RENAL BIOPSY

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

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