Kidney biopsy

Description:

Kidney biopsy — an intravital morphological research of renal fabric by means of a transdermal puncture (the closed biopsy) or an operational method (an open, half-open biopsy). The biopsy of a kidney has to be made only in specialized nephrology units according to strict indications.

Indications to a kidney biopsy:

- acute or chronic pathologies of body of not clear etiology;
- difficult infectious diseases of urinary tract;
- quickly developing glomerulonephritis;
- detection in urine of blood or protein;
- detection in blood of the increased amount of nitrogenous slags (uric acid, urea, creatinine);
- specification of various morbid conditions of the kidneys revealed at ultrasonography, KT;
- suspicion on oncology of a kidney or a nephrotic syndrome;
- unstable work of the replaced kidney;
- establishment of severity of this or that disease, damages;
- control over efficiency of the appointed therapeutic treatment.

Contraindications to a kidney biopsy:

Absolute contraindications:
- at the patient only one kidney functions;
- coagulability of blood is broken;
- there is an allergy to novocaine;
- the kidney tumor is revealed;
- the hydronephrosis, thrombosis of renal veins or a cavernous nephrophthisis is diagnosed;
- aneurism of a renal artery.

Carry the following states to relative contraindications:
- a diastolic hypertension in a severe form (from 110 mm of mercury.);
- last stages of the general atherosclerosis;
- the expressed renal failure;
- myeloma;
- the periarteritis is nodular;
- pathological mobility of a kidney;
- nephroptosis.

How to be prepared for a kidney biopsy:

Medical preparation.

The doctor appoints blood tests and urine for detection of infections. Studies the medical record regarding contraindications.
It acquaints the patient with the reasons of purpose of a biopsy of a kidney, with advantages of a method and possible risks.
Besides, the doctor allows the patient to sign consent to the procedure and explains how to be prepared for it.

What does the patient have to make?
To find out all disputed issues, answers to the interesting questions from the doctor.
To tell the doctor about the state of health, existence of various diseases, pregnancy, an allergy, hypersensitivity to certain drugs, about the medicine taken at present.
In one-two weeks prior to a biopsy to stop reception of the means liquefying blood (aspirin, a dabigatran, a rivaroksaban, etc.).
In a week to stop reception of the anesthetizing drugs as they influence coagulability of blood.
Not to eat within eight hours before the procedure. Just before a biopsy not to drink.

Technology of carrying out biopsy of a kidney:

Data about "a condition of coagulant system of blood (a koagulogramm, a bleeding time, number of thrombocytes), and also about total and separate functional capacity of kidneys, their arrangement and mobility are necessary for carrying out a biopsy (intravenous urography in a prone position and standing, a radio isotope renografiya, an ekhografiya). Blood typing and a Rhesus factor is obligatory. At a heavy hypertensive syndrome will be applied the managed hypotonia in the period of a biopsy and during 1-3 days after a puncture.

For definition of the place and depth of a biopsy calculation Urogramums on Kark and a two-dimensional ekhografiya is used. Search of a kidney is carried out under local layer-by-layer anesthesia of 50-70 ml of 0,25% of solution of novocaine. Emergence of indirect signs (the pendulum, connected with breath movements of a search needle, feeling of a puncture of the renal capsule, bleeding from a needle) demonstrates detection of a kidney. At the time of a biopsy of the patient ask to hold breath.

For prevention of complications of the patient during 3 h lies on a bubble with ice, during the subsequent 2 days the high bed rest remains, appoint hemostatics (Vikasolum, calcium chloride) and anti-staphylococcal antibiotics.

Efficiency of a biopsy increases when using an ekhografiya, especially at use of a method of sectoral scanning with control of search of a kidney a needle by means of the display. Immediate direct vision behind quality of a bioptat (existence of balls) by means of a magnifying glass is extremely important. Bioptat containing 8-10 balls, the quantity necessary for the morphological conclusion can be received at the closed biopsy in 90% of cases.

Complications after a kidney biopsy:

The bleeding in a renal pelvis, uric ways which is shown a microhematuria is observed in half of cases, the gross hematuria develops less often. The last can proceed asymptomatically, quite often is followed by renal colic. The long gross hematuria (more than 3 days) is usually caused by a kidney heart attack. Massive bleeding under the capsule, in perinephric cellulose with formation of a perirenal hematoma is observed in 0,5-1,3% of cases, clinically shown by megalgias in a waist, decrease in the ABP and hemoglobin of blood, at a rassasyvaniye is followed by fever. This complication comes to light at an ekhografiya and intravenous urography ("smazannost" of contours of m.psoas, lack of a smeshchayemost of a kidney at breath). The perirenal hematoma (even massive) seldom demands surgical intervention. The rupture of its lower pole, a purulent paranephritis, formation of an arteriovenous intra renal fistula, damage of other bodies belong to rare complications of a biopsy of a kidney (a liver, a spleen, a duodenum, a pancreas, a pleura and lungs, ureters, the lower vena cava).

The lethality at a biopsy makes 0,05-0,17%.

Types of a biopsy of a kidney:

Distinguish the following types of a biopsy:
1. Chrezkozhny (the needle under control of devices is entered through skin).
2. Opened (renal fabric undertakes directly during operation; for example, at an oncotomy; the open biopsy is carried out when only one kidney works for the patient or there are problems of bleedings).
3. Uretroskopiya with a biopsy (it is shown if in a renal pelvis or an ureter there are stones, there are anomalies or diseases of upper uric ways, there is a transplantirovanny kidney; the method is recommended for children and pregnant women).
4. A transjugular biopsy (in one of renal veins start a catheter; the method is recommended to patients with disturbances of coagulability of blood, with obesity, chronic respiratory insufficiency, congenital anomalies of kidneys).

After a kidney biopsy:

First, to the patient not less than six hours will suggest to have a rest in a bed.
Secondly, several times to it read pulse and blood pressure, will check presence of blood at urine.
Thirdly, it will be necessary to drink a lot of liquid.
Fourthly, within forty eight hours to avoid physical exercises and loadings. For two weeks – heavy lifting and intense activity.
In process of weakening of anesthesia the patient can feel a dorsodynia which is removed soft anesthetic. This day or on following (if everything is good) the person goes home.
After the procedure blood in urine is possible the first twenty four hours. When bleeding lasts longer, it is necessary to see a doctor urgently. Other indications for the request for medical care:
feverish state;
not stopping or severe pain in kidneys;
inability to an urination;
dizziness;
general weakness.
Kidneys of ways of diagnosis alternative to biopsy do not exist. Any of methods does not give such exact data.