The informativity of many diagnostic methods is still far from perfect, therefore in some cases the doctor has to take a puncture. A biopsy is a fence of a small area of the kidney using surgical instruments. The resulting sample is immediately sent for a thorough microscopic and histological examination.
Renal biopsy - indications and contraindications
The described technology helps the doctor to clarify the expected diagnosis, find out the severity and causes of the detected pathology and develop an effective therapy plan. In addition, it is used to differentiate diseases. A kidney biopsy with glomerulonephritis ensures its differentiation with other organ damage:
- amyloidosis ;
- Berger's disease;
- pyelonephritis;
- diabetic nephropathy ;
- interstitial, hereditary or chronic nephritis.
What kind of kidney disease is a biopsy?
Internal tissue intake is not performed at the patient's request, only an expert can recommend it only if there are good reasons for the procedure. Renal biopsy: readings:
- organic glomerular or tubular proteinuria;
- bilateral hematuria;
- nephrotic syndrome;
- renal failure, glomerulonephritis with rapid progression;
- tubulopathy of unexplained origin;
- suspected neoplasm;
- incorrect functioning of the transplanted organ.
Therapeutic kidney biopsy is performed for the following purposes:
- selection of adequate treatment;
- control the effectiveness of the selected course;
- monitoring the condition of the transplant.
Kidney biopsy - contraindications
There are diseases and pathological conditions in which this manipulation can not be performed:
- intolerance of novocaine-containing drugs;
- only one kidney works;
- impaired blood clotting;
- hydronephrosis;
- aneurysm of the renal artery;
- right ventricular failure;
- cavernous tuberculosis;
- thrombosis of the renal veins;
- purulent perinephritis;
- tumor;
- psychosis;
- dementia;
- stay in a coma.
In some cases, puncture biopsy of the kidneys is permissible, but should be performed with extreme caution:
- renal insufficiency in the severe stage;
- nodular periarteritis;
- diastolic hypertension with indices above 110 mm Hg;
- myeloma;
- marked degree of atherosclerosis;
- atypical mobility of the organ;
- Nephroptosis.
Kidney biopsy - pros and cons
The procedure under consideration is associated with dangerous complications, so the question of its expediency is decided by a qualified doctor. Puncture can provide the maximum amount of information about the causes, nature of the course and severity of the disease, helps to establish an accurate and error-free diagnosis. At the same time, it is capable of provoking negative consequences, especially if made in the presence of contraindications.
Separately, nephrologists discuss a biopsy of the kidney tumor. The presence of tumors in this organ is also diagnosed in other ways without the need for a puncture. Almost all the found out growths are subject to removal, which provides maximum access to the tissues of the kidney, and to the tumor itself. In this regard, specialists very rarely prescribe the described invasive manipulation for the study of neoplasms.
Is it painful to do a kidney biopsy?
The presented process is carried out under the action of local anesthetic (less often - sedation or general anesthesia). Even knowing about anesthesia, some patients continue to find out how unpleasant the kidney biopsy is - whether it's painful or not directly during and after the session. If the procedure is performed by an experienced specialist, it causes only mild discomfort. Proper use of anesthetic ensures minimal trauma.
Why is kidney biopsy dangerous?
A common complication (in 20-30% of patients) of manipulation is mild bleeding, which stops on its own within 2 days. Sometimes kidney biopsy is more difficult - the consequences can be manifested as follows:
- pneumothorax ;
- infection of muscle tissue;
- damage to adjacent internal organs;
- intensive hemorrhage;
- renal colic;
- fever;
- infarction of the organ;
- severe pain;
- rupture of the lower pole of the kidney;
- the appearance of perirenal hematoma;
- lowering blood pressure;
- suppurative paranephritis;
- formation of internal arteriovenous fistula.
Very rarely (less than 0.2% of cases) the kidney biopsy ends pitifully. The most dangerous complications of the procedure:
- cessation of the functioning of the body;
- need for nephrectomy;
- death.
What can replace a kidney biopsy?
Full-fledged, but less invasive and traumatic, analogs of the described technology studies have not yet been invented. Kidney biopsy as a diagnostic method is characterized by maximum informativeness and accuracy. Other ways to identify pathologies of the urinary system are not so reliable and can give false results. As an alternative to this manipulation, ultrasound is often used, but in advanced clinics, kidney biopsy is replaced by more modern technologies:
- computed tomography;
- intravenous urography ;
- radioisotope renography;
- veno- and arteriography;
- angiography;
- panoramic radiography with contrast.
How is a kidney biopsy done?
The classical variant of puncture is carried out in a closed way. Using the ultrasound or X-ray apparatus, the location of the kidney is displayed. According to him, the doctor introduces a special needle directly above the organ under examination, penetrating through the previously anesthetized skin and muscle tissue. Having reached the goal, the puncture device makes an automatic sampling. Sometimes, for a correct study, you need a lot of biological material, and you have to inject the needle several times (through one hole).
There are other methods, like a kidney biopsy:
- Open. Tissue samples and their subsequent analysis are made during surgery under general anesthesia.
- With access through the jugular vein. This technique is preferable for patients with impaired blood coagulation, respiratory failure, or congenital anomalies of the kidney structure.
- Urethroscopy with puncture. The method is prescribed in the presence of stones in the pelvis and ureter, transplanted organs, is recommended for pregnant women and children.
What causes the temperature after a kidney biopsy?
Feverish state or minor changes in thermoregulation are often observed after several hours or days from the puncture. Heat after a kidney biopsy may occur for the following reasons:
- inflammatory processes in the tissues of the organ or muscles;
- infection of the skin at the puncture site;
- purulent pathologies;
- damage to nearby structures.
A typical problem associated with kidney biopsy is intensive and profuse internal bleeding into the paranephric fiber and under the organ capsule (perirenal hematoma). When the consequences of this pathology disappear, and the accumulation of the curdled biological fluid dissolves, fever may occur. You should not try to find out its causes on your own, it's better to immediately get on an internal admission to the nephrologist.
Hematoma after a kidney biopsy
The described complication of the procedure is rare, it accounts for less than 1.5% of cases. The likelihood of an internal massive hemorrhage and the formation of a large hematoma depends on how well the kidney biopsy was performed correctly-how this manipulation is performed (the choice of method), whether preliminary anesthesia and antiseptic treatment were well conducted.
Periorenal hematoma does not refer to dangerous side effects of diagnosis and does not require surgical intervention, but is always accompanied by an increase in body temperature and additional unpleasant symptoms:
- lowering blood pressure;
- cutting, severe pain in the lower back;
- the appearance of blood in the urine or a change in its color to pink, reddish;
- reduction of hemoglobin concentration in blood tests;
- weakness, drowsiness;
- lack of appetite;
- disturbances of urination.