Kidney Biopsy, Here's What You Should Know

A kidney biopsy is a procedure to take a sample of kidney tissue. This procedure can be performed for various purposes, such as detecting problems with the kidneys, checking the condition of the kidneys, and monitoring the effectiveness of treatment for kidney disease.

Kidneys are a pair of organs that have an important function to filter and remove waste substances, minerals, fluids, and toxins from the body through urine (urine).

When there is a problem with the kidneys, various complications can arise, ranging from the buildup of waste in the body to damage to the central nervous system. In order to find out the cause of kidney disorders as well as determine the right treatment, one of them can be done with a kidney biopsy.

A kidney biopsy is a procedure for taking a sample of kidney tissue for later analysis under a microscope. Through this tissue sample, doctors can determine the condition of the patient's kidneys. In addition to diagnostic purposes, a kidney biopsy can also be used to evaluate treatment for the kidney.

Types of Kidney Biopsy

Kidney biopsy can be done by three methods, namely percutaneous biopsy, open biopsy, or laparoscopic biopsy. The method used will be adjusted to the patient's condition and the patient's own decision.

The following are kidney biopsy methods and their explanations:

Percutaneous biopsy

This method is the most frequently used method for sampling kidney tissue. A percutaneous biopsy is performed by inserting a needle through the surface of the skin over the kidney. In the process, an ultrasound or CT scan is used to help the doctor direct the needle to a specific area of the kidney.

Open biopsy

This method is usually the choice for patients who have failed to perform a percutaneous biopsy or who require more tissue samples. An open biopsy is performed by making an incision in the skin so that the kidney can be accessed directly for tissue collection.

Biopsy by laparoscopy

A laparoscopic biopsy is performed by making a small incision in the skin near the kidney area. Through this incision, the doctor will insert a laparoscope, which is a small tube-shaped instrument with a camera.

This biopsy may be an option for patients who have a blood clotting disorder or have only one functioning kidney.

Indications for Kidney Biopsy

A kidney biopsy is generally used to diagnose nephrotic syndrome, acute nephritic syndrome, or acute kidney failure of unknown cause. However, a kidney biopsy can also be done in someone who has the following conditions:

Have hematuria or bloody urine
Have albuminuria or proteinuria, which is a condition when it is known that there is excessive protein in the urine
Having problems with kidney function, which causes a buildup of waste substances in the blood
Have had a kidney transplant that didn't work well

Some of the purposes of doing a kidney biopsy are:

Diagnosing diseases or conditions involving the kidneys, and those that cannot be identified by blood or urine tests
Planning treatment for diseases or conditions involving the kidneys
Determining the stage or progression of kidney disease
Monitoring the effectiveness of treatment for kidney disease
Monitor follow-up conditions after a kidney transplant or find out why the transplanted kidney is not working properly

Kidney Biopsy Warning

Kidney biopsy should be done as indicated or according to the doctor's consideration and advice. To undergo a kidney biopsy, the patient must provide complete information about his health condition so that the risk of complications can be reduced. The patient also needs to undergo several examinations before the biopsy is performed.

Kidney biopsy may be postponed or even canceled if the doctor's judgment or examination finds the following conditions:

Immune system disorders, multiple sclerosis, or other conditions that can make bleeding difficult to control
Severe hypertension, which cannot be controlled with antihypertensive drugs
Kidney infection
Skin infection in the area of the biopsy
Polycystic kidney disease (PKD)

In addition to the above conditions, doctors also do not recommend a kidney biopsy in patients who have end-stage chronic kidney disease, have only one functioning kidney, have kidney deformities, or suffer from kidney swelling due to a buildup of urine (hydronephrosis).

During a kidney biopsy procedure, the doctor may perform some additional procedures, such as a blood transfusion or surgery to repair damaged blood vessels. However, this rarely happens.

Before Kidney Biopsy

Before undergoing a kidney biopsy, the doctor will ask the patient a number of questions regarding the complaints they have, the history of the disease they have suffered, the drugs used, as well as a history of allergies to anesthetics, latex, or other drugs.

If the patient is taking a blood thinner, such as aspirin, the doctor will ask the patient to stop taking the drug.

