RENAL BIOPSY – Indications, Types, Site and Position, Contraindications, Investigations, General Instructions, Preliminary Assessment, Preparation of the Patient and Environment, Equipment, Procedures, Post-procedure Care and Complications
Renal biopsy means removal a bit of the renal tissue percutaneously for histological examination.
INDICATIONS
Renal biopsy is done in the following conditions:
- Asymptomatic proteinuria
- Chronic renal failure, where there is no obvious case
- Acute renal failure, where there is no obvious cause
- Acute nephritis with persisting oliguria
- Nephritic syndrome in adults
Follow-up cases of glomerulonephritis
TYPES OF RENAL BIOPSY
- Open biopsy: it requires surgical procedures and is costly
- Closed biopsy: it is the retrograde renal and ureteral brush
SITE AND POSITION
Site: the side where the disease is suspected is the site of the biopsy
Position: patient is placed in a prone position with a firm pillow under the abdomen
CONDRAINDICATIONS
- Uncooperative patient
- Pregnancy
- Previous history of renal failure
- Coagulation disorders
- Single functioning kidney
- Malignant tumors
- Infections – perinephric abscess, pyonephrosis,
- Severe hypertension
INVESTIGATIONS
Investigations to be done are:
- Bleeding, clotting and prothrombin time
- Blood grouping and cross-matching
- Blood urea
- Renal function tests, e.g. urine culture, urine analysis, serum creatinine, etc
- IVP or plain X-ray abdomen determine the size of the kidneys
GENERAL INSTRUCTIONS
- Maintain aseptic technique throughout the procedure to avoid entry of infection
- Before renal biopsy, the patient should be investigated thoroughly. Prepare the part thoroughly
- Patient should be advised to take complete bed rest after the procedure
- Keep the patient nil by mouth for 4 hours
- Keep the patient in supine position for the next 24 hours
- Encourage the patient to take plenty of oral fluids post-operatively to avoid clot formation
- The biopsy is taken after the one week of menstruation, because during these days the cervix is least vascular
PRELIMINARY ASSESSMENT
Check
- Doctor’s order for any specific instructions
- Written informed consent of the patients or the relatives
- General condition and diagnosis of the patient
- Mental status of the patient to follow instructions
- Articles available in the unit
PREPARATION OF THE PATIENT AND ENVIRONMENT
- Admit the patient, at least 24 hours prior to renal biopsy and he should remain in the hospital, at least 24 hours after the biopsy
- Renal function tests must be carried out, e.g. routine urine analysis, blood urea, serum creatinine, etc
- Explain the procedure to the patient and his relatives thoroughly so that their fear and tension are relieved
- Get written consent from the patient or his relatives
- Observe vital signs and record the fact on the nurse’s record
- Give premedications according to physician’s order half an hour prior to the procedure and record it
EQUIPMENT
A sterile tray containing:
- Sponge holder
- A 5 ml syringe with needle for local anesthesia
- Probe needle
- Specimen bottles with formalin 10%
- Gall pot with cleaning lotion
- Dressing towel
- Dissecting forceps
- Dressing material
- Gown, mask, gloves
- Cytoscope
An unsterile tray containing:
- Spirit, iodine, Tr. Benzoin
- Lignocaine 2%
- Mackintosh and draw sheet
- Kidney tray
- Adhesive tape and scissors
PROCEDURES
- The patient is placed in a prone position with a firm pillow under the abdomen
- The patient is instructed to take in as deep a breath as positioned inside the renal capsule
- The probe needle is inserted through the skin and positioned inside the renal capsule
- After confirming its position, take a biopsy
- When enough tissues are obtained the needle is removed and firm pressure is applied
- The pressure site sealed with a tincture benzoin seal
POST-PROCEDURE CARE
- Observe pulse, respiration and blood pressure every half hourly for first few hours and then one hourly for first 24 hours
- Keep the patient nil by mouth for 4 hours
- Give complete bed rest and encourage taking plenty of oral fluids to prevent clot formation in the kidney
- Provide complete bed rest and encourage him to take oral fluids to prevent clot formation in the kidney
- Sent the specimen to the histopathological lab with proper labeling and a requisition form
- If there is pain, analgesics may be given with physicians order
COMPLICATIONS
- Hematuria
- Infections causing renal abscess
- Injury to ileo-inguinal nerves which causes intense pain
- Pre-renal hematoma, causing dull pain and swelling in the loin
- It is the removal of a small piece of tissue from the cervix for the histopathological examination
