Kidney Biopsy - XL

Biopsy

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Histology of renal tissue.

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Kidney Biopsy -XL

Why is it done?
- A kidney biopsy is a procedure that obtains a small sample of kidney tissue for microscopic examination to diagnose kidney disease and determine the underlying cause of kidney dysfunction
- Indications include: unexplained proteinuria (protein in urine), hematuria (blood in urine), acute kidney injury of unknown etiology, chronic kidney disease of undetermined cause, systemic diseases affecting the kidneys (lupus, vasculitis), evaluation of kidney transplant rejection, and suspected glomerulonephritis or interstitial nephritis
- Timing: Performed when noninvasive tests (blood work, urinalysis, imaging) fail to establish a diagnosis, and when treatment decisions depend on histopathological findings to guide targeted therapy
Normal Range
- Normal kidney biopsy findings show: intact glomeruli with normal basement membrane thickness (approximately 320-340 nm in males, 280-320 nm in females), normal mesangial cellularity, intact tubules and interstitium without fibrosis or inflammation, and patent blood vessels without atherosclerotic changes
- Immunofluorescence: Negative or minimal staining for immunoglobulins (IgG, IgA, IgM) and complement (C3, C4) deposits
- Electron microscopy: No electron-dense deposits, normal glomerular filtration barrier architecture, and intact podocyte foot processes
- Interpretation: Normal results indicate absence of primary or secondary kidney disease pathology; however, chronic changes may still be present depending on clinical context
Interpretation
- Proliferative Glomerulonephritis: Increased mesangial cells and/or endothelial proliferation with immune complex deposits (IgG, IgA, C3); indicates active inflammation requiring immunosuppressive therapy
- Membranous Glomerulonephritis: Thickened glomerular basement membrane with 'spike and dome' appearance on electron microscopy; subepithelial IgG and C3 deposits; presents with nephrotic syndrome
- IgA Nephropathy: Predominant IgA deposits in glomeruli; most common primary glomerulonephritis globally; ranges from mild to crescentic forms affecting prognosis
- Lupus Nephritis: Class I-VI disease classification; 'full house' pattern with IgG, IgA, IgM, C3, C1q deposits; wire-loop lesions and hyaline thrombi indicate active disease
- Diabetic Nephropathy: Nodular glomerulosclerosis (Kimmelstiel-Wilson lesions), thickened basement membrane, mesangial expansion, and hyaline arteriolosclerosis
- Interstitial Nephritis: Inflammation and edema in interstitium with tubular atrophy; may indicate drug-induced injury, infection, or systemic disease; degree of fibrosis predicts recovery
- Chronic Kidney Disease Changes: Glomerulosclerosis, tubular atrophy, and interstitial fibrosis percentages determine KDIGO grade; higher fibrosis indicates worse prognosis and limited treatment options
- Vasculitis: Crescents with ANCA patterns (c-ANCA/PR3, p-ANCA/MPO) or ANCA-negative; indicates ANCA-associated vasculitis requiring aggressive immunosuppression
- Factors affecting interpretation: Biopsy timing (acute vs chronic changes), number and quality of glomeruli sampled (minimum 8-10 glomeruli recommended for adequate assessment), and clinical history must be considered for accurate diagnosis
Associated Organs
- Primary organ: Kidneys - filtration, electrolyte balance, acid-base regulation, and endocrine functions
- Related organ systems affected by kidney disease: Cardiovascular (hypertension, heart failure, left ventricular hypertrophy), hematologic (anemia from erythropoietin deficiency), endocrine (hyperparathyroidism, bone disease), and neurologic systems
- Conditions diagnosed by kidney biopsy: Systemic lupus erythematosus, ANCA-associated vasculitis, anti-glomerular basement membrane disease, primary glomerulonephritis variants, medication-induced nephrotoxicity, secondary hypertension, amyloidosis, thrombotic microangiopathy, and genetic kidney diseases
- Potential complications of abnormal findings: Progressive renal failure requiring dialysis or transplantation, hypertensive crisis, nephrotic syndrome with thrombotic complications, pulmonary hemorrhage (in vasculitis), electrolyte disturbances, acidosis, and cardiovascular events
- Procedure-related risks: Hematuria, perinephric hematoma, arteriovenous fistula formation, infection, and rarely, acute kidney injury or loss of renal function in patients with solitary kidneys
Follow-up Tests
- Confirmatory tests: Serum creatinine and estimated glomerular filtration rate (eGFR), blood pressure monitoring, serology (ANA, ANCA, anti-GBM), and complement levels (C3, C4)
- Disease monitoring tests: 24-hour urine protein quantification, urinalysis with microscopy, phosphorus and calcium levels, parathyroid hormone (PTH), hemoglobin and hematocrit, and bone mineral density studies
- Imaging follow-up: Renal ultrasound to assess echogenicity and kidney size, CT scan if vascular complications suspected, and follow-up ultrasound 24-48 hours post-biopsy to evaluate for hematoma
- Monitoring frequency: Every 1-3 months for acute glomerulonephritis under treatment, every 3-6 months for stable chronic disease, and annually for patients in remission with normal kidney function
- Repeat biopsy indications: Unexplained decline in renal function despite treatment, clinical relapses with proteinuria recurrence, transplant graft dysfunction, or to assess response to novel therapies
- Related complementary tests: Direct immunofluorescence, electron microscopy for specific diagnosis, genetic testing for hereditary kidney diseases, and circulating immune complex measurements
Fasting Required?
- Fasting: NO - Fasting is not required for kidney biopsy as it is an invasive diagnostic procedure, not a laboratory blood test
- Medication instructions: DISCONTINUE aspirin, NSAIDs (ibuprofen, naproxen), and anticoagulants (warfarin, dabigatran, apixaban) 5-7 days before procedure; continue essential antihypertensives and other chronic medications; notify provider of all supplements
- Pre-procedure preparation: NPO (nothing by mouth) for 4-6 hours before procedure if sedation is planned; baseline blood work (CBC, PT/INR, platelet count, serum creatinine) required within 1 week; urinalysis and blood type and screen; current blood pressure documentation
- Additional requirements: Informed consent documentation; pregnancy test if applicable; arrange transportation as sedation may be used; wear comfortable, loose clothing; remove jewelry and metal objects; arrive 30-60 minutes early for check-in and vital signs
- Post-procedure care: Bed rest for 4-6 hours; avoid strenuous activity, heavy lifting, and contact sports for 1-2 weeks; increase fluid intake to maintain hydration; monitor for hematuria, flank pain, or fever; mild pain controlled with acetaminophen only

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