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

Consent is obtained jointly by the referring nephrologist and the practitioner (usually a radiologist) performing the biopsy.  We therefore use a dedicated consent form (download pdf here).  The top part is completed by the nephrologist; the bottom part by the radiologist.  This should be attached to the front of the case-notes next to the pathology form so that it is easily accessible to the radiologist performing the biopsy.

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.