kidney biopsy

What is a kidney biopsy?

As you know kidney is the most important organ in the body which performs multiple functions like balancing the hormones, produce urine and filter the toxic extra waste from the body. However, like everything in this world can’t be the same and face difficulties at some point, our kidneys can also fall ill. Due to unhealthy lifestyle and other reasons our kidney gets damaged and stop performing the essential functions. In this situation, if the patient is unable to identify the actual cause of kidney damaged, the nephrologist suggests the patient go for a kidney biopsy. 

The kidney biopsy is also known as renal biopsy because the word renal typifies kidney. It helps to identify the cause of kidney disease or issues faced by the patient. This assist nephrologists to give suitable treatment to the patient. Such complications that cannot be identified can be scarring, swelling and deposit of protein that is unable to be diagnosed through tests like ultrasound, blood and urine tests.

Apart from this, the test also helps the nephrologist to monitor thoroughly that how well a kidney transplant is working and observe the progression of kidney disease. The test helps also the nephrologist identify the type of kidney disease the patient has and how severe it is and the best treatment for it. In kidney biopsy, a small piece of kidney is taken as a sample in order to be examined by the professionals.

Why is kidney biopsy needed?

Kidney biopsy AKA renal biopsy is needed in some special circumstances. If the patient noticed any abnormality about the kidneys but it is unable to recognise the cause, the nephrologist suggests the patient for a kidney biopsy in certain situations like:

1. When the patient has a kidney transplant- In kidney transplant the damaged kidneys are replaced with new kidneys donated by either a living donor or deceased donor. 
2. Abnormal blood test result- as the normal blood test is based on various factors when the result come as outside the ranges, it is considered as an abnormal blood test result.
3. Glomerular disease- Glomeruli are the tiny network of blood vessels that function as the “cleaning units” of the kidney. They are responsible to filter toxic waste and remove extra fluids from the blood. In this disease, the glomeruli get damaged. It let protein and sometimes red blood cells leak into the urine. This condition is known as glomerular disease.
4. Hematuria- hematuria is the condition in which the blood is presented in the urine. There are two types of hematuria:
5. Gross hematuria- a condition in which the patient can see the blood in his or her urine.
6. Microscopic hematuria- in this type, the patient is unable to see blood in the urine. However, it can be seen with the help of a microscope. 
7. Proteinuria- when the level of protein in the urine increases, it causes damage to the kidneys. It’s called proteinuria. 
8. Some kidney-related complications without a known cause.

Two types of kidney biopsy

As we have learned about the basics of kidney biopsy, Now, we will talk about different ways in which biopsy can be done. There are two ways:

1. Percutaneous- in this procedure, an anaesthetic is given to the patient and the nephrologist inserts a thin needle through the skin and devices like ultrasound or computerised tomography helps the nephrologist by guiding the needle into the kidney to remove tissue. This type of kidney biopsy is not suggested for patients who have a history of bleeding problems, blood-clotting disorder or have only one kidney. 
2. Open biopsy- This is a surgical method of biopsy. After giving anaesthesia, an incision is made in the skin of the patient and a piece of kidney is surgically removed. The nephrologist makes a cut near the kidneys. This is best for patients who cannot have a percutaneous biopsy. Those who have a history of bleeding problems can go for an open biopsy so that the nephrologist can see the kidney to get a perfect sample for the test. This method is mostly used when a large piece of tissue is needed.

How does it perform?

The kidney biopsy is done either at a hospital or outpatient centre. For the biopsy, the position depends on the best access to the kidneys. Some patients lie on their abdomen but patients with transplanted kidneys mostly have to lie on their backs. 

The procedure starts with an ultrasound in which the nephrologist identifies the exact area to insert the needle. However, in some cases, a CT scan is also used. After this, the nephrologist marks the skin where the biopsy will be done and then clean the area and give an anaesthetic medication. A small cut is made where the needle will be inserted and uses the ultrasound device to guide the needle into the kidneys.

 (On the other hand, for laparoscope biopsy, the nephrologist will make a small cut and insert a thin lighted tube with a video camera at the tip of the laparoscope which will enable the nephrologist to view the kidney on a video screen and remove the tissues) 

The nephrologist can ask the patient to hold their breath while collecting the sample through a spring-loaded instrument. It can make the patient feel pressure and sense a clicking sound. For collecting enough tissue, the nephrologist needs to insert the needle multiple times through the same cut. After collecting the sample, the incision is covered by a small bandage. 

After the biopsy is done, the patient needs to rest for six hours. Blood pressure, pulse and breathing are monitored by the staff and some tests are done to check other complications. The patient can feel pain in the area for a few hours which can be treated with medication given by the nephrologist. If a patient feels normal after a few hours of the biopsy he or she can go home the same day. The nephrologist recommended two days of rest and avoid lifting heavy weight for some days.

What are the risks of a kidney biopsy?

