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Investigations

Biopsy of the kidney

This procedure is used to ascertain the nature and severity of renal disease, so that the prognosis and need for treatment may be assessed. The needle is guided by ultrasound into the renal pole. The acquired tissue is examined by microscopy and/or immunohistology.

Any pain associated with the procedure should usually be mild. There may be some bleeding around the kidney or into the urine, which in a small (<5%) proportion of patients can be severe and require observation, arteriography, and very rarely operation. For this reason 6-8h of observation post-procedure is essential and many centres require overnight admission.


Indications

  • Unexplained acute renal failure (ARF)
  • Chronic renal failure (CRF) with normal sized kidneys
  • Nephrotic syndrome or heavy proteinuria in adults
  • Nephrotic syndrome in children that is atypical or unresponsive to steriod therapy
  • Haematuria with signs of renal disease

Contraindications

  • Coagulation disorder or thrombocytopaenia
  • Uncontrolled hypertension
  • Kidneys smaller than 60% of predicted size
  • Solitary kidney

All of these are relative contraindications that should be balanced with possible benefits from the information that may be obtained.