Percutaneous Renal Biopsy

UROLOGY DIVISION

SURGERY DEPARTMENT,LASUTH.

Outline

• Introduction/Definition

• Indications

• Contraindications

• Pre procedural preparation

• Equipment

• Technique

• Post operative care

• Complication

Introduction/Definition• Renal biopsy is a procedure used to obtain segment

of renal tissue, usually through a needle or another

surgical instrument.

• This is done utilizing either ultrasound scan or the CT scan.

• This allows for an accurate, reliable method of

acquiring renal tissue for histopathological

assessment.

Introduction cont’d• Biopsy maybe of a native or transplanted kidney

and its divided into 2 types.

Non-focal or non-targeted

Focal or targeted

• Either type can be performed as a CT guided

biopsy or an Ultrasound guided biopsy.

• 3D cone beam CT for challenging focal lesions.

• Both patients’ and surgeons’ factors are considered.

• Transplant renal biopsy is usually undertaken with

ultrasound guidance.

• Alternative option for percutaneous CT/USS guidance

is the trans-jugular renal biopsy.

Indications• focal lesion non-characterised on diagnostic imaging

• renal failure with unknown cause (typically a

nephropathy)

• deteriorating renal function in transplant patient

• Acute nephritic syndrome

• Nephrotic syndrome

• Isolated glomerular hematuria

For focal mass lesions the established indications

include:

• known extra-renal malignancy

• suspected renal renal lymphoma

• prior to ablation therapy

• multiple or bilateral renal masses

• diagnostic dilemma of infection/malignant mass

Contraindication

The contraindications should be individualized in each

case

Absolute

• Uncontrolled bleeding diathesis

• Uncontrolled severe hypertension

• Active renal or peri-renal infection

• Skin infection at biopsy site

Relative Contraindications

• Uncooperative patient

• Anatomic abnormalities of the kidney

• Small kidney

• Solitary kidney

Pre-procedure preparations

• Assessment of patient’s cooperation

• Informed consent

• Laboratory parameters

coagulation studies (INR ≤ 1.5 )

Platelet

Equipments

• Single or co-axial needle set

• 1% lidocaine

• Midazolam

Technique

• Focal biopsy usually require a single core

• Non-focal biopsies typically requires two cores

• For native and transplanted non-focal kidney

biopsies, the core is usually taken from the

lower pole

• Both Ultrasound and CT biopsies are

performed with the patient prone or

occasionally ipsilateral side up position in the

pelvis

• Preliminary USS or single shot CT is done to

locate and map the kidney

• The skin is prepared and draped and the mapped

area infiltrated up to the capsule of the kidney.

• The specimen is taken with the needle directed

vertically.

• CT guidance is preferred for those with large

body habitus.

• After the procedure, a brief assessment for

perinephric or intra-parenchyma hemorrhage is

done.

Postoperative Care

• Bed rest is advised as well as regular observation

for 4-6hrs.

• Early complication identification improves

outcome

( > 90% of complication occur within 24hrs)

ComplicationsRisk of complication is higher in patients with advanced

renal insufficiency and also hypertension and Amyloidosis.

• Perinephric (retroperitoneal) hematoma

• Intra-renal hematoma

• Hematuria

• Ureteric obstruction

• AV fistula and pseudo-aneurysm

• Pneumothorax