Although kidney biopsy is a safe procedure and dizziness and feel faintness are common symptoms that can be cured easily, however, it does have some risks and the patient can face some complications. The risks can be:

1. Bleeding- after biopsy, blood in the urine for a few days is normal after the biopsy but if the blood clots in urine don’t stop, it is a matter of concern. The serious bleeding issue can sometimes need surgery to stop the blood in the urine.
2. Severe pain- the area of biopsy may hurt for a few hours but if the pain becomes severe, the patient should call the nephrologist.
3. Arteriovenous fistula- when the biopsy needle accidentally damages the walls of an artery or vein presented near the area of biopsy, it increases the risk that an abnormal fistula can form between the two blood vessels. However, the fistula heals on its own.
4. Abnormal urination- the chances of burning in urine, frequent need to urinate and sometimes even unable to urinate at all can increases. The patient can also experience Urinary infection
5. Fever- if the patient has a fever over 100.4 F(38 C), it is suggested to the nephrologist without any delay. 
6. Bruising and discomfort at the area of biopsy can be a side effects.
7. On-going bleeding from the area of biopsy is another issue faced by the patients.
8. Increased Chances of Infection near the biopsy area.

Frequently asked questions 

Q1. Is kidney biopsy painful?

The process of kidney biopsy involves the step in which the nephrologist make a cut. However, numbing medicine is used so that the patient doesn’t feel much pain but slight pain. After the procedure, the area can hurt for a few hours. If the patient lifts any heavyweight it may cause pain, so it is suggested to not do such strenuous activities for some days after the biopsy. 

Q2. Pregnancy and biopsy?

According to the studies and evidence the impact on kidney biopsy in pregnancy is heterogeneous, however, kidney biopsies during pregnancy may have a significantly higher risk of complications that can put both the mother and foetus in danger, rather postpartum biopsies are less dangerous.

Q3. What is the risk in kidney biopsy?

The patient can notice some complications that can be cured easily with some medications. Changes like blood in urine, unable to urinate, fever over 100.4F, soreness, pain and redness near the area of biopsy, dizziness and faintness are normal after the biopsy but if these complications become severe immediately contact the nephrologist.

Q4. What are the checkups which are necessary before the kidney biopsy?

Before the biopsy, blood tests and urine sample is important to check if the patient has an infection. Also, it is to tell the nephrologist if the patient is pregnant or not. Fasting from food and drinks for approximately eight hours prior to the biopsy is important.

Q5. When can someone have kidney biopsy 

A person who have an kidney infection, bleeding problems, imbalanced blood pressure and one working kidney may not be able to have a kidney biopsy. Such patients should consult their Healthcare centre for the best treatment.

Q6. What the patient should not do before the biopsy?

It is strictly recommended to the patient that does not use any deodorant, talcum or bath oil On the day of the biopsy. Also, do not wear any necklace or earrings. Patients are not advised to take aspirin and ibuprofen like Advil or any blood thinner for at least 7 days before the day of kidney biopsy.

Q7. Who performs the kidney biopsy?

A Nephrologist performs all the procedures related to the kidney.

Q10. How many days does it take to heal from a kidney biopsy? 

As you know, in kidney biopsy a little surgery is done by making a cut on the skin near the kidney location, the cut usually takes 2 -3 weeks to heal. Some patients face extreme pain and long recovery however, others recover in very little time and doesn’t face severe pain. The healing process depends on person to person.

Q12. How long a patient has to stay at the hospital after a kidney biopsy?

After the surgical step of biopsy, the patient needs to get rest for about six hours and some essential tests are also done after the biopsy to check the patient. Some patients go home the same day and other patients can leave the hospital after 12 -24 hours of the biopsy.

Q13. What things are prohibited after the kidney biopsy? 

The patients should take care of themselves after the biopsy like they are advised not to take shower for at least 24 hours. It is important to take bed rest for 24-28 hours and do not remove the bandage on the cut before 24-48 hours. 

Q14. Does the kidney biopsy leave scars?

In a percutaneous biopsy, after the procedure, the nephrologist applies the bandage on the biopsy area. On the other hand, in the open biopsy, the part of the kidney from which the biopsy tissue needs to be taken and the tissue is removed is closed with stitches (sutures), The scars fall off once the wound is healed and the sutures are removed. 

Q15. What other things can be find through kidney biopsy?

The kidney biopsy is not only beneficial to know the condition of kidney but many other purposes. It also help in finding out a kidney tumor, the reason behind malfunctioning of transplanted kidney; helps the nephrologist to find the suitable treatment, if any treatment is hurting the kidneys, how much kidney is damaged, the result of treatment whether getting better or worsening and some other unusual complications. 

Q16. After how much time does the report come?

After the kidney biopsy, the sample of the kidney tissue is sent to the pathological lab where the pathologist interpret the kidney biopsy and observation takes place. The observation can take three to five days to find the result. However, in some cases, the patient can get a report within 24 hours.