Advancements in Kidney Biopsy Procedures

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Percutaneous (laparoscopic, fine needle or biopty device) and open surgery are standard kidney biopsy procedures. Your physician may need to have your kidney or renal cells examined under a microscopic to screen for problems. The pathologist will look for infections, scarring, growths or other unusual conditions. Finding a problem in the cells could allow your physician to treat or cure the disease or define exactly how far and how fast disease is progressing. The percutaneous method (through the skin) has three methods, laparoscopy, fine needle or biopty gun device. Open surgery involves cutting through the skin with a knife to see the whole kidney and cutting out a tissue sample.

Percutaneous Biopsy

Minimally invasive procedures like the percutaneous biopsies, are the method of choice. Smaller incisions are made and risks for infections and postoperative tenderness are reduced. Advances in imaging using sonograms, x-rays, unltrasound and injection of dye into the veins, helps the surgeon locate the kidney without cutting into your body. Imaging techniques, smaller needle development, and needle guns like the biopty device have made kidney biopsies safer and more accurate for the patient.

The Procedure

Using dye, x-ray, ultrasound, sonogram or laparoscope, the kidney is located while the patient is lying on the stomach, allowing access to the back where the kidneys are more easily reached. The kidney is located with an imaging technique, the area is cleaned thoroughly with an antiseptic, a local painkiller or general anasthetic is administered and the tissue sample is collected. The kidney wound sites may be closed or fulgerated with electronic fusing such as an argon beam coagulator and oxidised cellulose to form an artificial blood clot. When hemostasis is complete, the site is closed with absorbable sutures. The entire process may take only an hour.

Percutaneous Biopsy Methods

  • Laparoscopic: the laparoscope is a fiber optic system with a light source and a microscope. Ports are opened in the site and the laparoscope inserted in order to view the kidney. A fine needle or biopsy forceps are inserted through another port, or small incision to take multiple samples.
  • Biopty Device with real-time ultrasound: an automated spring-loaded biopty device is used to sample the tissue while ultrasound is employed to image the kidney, under local anesthesia.

Open Biopsy

Contraindications (conditions or reasons against) for percutaneous renal biopsy are having only one kidney, although some physicians have found percutaneous biopsy safe for this condition. Other conditions which need open surgery are an uncontrolled bleeding disorder, severe uncontrolled hypertension, congenital abnormalities, multiple cysts and uncontrollable patients. The risks of general anesthesia usually outweigh the risks of open surgery, however in these cases, percutaneous kidney biopsy procedures are not available to the patient. As such, risks for infection are also elevated, healing and recovery is also prolonged.

References

Kidney International (1998) 54, 525–529; Laparoscopic Renal Biopsy

Nephrol Dial Transplant (1998) 13: 975-977