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.
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.
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