Kidney Biopsy: When and Why Doctors Recommend One

What Is A Kidney Biopsy?

A kidney biopsy involves removing one or more tiny pieces of kidney tissue. A pathologist then examines the tissue under a microscope to look for signs of disease or damage. There are different kinds of kidney biopsies; a few of the most commonly used ones are the following:

• Percutaneous biopsy: A needle passes through the skin into the kidney. This is the most common approach.
• Ultrasound-guided biopsy: Ultrasound helps the doctor guide the needle to the kidney.
• CT-guided biopsy: CT imaging is used when ultrasound guidance is unsuitable.
• Transjugular biopsy: The kidney is reached through a vein. It is considered safer in selected patients with higher bleeding risk.

Kidney Biopsy Indications: When Is It Recommended?

Doctors do not recommend a biopsy for everyone with abnormal kidney test results. The decision depends on the suspected disease and whether the result could change treatment. Common kidney biopsy indications include:

• Persistent protein in urine: A biopsy identifies the kidney disease causing significant or unexplained protein loss.
• Blood in urine: Persistent blood in urine requires tissue examination when a kidney disorder is suspected.
• Unexplained kidney dysfunction: A biopsy helps to investigate a sudden or progressive decline in kidney function.
• Rapidly progressive kidney disease: A biopsy helps to figure out the diseases causing rapid loss of kidney function.
• Kidney disease linked to systemic conditions: Diseases affecting several organs can also damage the kidneys.

When May A Kidney Biopsy Be Delayed Or Avoided?

A kidney biopsy is avoided if the patient has the following symptoms:

• Uncontrolled blood pressure: High blood pressure can increase bleeding risk.
• Bleeding or clotting problems: Abnormal clotting needs assessment and correction before biopsy.
• Blood-thinning medicines: Medicines such as anticoagulants and some antiplatelet drugs may need review.
• Small or shrunken kidneys: A biopsy provides limited useful tissue and carries additional concerns.
• Certain kidney infections: Active infection needs treatment first.

What Do Indian Kidney Biopsy Studies Show?

Indian studies show that the diseases found on biopsy vary between patient groups and regions.

A two-centre study from Central India analysed 800 kidney biopsies. Glomerular disorders accounted for 90.5% of cases. Lupus nephritis was the most common diagnosis at 17.4%, followed by membranous nephropathy at 15.5%, minimal change disease at 13.7% and IgA nephropathy at 13.2% [3].

An earlier South Indian study of 1,849 biopsies found nephrotic syndrome was the most common reason for biopsy, accounting for 49% of cases. Chronic renal failure accounted for 13.6%, while rapidly progressive renal failure accounted for 12% [4].

Kidney Biopsy Procedure: How Is It Performed?

The usual kidney biopsy procedure is a percutaneous (passed or performed through the skin) biopsy performed with imaging guidance.

Before the Procedure

The doctor reviews your medicines, blood pressure, kidney function, and blood-clotting tests. Tell the medical team if you take blood thinners, aspirin, or other medicines that can affect bleeding. Do not stop any prescribed medicine without medical advice.

Here are a few checks and precautions tabulated below that can help reduce risks and ensure the procedure is performed safely.

During the Procedure

You usually lie on your stomach for a native kidney biopsy. The skin over the kidney is cleaned, and local anaesthetic is given to numb the area. Ultrasound is commonly used to locate the kidney and guide the needle. The doctor then passes a biopsy needle through the skin to collect small tissue samples. The procedure itself is usually completed within a short period, but preparation and observation take additional time.

After the Procedure

You are monitored for several hours. The team checks your blood pressure, pulse, and urine for signs of bleeding. Some patients can go home after observation. Others may need overnight monitoring based on their medical condition and bleeding risk.

Is a kidney biopsy painful?

A local anaesthetic is used to numb the biopsy area. You may feel a brief sting from the anaesthetic, followed by pressure when the biopsy needle is used.

Mild soreness can occur afterwards and usually improves over the next few days.

How Long Does It Take To Get Kidney Biopsy Results?

Routine kidney biopsy results take several days (often takes 7 to 10 days). Some cases requiring additional laboratory tests extend the reporting time. In urgent situations, a preliminary report is often made for the initial treatment.

What Are The Risks Of A Kidney Biopsy?

Bleeding is the main risk because the kidneys receive a high blood supply. A systematic review and meta-analysis of 118,064 native kidney biopsies estimated:

• Pain: 3%
• Haematoma: 11%
• Visible blood in urine: 5%
• Blood transfusion: 6%
• Intervention to control bleeding: 3%
• Death attributed to biopsy: 06% [6]

When Should You Contact A Doctor After A Kidney Biopsy?

Seek medical attention if you develop:

• Heavy or persistent blood in the urine
• Blood clots in the urine
• Increasing or severe pain
• Fever (over 100 degree celsius)
• Dizziness or fainting
• Difficulty passing urine
• Increasing swelling, redness, or bleeding at the biopsy site

Kidney Biopsy at Eskag Sanjeevani Hospitals

If you are searching for the best nephrologist in Kolkata, consider Eskag Sanjeevani’s expert nephrology team, their clinical experience and access to relevant diagnostic and hospital services. Eskag Sanjeevani Hospitals has a dedicated nephrology department with nephrologists practising across its Baghbazar, Baranagar and Khardah hospitals.

You can also review the hospital’s nephrology services and doctor directory before scheduling a consultation.