require a renal biopsy indication to rule out the presence of immunoglobulin light-chain (AL) amyloidosis or monoclonal immunoglobulin deposition disease.
Patients with poorly controlled diabetes are at increased risk of developing kidney disease. Almost 20 to 30% of patients with diabetes develop renal disease. However, not all cases of diabetic nephropathy progress to kidney failure. Over time, high blood sugar levels damage the filtering units of the kidney.
Uncontrolled high blood pressure not only initiates kidney damage but also worsens the already existing chronic kidney disease. Uncontrolled high blood pressure weakens, narrows, or hardens the arteries. The damaged arteries cannot facilitate optimal blood flow to the kidneys, resulting in reduced kidney function.
Apart from diabetes and high blood pressure, there are several causes of kidney disease. These include smoking, cardiovascular diseases, obesity, acute kidney injuries, abnormal structure of the kidneys, inflammation of tubules and glomeruli, recurrent kidney infection, prolonged urine obstruction due to prostatitis, urinary tract cancers, and kidney stones.
Several procedures are available to perform the renal biopsy. The choice of the kidney biopsy procedure depends upon several factors, such as the site of the biopsy, the underlying risk in specific patients, and the quantity of abnormal tissues required for the examination.
It is one of the most common procedures for performing renal biopsy. The nephrologists insert the needle through the skin into the kidney to remove the samples. The CT or ultrasound scan may also guide the needle to the biopsy site during the percutaneous biopsy.
There are two types of percutaneous biopsy. These include fine needle aspiration and needle core biopsy.
A fine needle aspiration biopsy involves using a very fine needle that is inserted into the skin and guided to the biopsy area. A syringe is fitted with a needle that suctions the tissue sample with or without fluid. The sample obtained during this kidney biopsy procedure is subjected to a cytological examination.
A core needle biopsy involves using a wider needle than the fine needle aspiration technique. It allows the nephrologists to obtain more samples from the abnormal area. It may involve using an anesthetic to avoid pain during the kidney biopsy procedure. The samples obtained during the core needle biopsy undergo histological examination.
During an open kidney biopsy, the surgeons make an incision in the skin to expose the kidney. A tissue sample of the kidney is taken, and the incision is closed with stitches. An open kidney biopsy is done under general anesthesia. This kidney biopsy procedure is not commonly used and is restricted to cases where a percutaneous biopsy is not possible.
There are certain other methods to obtain a sample of kidney tissues. These include:
This kidney biopsy involves using a laparoscope to remove the tissue sample. A laparoscope is a long, thin tube with a camera at the end. The laparoscopic surgeon makes two small incisions in the skin. Through one incision, a laparoscope is inserted to view the location of tissue sampling. Through other incisions, instruments are inserted to obtain the kidney tissues for examination.
The jugular vein is present in the neck. The surgeon inserts a catheter in the jugular vein and guides it to the kidney to obtain the tissue sample. It is usually performed in high-risk patients in whom percutaneous biopsy is contraindicated.
A kidney biopsy is an invasive procedure. Like other invasive procedures, a kidney biopsy also has certain risks and side effects. Some of the kidney biopsy risks are:
It is a common complication after a renal biopsy. Several patients have blood in their urine after the biopsy. The bleeding generally stops a few days after the kidney biopsy procedure. There are fewer chances of severe bleeding. However, if severe bleeding occurs, patients need a blood transfusion.
Any incision on the skin increases the risk of infection. Infection is not a common kidney biopsy side effect. However, if it occurs, it should be managed with antibiotics.
The pin is a common kidney biopsy side effect. Patients with kidney biopsy procedures may experience pain at the incision site once the anesthesia effect wanes. However, it persists only for one to two days and is effectively managed with analgesics.
Arteriovenous Fistula is a kidney biopsy side effect in some patients. During the biopsy procedure, the needle sometimes injures the walls of the vein or arteries. It results in the formation of a connection between nearby blood vessels (known as a fistula). No medical intervention is usually required, and the fistula closes on its own with time.
In a few cases, an infection occurs in the blood that collects around the kidney (hematoma). It is managed through surgical intervention and the administration of antibiotics. In rare cases, patients may have increased blood pressure due to the formation of a large hematoma.
The precautions to lower the risk of side effects during a kidney biopsy include:
Nephrologists perform a complete health examination of the patients before performing a kidney biopsy to determine their tolerance for the procedure. A detailed medical history, especially the history of cardiac and pulmonary diseases, is obtained. The urinary parameters, such as creatinine levels and glomerular filtration rate, are also evaluated before the procedure.
If there is any serious underlying medical condition, the anesthesiologist monitors the health of the patient throughout the sedation period. Patients with recent angina, myocardial infarction, congestive heart failure, or respiratory diseases, such as obstructive sleep apnea and emphysema, should be closely monitored during the procedure.
Image-guided biopsy significantly lowers the risk of renal biopsy complications. The imaging techniques, such as ultrasound or CT scans, allow the nephrologists to view the precise location from which the samples are to be collected.
