• Reference Number: HEY498-2020
• Departments: Renal Service
• Last Updated: 1 May 2024

Introduction

This leaflet has been produced to give you general information about your kidney biopsy procedure.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

What is a kidney biopsy?

A kidney biopsy is a procedure to take a sample of kidney tissue, about the size of a small pin, which can be examined under the microscope.

Why do I need a kidney biopsy?

A kidney biopsy is necessary when a patient has a significant abnormality in their kidney function and a diagnosis cannot be made by blood tests or a scan.

Can there be any complications or risks?

Serious complications are extremely rare. Most risks are to do with internal bleeding after the biopsy. You will be observed very closely so any bleeding is detected and treated early.

Common risks

Mild discomfort over the biopsy site, which can be treated with pain relief, e.g. paracetamol.

Estimated 1 in 20 or less:

• Minor bleeding with blood in the urine may occur after a biopsy – this usually settles quite quickly.

Estimated 1 in 50 or less:

• Collection of blood around the kidney (bruise-haematoma), which can cause discomfort, but usually settles on its own.
• Failure of the biopsy to obtain sufficient kidney tissue to make a diagnosis.

Rare risks

Estimated 1 in 100 or less:

• Heavier bleeding requiring the need for a blood transfusion or treatment to stop a bleeding blood vessel (embolization).

Very rare risks

Estimated 1 in 1000 or less:

• More severe bleeding requiring an operation including removal of the bleeding kidney may very rarely be needed.
• Damage to surrounding structures/tissues (gut/spleen etc).

Extremely rare risk

Estimated less than 1 in 3000:

• Death.

How do I prepare for the kidney biopsy?

Please read this information leaflet.  Share the information it contains with your partner and family (if you wish) so that they can be of help and support.  There may be information they need to know, especially if they are taking care of you following this examination.

Most kidney biopsies are undertaken as a day case procedure. You will need to have some blood tests done beforehand to ensure it is safe to go ahead with the biopsy.  These can be done at your GP surgery, or you may need to attend the hospital.  You will need a further blood test on the day of the biopsy.

In some situations if may be necessary for you to be an inpatient for a kidney biopsy and your doctor will discuss this with you and provide an explanation

If you take any blood thinning medicines, these must be stopped before the procedure and your kidney doctor will discuss this with you. The doctor will discuss with you after the biopsy when these medications can be restarted.  On the day of the biopsy take all other medications as normal.  It is essential the doctor has a full list of all your medicines, including any not prescribed.  If you have not received any advice you should contact the renal department on tel: 01482 675050.

Bring any medication that you take regularly.  It is important that your blood pressure is well controlled to be able to go ahead with the biopsy.  If your blood pressure is too high on the day the biopsy is planned, the biopsy will be postponed.

Do not drive on the day of the biopsy.

What will happen?

The doctor will discuss how the biopsy will be done, the risks involved and ask you to sign a consent form.

This confirms that you have:

• understood the reason for the biopsy;
• understood how it will be performed;
• understood the risks involved and any other procedures which may be needed;
• agreed to have it performed.

The kidney biopsy is usually performed in the X-ray Department.  You will be asked to lie on your front and a pillow may be placed under your tummy to help in the procedure.  The Radiographer will do an ultrasound scan to check the position of your kidneys and allow the doctor to choose a site from which to take the biopsy.

Either kidney may be biopsied.  You will be covered with sterile towels.  The skin will be cleaned and numbed with an injection of local anaesthetic into the skin over your kidney.  There may be some slight discomfort.  Once the skin is numb, a biopsy needle is inserted through the skin to take the biopsy.  This may be repeated 2 or 3 times.  You will be asked to take a breath in and hold your breath so that your kidney does not move.  Most people feel only a pushing sensation. Afterwards a plaster is placed over the site and a further scan of the kidney is done to check for any bleeding.

You will then have 6 hours bed rest.  You will be encouraged to drink.  You will need to use either a urine bottle or a bedpan to pass urine.  The nursing staff will check your pulse and blood pressure regularly.  If you have any bleeding you will be seen again by the doctor and receive treatment if needed.  Most patients go home the same day.

What happens afterwards?

Biopsy results take at least 2 weeks. Very specialist tests from the biopsy take several months. Results will be discussed at your next clinic appointment.

If you get any discomfort from the biopsy site, you should take paracetamol for 24 to 48 hours after the biopsy (aspirin or anti-inflammatory agents (tablets or gel) such as ibuprofen should be avoided).

You should not drive for 2 days and should avoid any heavy lifting or strenuous exertion for 10 days. You can shower or bathe as normal. If you notice any blood or clots in your urine, feel any new or severe back pain, or become faint after you have gone home you should attend your local Emergency Department immediately.

The slides that are made from the biopsy are kept indefinitely in the Pathology Department in case we need to refer to them for comparison with other biopsies in future years. Biopsy tissue samples may also be used for research into understanding various diseases and improving treatment of these.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Renal Department on tel: 01482 675050 or ask to speak to the doctor who referred you.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.