Kidney Biopsy : Procedure, Test, and Report

Kidney biopsy is a procedure to procure tissue samples from the abnormal kidney with an aim to identify the pathology. This test is also called renal biopsy test. It helps to correctly diagnose the various diseases, as well as help healthcare professionals to plan treatment and foretell associated prognosis.

During the procedure, the tissue samples will be collected by your health care professional and then marked and labelled for identification before sending it to a pathologist for careful assessment under microscope. The reporting usually takes around 5 to 7 days depending on available laboratories and logistics. Make sure to get your kidney biopsy test report analyzed through an expert.

Who needs a kidney biopsy?

Kidney is your main excretory organ and helps the body to eliminate a variety of toxins from the body by producing urine. It also helps the body to maintain normal levels of various electrolytes in the body. The kidneys produce an average of around 2 litres of urine per day in a healthy adult. While most kidney problems are identified with simpler investigations like routine urine examination, urine gram stain and culture sensitivity, some people may need to undergo ultrasound of kidneys and on rare occasions require radiographic CT and special X Ray images. However at times when these investigations are not enough to correctly diagnose the pathology, a kidney biopsy is planned. Some of the indications of a kidney biopsy are as follows

• Blood (haematuria) or protein (proteinuria) in the urine
• Abnormal blood test results suggesting a kidney cause
• Acute or chronic kidney diseases where other investigations have not yielded fruitful results
• Nephrotic syndrome (a condition involving excessive leakage of proteins in urine)
• Glomerular disease (condition affecting the filtering units of the kidney)
• To determine the results of ongoing treatment like if the patient is improving or deteriorating
• In people with deteriorating kidney functions post-transplant, it helps to identify a specific cause and even save the transplanted kidney at times.
• In diagnosis of suspected kidney tumor.
• Other unusual or special conditions.

How do you prepare yourself for a kidney biopsy?

The risk of kidney biopsy though very small is not negligible and the same should be understood from the doctor before signing the consent for it.

• You are advised to disclose all your medical history to your doctor in advance like any history of other diseases like diabetes, high blood pressure, thyroid problems or any disease pertaining to heart or breathing or even a history of stroke. Any history of bleeding disorders must be told to your doctor.
• Disclose all the medications you are presently consuming especially if you are on blood thinners, non-steroidal anti-inflammatory drugs (NSAIDS) and aspirin. The most common complication is bleeding which may require blood transfusion or even surgery at times. For patients on aspirin medication should be stopped a week before surgery to avoid increased risk of bleeding. Medications to control high blood pressure may be taken till the morning of the procedure.
• Blood work up before the biopsy is done to rule out any pre-existing bleeding disorder, blood infection and low haemoglobin. You may also be advised to undergo investigations like chest X-Ray, ECG, Ultrasound and some routine blood work up prior to the procedure to determine the safety of anaesthetic agents
• You are advised to disclose any allergies if any specifically to contrast agents. The biopsy procedure may involve general anaesthesia, so patients are advised to have 6 to 8 hours of fasting before the procedure.

Kidney biopsy test price may vary from lab to lab. Always book your test through a trusted lab partner.

How is kidney biopsy done?

Kidney biopsy is usually performed by a nephrologist or a radiologist. There are various methods to obtain a biopsy sample from the kidneys. The most commonly used approach is a percutaneous approach, however other approaches which can be employed to secure a tissue sample are laparoscopic, open and rarely trans-jugular. A laparoscopic approach involves the use of a thin biopsy needle through your skin to acquire samples of your kidney tissue. The procedure is usually completed within an hour. The patients are advised to lie prone with a firm support under the belly unless biopsy is indicated in a transplanted kidney. Special circumstances like obesity or pregnancy may require lying down, seated, or other comfortable positions. Procedure requires intravenous (IV) or local sedatives to help you stay comfortable during the procedure. Radiological assistance may help guide the location, depth and angulation of biopsy needles to secure adequate biopsy samples. Finally the desired puncture site is cleaned with an antiseptic solution to avoid infection. The health care professional might ask you to withhold your breathing during the biopsy to avoid damaging blood vessels and normal organs. The procedure does not require any stitches and just a normal dressing is sufficient at the puncture site.

Post kidney biopsy care and risks

• Post procedure the patients are observed for signs of bleeding with continuous monitoring of vitals. Typically patients are advised bed rest for a duration of 12 to 24 hrs. Patients are advised to refrain from heavy lifting, strenuous exercise and competitive sport for a couple of weeks post procedure.
• While minimal amounts of blood in urine post biopsy is expected, passage of blood in urine beyond 24 hrs of biopsy is unusual and requires urgent attention from your concerned doctor.
• Pain at the site of biopsy is mild and usually lasts only for a few hours post procedure, however continuous worsening of pain requires thorough evaluation.
• Other red flag signs are unable to pass urine, high fever or have loss of consciousness post biopsy.
• Pain, redness, swelling and oozing of tissue fluids from the biopsy site indicate infection.
• The biopsy report takes around 5 days however you may have a provisional report in a couple of days.