University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

179

Pages:

2
Author:

Mariam A. A.

Renal Biopsy Indications • Proteinuria and/or haematuria (although if either is isolated and mild without much other clinical suspicion then this may not be necessary) • AKI with ischaemic ATN, especially if recovery is delayed. • CKD with proteinuria, glomerular haematuria, sudden/unexplained reduced GFR etc. • Impaired function of the renal graft. • Involvement of the kidney in a systemic disease. Contradictions • • • • • • • uncontrolled severe hypertension. Haemorrhagic diathesis -> as there is a complication of a haemorrhage. Renal neoplasm -> to avoid the spread of malignancy across the needle of the biopsy. Acute urinary infections. Large and multiple cysts. Solitary kidney Urinary tract obstruction Procedure • • • • • • Patient consent Ultrasound/CT to determine the size of the kidney. Blood pressure should be less than 160/90 mm of Hg. Bleeding time, coagulation time. Blood sample for blood grouping. Patient is sedated before. • • • • • • Patient lies in prone position. The whole position will be done under the guidance of a US. Below placed under abdomen. Select side which should be disinfected and there should be a local anaesthetic should be infiltrated. Small skin incision given with a scalpel and the local anaesthetic is infiltrated down to the renal capsule. Sample most obtained from lower pole of the kidney. Complications • Bleeding (if a larger vessel is punctured) • Pneumothorax (if the diaphragm is punctured and the parietal pleura is pierced) • Pain lasting over 12 hours (may be from obstruction of the ureter from a clot in a patient with gross haematuria, or stretching of the renal capsule by a subcapsular haematoma) • Arteriovenous fistula (if an adjacent artery and vein join, though this is usually clinically silent and resolves spontaneously over 1-2 years, though there can be risk of bleeding and/or rupture) • Hypertension (if a large subcapsular haematoma causes ischemia due to the pressure it places on the renal parenchyma, there can be persistent RAAS activation) • Puncture of adjacent organs (e.g., liver, pancreas, spleen).