Renal biopsy

Patients are admitted on day of procedure, or earlier if less fit. Must be arranged in advance via ultradound sec or by discussin with radiologist who has a list. If deemed suitable for day care, can be assessed by Clinical Nurse Practitioner. If admitted to general wards to be assessed by medical staff.

Pre-procedure  
  • aspirin/clopidogrel stop 1 week in advance; other NSAIDs omitted on the day
  • warfarin stop AT LEAST 2 days in advance if indication permits.  Some patients will need iv heparin until day of biopsy
  • all medications including anti-hypertensives and anti-anginals to continue (usually patients’ own supply)
  • pathology request form must be filled in by renal team and attached to front of notes. Do same with consent form if obtained in advance
  • Fluids only for 2 hours prior to procedure but no need to fast
Investigations and observations

Ensure no major change in condition or therapy (seek advice if there is)

  • BP should be <160/90

Recent results for the following must be available:

  • FBC (Hb must be > 80 g/l, Pts > 100×1012/l)
  • coag screen ( PT and APTT must be within 3 seconds of control value)
  • Group and save
  • U & E in patients on dialysis, or if uraemic
  • if any values are outwith these ranges the Registrar and the radiologist should be informed
Consent

May be obtained in OPD. Should be attached to front of notes, with pathology request form. Inform of small risk of bleeding, very small risk of requiring intervention (including  surgery). See patient info.

Edinburgh: Consent form should be attached to front of notes, with pathology request form
Post-procedure
  • bed rest 6hrs: first 2h lying flat
  • pulse and BP:
    • half-hourly for 2 hours
    • then hourly for 2 hours
    • at 6h, then 6-hourly to 24h if still an in-patient
  • advise patient to drink plenty
  • pain relief: paracetamol is adequate in most instances
  • assess and document:
    • biopsy site
    • presence/absence of haematuria (macroscopically  only)
    • dialysis or uraemic patients: check [K] the following day
  • Aspirin and warfarin can be restarted the following day if uncomplicated
  • Discuss reintroduction of heparin if patient at high risk of thrombosis
Discharge

At the agreed time if all the above satisfactory. Minimum is 6h if suitable for day-case biopsy, see below. In all cases:

  • patient must have passed urine
  • 6h or final BP must have been recorded
  • patient must have been given a number to call if problems (renal ward or doctor)
  • results usually given at an outpatient appointment in the near future
  • returning to work and other activities: a day or two off work is usually enough. Heavy manual activities should be avoided for a few days. No other special precautions are required.
Day case biopsies

These are suitable if the following conditions can be met:

Inclusion criteria: Low risk
Suitable responsible person at home
Can arrange own transport for evening discharge
Exclusion criteria: Anticoagulation
Creatinine >250 micromol/l
Serious comorbid disease

Diabetes mellitus does not automatically exclude day case biopsy as there is no requirement to fast.
Patients must have an appropriately early biopsy.

Urgent biopsies – warn renal pathologist

Out of hours procedures – contact the consultant pathologist first

Further information 

Patient information explaining renal biopsy is available from EdRenINFO

Acknowledgements:   Angela Webster and Paul Allan were the main authors for this page. It was later reviewed by Anne Petherick. The last modified date is shown in the footer.

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