Indications and considerations for kidney biopsy: an overview of clinical considerations for the non-specialist

Abstract

Around 3 million people in the UK have chronic kidney disease and 20% of hospital admissions are complicated by acute kidney injury. Decline in kidney function is not a diagnosis; it is essential to identify and treat underlying causes of acute and chronic kidney disease to either achieve recovery or slow the decline of kidney function. Thorough clinical assessment and simple investigations help determine the category of kidney injury (pre-renal, intrinsic or post-renal) and inform the need for kidney biopsy, which can provide significant information in the evaluation of suspected intrinsic kidney disease, supporting diagnosis, guiding prognosis and management, and identifying disease relapse. The procedure is invasive and not without risk, which although small has the potential to be both organ- and life-threatening. This review outlines roles of kidney biopsy for the non-specialist, with focus of its role in patients with diabetes, lupus, myeloma and in the older patient.

Keywords: acute kidney injury; chronic kidney disease; haematuria; kidney biopsy; proteinuria.

Fig 1.

Haematuria assessment pathway, adapted from NICE urological cancers clinical knowledge summary and NICE chronic kidney disease guidelines. ACR = albumin–creatinine ratio; DRE = digital rectal examination; eGFR = estimated glomerular filtration rate; NICE = National Institute for Health and Care Excellence; PCR = protein–creatinine ratio; PSA = prostate specific antigen; 2WW = 2-week wait; UTI = urinary tract infection.