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Kidney Biopsy
Overview
A kidney biopsy is a procedure to remove a small piece of kidney tissue that can be examined under a microscope for signs of damage or disease.
Your doctor may recommend a kidney biopsy — also called renal biopsy — to diagnose a suspected kidney problem. It may also be used to see how serious a kidney condition is, or to monitor treatment for kidney disease. You may also need a kidney biopsy if you’ve had a kidney transplant that’s not working properly.
Why it’s done
A kidney biopsy may be done to:
- Diagnose a kidney problem that can’t otherwise be identified
- Help develop treatment plans based on the kidney’s condition
- Determine how quickly kidney disease is progressing
- Determine the extent of damage from kidney disease or another disease
- Evaluate how well treatment for kidney disease is working
- Monitor the health of a transplanted kidney or find out why a transplanted kidney isn’t working properly
Your doctor may recommend a kidney biopsy based on the results of blood or urine tests that show:
Blood in the urine originating from the kidney
Excessive or rising urine protein with kidney disease.
Kidney function problems causing waste buildup.
Risks
In general, percutaneous kidney biopsy is a safe procedure. Possible risks include:
Bleeding
Kidney biopsy bleeding usually stops within days; rarely, serious bleeding requires transfusion or surgery afterward.
Arteriovenous fistula
If biopsy needle damages a nearby artery and vein, an abnormal fistula can form. It causes no symptoms and closes.
Pain
Pain at the biopsy site is common after a kidney biopsy, but it usually lasts only a few hours.
Others
Rarely, a kidney hematoma becomes infected, requiring antibiotics, drainage, and potentially causing high blood pressure.
Medications
When you meet with your doctor, bring a list of all medications you take, including over-the-counter medications, vitamins and herbal supplements. Before your kidney biopsy, you’ll be asked to stop taking medications and supplements that can increase the risk of bleeding. These include:
Blood-thinning medications, including warfarin and rivaroxaban.
Clopidogrel (Plavix) prevents excessive platelet sticking.
Certain supplements, such as omega-3 fatty acids
Ibuprofen and other anti-inflammatory drugs (NSAIDs)
Blood and urine samples
Before your biopsy, you’ll have blood drawn and provide a urine sample to make sure you don’t have an infection or another condition that would make the biopsy risky.
Diet
You may be asked not to drink or eat for eight hours before the kidney biopsy.
What you can expect
You’ll have a kidney biopsy at a hospital or outpatient center. An IV will be placed before the procedure starts. Sedatives may be given through the IV.
During the procedure
During the biopsy, you’ll be awake and lie on your abdomen or your side, depending on which position allows best access to your kidney. For a biopsy of a transplanted kidney, most people lie on their backs.
A percutaneous biopsy includes these steps:
- With an ultrasound probe, your doctor identifies exactly where to insert the needle. In some cases, a CT scan may be used instead of ultrasound.
- Your doctor marks your skin, cleans the area and applies a numbing medication (local anesthetic).
- Your doctor makes a small incision where the needle will go in and uses the ultrasound device to guide the needle into your kidney.
- You may be asked to hold your breath as your doctor collects a sample using a spring-loaded instrument. You may feel a “pop” or pressure and hear a sharp clicking noise.
- Your doctor may need to insert the needle several times — often through the same incision — to get enough tissue.
- Your doctor removes the needle and places a small bandage on the incision.
Other kidney biopsy procedures
Percutaneous kidney biopsy isn’t an option for some people. If you have a history of bleeding problems, have a blood-clotting disorder or have only one kidney, your doctor may consider a laparoscopic biopsy.
In this procedure, your doctor makes a small incision and inserts a thin, lighted tube with a video camera at its tip (laparoscope). This tool allows the doctor to view your kidney on a video screen and remove tissue samples.
After the procedure
After the biopsy, you can expect to:
- Spend time in a recovery room where your blood pressure, pulse and breathing will be monitored.
- Have urinalysis and complete blood count tests done to check for bleeding and other complications.
- Rest quietly for around four to six hours.
- Receive written instructions about your recovery.
- Feel some soreness or pain at the biopsy site for a few hours. You’ll be given medications to relieve pain.
Most people can leave the hospital the same day, about 12 to 24 hours after the procedure. Once home, your doctor will probably recommend that you rest for another day or two. Your health care team will let you know about any activity restrictions, such as avoiding heavy lifting and strenuous exercise.
Your kidney tissue goes to a lab to be examined by a doctor who specializes in diagnosing disease (pathologist). The pathologist uses microscopes and dyes to look for unusual deposits, scarring, infection or other abnormalities in the kidney tissue.
Results
It may take up to a week before your doctor has your biopsy report from the pathology lab. In urgent situations, a full or partial report may be available in less than 24 hours.
Your doctor will usually discuss the results with you at a follow-up visit. The results may further explain what’s causing your kidney problem, or they may be used to plan or change your treatment.