After that, the doctor will perform a physical examination to make sure the patient is in good health. The doctor will also perform blood tests or urine tests to make sure the patient is not suffering from an infection or other condition that can increase the risk of complications.

Although pregnancy is not a contraindication, patients who are pregnant still need to inform the doctor, so that the doctor can further consider whether the condition of the mother and fetus is safe to undergo a kidney biopsy.

For patients who undergo kidney biopsy by open biopsy or laparoscopic method, the doctor will ask the patient to fast for 8 hours before the procedure. In addition, if the patient feels afraid during the procedure, the doctor can give a sedative.

Kidney Biopsy Procedure

Each kidney biopsy method has different stages of the procedure. The full explanation is as follows:

Percutaneous biopsy procedure

In a percutaneous biopsy, kidney tissue is removed using a needle that is inserted through the skin closest to the kidney. To direct the needle, the doctor will use the help of ultrasound or CT scan.

The following are the steps that kidney doctors perform in the percutaneous biopsy method:

The doctor will identify the area where the needle will be inserted with the help of an ultrasound or CT scan.
The doctor will clean a predetermined area of skin, then give a local anesthetic so that the patient does not feel pain when the needle is inserted.
The doctor will make a small incision on the surface of the skin for the needle to enter.
Once the needle is inserted, the patient will be asked to take a deep breath so the doctor can take a tissue sample.
The doctor may insert the needle several times until the sample of kidney tissue needed is sufficient.
Once a tissue sample is obtained, the doctor will remove the needle and apply pressure to the area to stop the bleeding.
The doctor will put a bandage on the biopsy area.

Open biopsy procedure

An open biopsy is performed by making a large incision in the skin near the kidney. This procedure requires general anesthesia (general anesthesia), so the patient will fall asleep and feel no pain during the procedure.

After the anesthetic has worked, the doctor will perform an open biopsy with the following steps:

The doctor will make an incision to directly access the kidney.
After the kidney is seen, the doctor will determine which part of the kidney to take a tissue sample.
The doctor will take the sample, then insert it into a small tube.
After the sample is taken, the doctor will close the incision with stitches.

Laparoscopic biopsy procedure

A laparoscopic biopsy is done using a special instrument in the form of a camera tube called a laparoscope. The doctor will make a small incision in the skin to provide access for the device. Like an open biopsy, a laparoscopic biopsy also requires general anesthesia (general anesthesia).

The following are the steps for a laparoscopic biopsy:

The doctor will make a small incision in the abdomen or back area to insert the laparoscope.
After the laparoscope is in, the doctor will deliver gas so that the abdominal cavity bulges, so that the kidneys are seen more clearly through the monitor.
The doctor will insert a cutting tool to take a tissue sample.
After the sample of kidney tissue is taken, the doctor will remove the laparoscope and cutting tools, then remove the gas.
After the biopsy equipment and gas are removed, the doctor will close the incision with stitches.

After Kidney Biopsy

After undergoing a kidney biopsy procedure, the patient will be taken to the treatment room to rest and reduce the anesthetic effect, approximately for 4-6 hours. The doctor will monitor the patient's blood pressure, pulse, temperature, and breathing.

Generally, patients can be allowed to go home on the same day. However, the patient must first undergo a urine test and a blood test to confirm the presence or absence of bleeding or other complications.

After the biopsy, the patient's urine will usually contain a small amount of blood. This is normal. However, if the bleeding is too much, the patient needs to immediately notify the doctor so that treatment can be given as soon as possible.

Even after being allowed to go home, the patient still needs to rest for 1-2 days. Patients are also advised not to do strenuous activities, such as lifting heavy weights, for at least 2 weeks after surgery.

Risks of Kidney Biopsy

A kidney biopsy is generally safe to do. However, this does not mean that this procedure has no risks at all. The following are some of the risks that can occur after undergoing a kidney biopsy:

Bleeding, redness, and swelling at the biopsy area
Infection in the biopsy area
Bloody pee
Pain in the area of the biopsy
Arteriovenous fistula, which is the formation of an abnormal connection between two blood vessels that can occur as a result of injury from the biopsy needle
Hematoma

Call your doctor right away if you experience any of the following symptoms after a kidney biopsy: