Renal biopsy: Still a landmark for the nephrologist

Abstract

Renal biopsy was performed for the first time more than one century ago, but its clinical use was routinely introduced in the 1950s. It is still an essential tool for diagnosis and choice of treatment of several primary or secondary kidney diseases. Moreover, it may help to know the expected time of end stage renal disease. The indications are represented by nephritic and/or nephrotic syndrome and rapidly progressive acute renal failure of unknown origin. Nowadays, it is performed mainly by nephrologists and radiologists using a 14-18 gauges needle with automated spring-loaded biopsy device, under real-time ultrasound guidance. Bleeding is the major primary complication that in rare cases may lead to retroperitoneal haemorrhage and need for surgical intervention and/or death. For this reason, careful evaluation of risks and benefits must be taken into account, and all procedures to minimize the risk of complications must be observed. After biopsy, an observation time of 12-24 h is necessary, whilst a prolonged observation may be needed rarely. In some cases it could be safer to use different techniques to reduce the risk of complications, such as laparoscopic or transjugular renal biopsy in patients with coagulopathy or alternative approaches in obese patients. Despite progress in medicine over the years with the introduction of more advanced molecular biology techniques, renal biopsy is still an irreplaceable tool for nephrologists.

Keywords: Acute kidney injury; Bleeding; Chronic renal failure; Haematuria; Hematoma; Renal biopsy.

Figure 1

Rate of performers (nephrologists and radiologists) of renal biopsy along the course of the years[10].

Figure 2

Bleeding time procedure. A: Place the sphygmomanometer on the upper arm and inflate to 40 mmHg; B: Make a small cut on the lower arm with automatic standard device; C: Blotting paper is used to draw off the blood every 30 s (normal range 3-7 min).