The nephrologists may provide detailed information about the kidney biopsy recovery time and resuming routine activities at the time of discharge.
It is important to take care of the wound to reduce the risk of infection. The patients should follow all the instructions of the nephrologists related to wound care. The patients may be advised to remove the dressing within 24 to 48 hours after the procedure. It is also advised to avoid showers for at least 24 hours. If required, the patients may wash with a washcloth or sponge.
Patients should follow the restrictions to reduce the kidney biopsy recovery time. The patients are advised to rest for 1 to 2 days and avoid driving for a few days. Further, heavier objects should not be lifted for at least 3 to 4 days. The patients may ask the nephrologists about resuming work, as days of restriction from work depend upon the type of work.
The patients are prescribed certain medications during discharge. The medications include antibiotics to reduce the risk of infection and analgesics to manage pain and inflammation. If the patient was on any medication before the procedure, the nephrologists may advise resuming such medications.
The patients may resume their normal diet after the procedure. Drink enough fluids. If the patients have stomach upset after the procedure, they may be advised to take low-fat foods, such as yogurt, toast, and plain rice.
Several factors affect the cost of a biopsy test for kidney. These factors include:
Patients with underlying medical conditions may have a higher kidney biopsy cost than patients in relatively good health. Patients with poor health require comprehensive care and monitoring before, during, and after the procedure.
The kidney biopsy cost also depends on the technique used in the procedure. The ultrasound-guided biopsy was reported to be slightly more expensive than the CT-guided kidney biopsy.
Surgeons who are experts in performing kidney biopsies usually charge more than less experienced surgeons.
Patients undergo detailed health examinations before the procedure to determine their eligibility to undergo a biopsy test for kidney. The costs of these examinations (laboratory and imaging tests) also add to the overall kidney biopsy cost.
Once the kidney biopsy results are received, the patients require consultation with the nephrologists to get recommendations about the next course of action. The cost of consultation also increases the overall cost.
The cost of a biopsy test for kidney is also affected by the city where the tests are performed. Usually, tier 2 and 3 cities have lower kidney biopsy costs than tier 1 cities. Further, kidney biopsy costs are relatively higher in developed countries like the US and UK compared to developing countries like India.
HCG is the leading cancer care center in India, equipped with advanced diagnostic and treatment facilities. A kidney biopsy for a kidney cancer diagnosis is performed at the center using advanced techniques. Nephro-oncologists at the hospital are experts in performing kidney biopsies. Advanced techniques coupled with experienced surgeons at HCG significantly reduce kidney biopsy complications and make HCG the center of choice for the procedure.
A kidney biopsy involves collecting samples of kidney tissues and examining them under the microscope for the presence of disease, such as cancer. The renal biopsy indications include urinary sediments, diabetic nephropathy, hematuria, and proteinuria. The techniques chosen for biopsy test for kidney include percutaneous, open, laparoscopic, and transjugular. The kidney biopsy complications include blood in the urine, hematoma, infection, pain, and an arteriovenous fistula. It is important to follow the instructions of the nephrologists during the recovery period after a kidney biopsy test.
A kidney biopsy test is one of the most precise and accurate methods to diagnose several kidney diseases, including kidney cancer. It has high sensitivity and specificity. It assists nephrologists in clinical decision-making and helps them develop optimal treatment strategies.
The number of glomeruli in a kidney biopsy test depends on the disease suspected by the nephrologists. Usually, the number of glomeruli is higher when the severity of kidney disease is determined compared to when the presence of the disease is considered. Usually, about 10 to 15 glomeruli are optimal, while 6 to 10 glomeruli are most often sufficient. Even a single glomerulus is sufficient in some cases to determine the presence of disease.
Percutaneous kidney biopsy and laparoscopic kidney biopsy leave no or fewer scars compared to the open surgery performed for kidney biopsy.
In rare cases, a kidney biopsy test may spread cancer. The mechanism through which the cancer spreads during biopsy is known as needle seeding or tumor seeding.
Because of advanced techniques, such as image-guided biopsy, there is a significant reduction in kidney biopsy complications during and after kidney biopsy test. However, in some cases, a kidney biopsy may result in kidney damage.
In some cases, the level of creatinine increases after a kidney biopsy. Studies have shown that patients with acute and chronic kidney disease are at elevated risk of elevated creatinine levels after kidney biopsy compared to individuals with no kidney disease. However, the level may improve within a few days to a few weeks.
A kidney biopsy is performed under anesthesia. Thus, the patients do not experience pain during the kidney biopsy procedure. Once the effect of anesthesia wanes, the doctor may prescribe analgesics to manage the pain. The pain after a kidney biopsy is usually not severe and is tolerable.
A needle biopsy is preferred over an open biopsy because there is less pain, no or little scarring, and fewer kidney biopsy complications. An open biopsy is usually performed when a needle biopsy is contraindicated.
