Native kidney biopsy is usually performed for Dgx of acute & CKD but is invasive and may be complicated by bleeding-related sequelae.
Complication rates among native kidney biopsies (Oct. 2020)
Native kidney biopsy is usually performed for Dgx of acute & CKD but is invasive and may be complicated by bleeding-related sequelae. Meta-analysis: 87 reports with > 118,000 native, percutaneous renal biopsies, 3.5 % showed transient macroscopic hematuria, 11 % perinephric hematoma (usually small), 1.6 % transfused (blood transfusion), & 0.3 % needs urgent intervention to hold bleeding. Death complicating native kidney biopsy seen in 0.06 % of ALL biopsies but only 0.03 % of OPD biopsies. Consistent with these data and previous reports, native renal biopsy, despite invasive, are generally safe with substantial low rates of bleeding sequelae and mortality.
Poggio ED, McClelland RL, Blank KN, et al. Systematic Review and Meta-Analysis of Native Kidney Biopsy Complications. Clin J Am Soc Nephrol 2020; 15:1595.
In nephrology practice, percutaneous renal biopsy may be necessitated to settle a Dgx, guiding therapy, and assessing the magnitude of active & chronic alterations. Routine assessment of kidney biopsy may involve histopathological testing via LM, IF, and EM. The indications of renal biopsy are variable according to the presenting Sns & Sms and physician interpretations:
1) Ptns with NS, biopsy is usually required in lupus nephritis to determine the current type of pathology. It is also performed in ptns with NS + no evidence of systemic manifestations, both for therapeutic decisions and for unexpected Dgx.
2) Acute nephritic syndrome is usually related to systemic pathology requiring a renal biopsy to settle a Dgx and guide therapy. However, absence of systemic disease, acute nephritic syndrome usually requiring biopsy to assure Dgx and tailor therapeutic plan.
3) Unexplained AKI, to settle a Dgx.
Renal biopsy is generally NOT routinely required to settle a Dgx in the following:
1. Isolated glomerular hematuria, unless markers of progressing pathology e.g., rising proteinuria or elevated SCr were associated.
2. Low-grade proteinuria (< 500 mg/d), absent glomerular hematuria, normal renal profile, & absent clinical/serologic criteria related to systemic GN illness.
For most ptns, a percutaneous kidney biopsy is the preferable as it’s less invasive as compared to other approaches. Other approaches includING open (surgical) biopsy, laparoscopic & trans-jugular one. Prior to proceed to a kidney biopsy, full detailed history, physical examination, and routine lab profiles should be obtained to recognize ptn with increased risk for potential complications (e.g., bleeding). Recommended lab testing may include biochemical profiles, CBC, platelet count, PT, aPTT and INR. Some physicians also ask for bleeding time, but its value still in debate. A kidney US should be performed prior to the biopsy to recognize kidney dimensions and the possibility of any anatomical abnormalities that may impede the safety of a percutaneous needle biopsy.
Percutaneous renal biopsy is often performed under US guidance with local anesthesia. Using the real-time US rather than the blind approach in which US is used for localization only. Real-time US is associated with few important sequelae providing high diagnostic yield. Using a spring-loaded needle for native kidney biopsy considering its more ease approach and possible higher diagnostic yield; however, the option is usually chosen according to local facilities. For native kidney biopsy, using a 16-gauge needle rather than an 18-gauge needle is advised. Two cores of renal tissue are currently required. For most ptns undergoing percutaneous kidney biopsy, an extended duration of post-biopsy in-ptn hospital admission & monitoring are currently recommended. Observe the ptn for 24 h. in the hospital, despite some experts suggest a 6-12-h. for ptn observation. Bleeding is the 1st expected sequela for a kidney biopsy.