Kidney Biopsy

Abstract

The introduction of renal biopsies has transformed practice in nephrology, particularly with regard to glomerular disease and the care of kidney transplant recipients. A biopsy can provide information about the diagnosis and prognosis of kidney disease while most importantly often leading to changes in therapy that can be life saving. Four groups of patients benefit most from renal biopsy: those with nephrotic syndrome, those with acute nephritic syndromes with rapid deterioration of renal function, those with unexplained acute kidney injury and renal transplant recipients. Non-nephrotic range proteinuria and/or hematuria or unexplained chronic kidney disease represent indications in selected cases. The evaluation of patients prior to undergoing a kidney biopsy requires a careful assessment that includes a detailed history to confirm the relative benefit of a biopsy in making an accurate diagnosis compared with individual’s risk of bleeding. The use of real-time ultrasound or CT-guidance with gun-mounted biopsy needles is paramount for the successful performance of the biopsy and reduction of risks. renal biopsies are mostly done as an inpatient but can be performed on an outpatient basis in selected cases. A renal biopsy has a bleeding risk of up to 5% and is considered a “high bleeding risk procedure”. For patients receiving -antithrombotic therapy, the approach to periprocedural use of antithrombotic agents needs to be individualized. Because it is a high-risk procedure, all efforts must be undertaken to minimize the risk including a careful assessment of the patient's specific situation, and only experienced operators at institutions that can care for post-biopsy complications should perform the procedure. This review contains 7 tables, 7 figures and 83 references Key words: kidney biopsy, native kidney, transplant kidney, indications, preparation, performing biopsy, ultrasound guidance, transjugular, CT-guided, complications