• Reference Number: HEY-834/2020
• Departments: Renal Service
• Last Updated: 2 January 2020

Introduction

This leaflet has been produced to give you general information about your procedure of transplant kidney biopsy.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and the healthcare team, 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.

What is a transplant kidney biopsy?

Depending on the results of blood tests taken in the transplant clinic and following discussion with your kidney doctor (nephrologist) they have advised a transplant kidney biopsy.

You may be contacted by the transplant nurse to arrange a transplant kidney biopsy to help find out the cause of the reduction in kidney function.

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

Why do I need a transplant kidney biopsy?

Direct examination of a sample of the transplant kidney under the microscope is necessary to make a precise diagnosis and plan specific treatment.

Your doctor or the transplant nurses will tell you what is being looked for and answer any questions about the procedure. Please feel free to ask any questions.

Can there be any complications or risks?

The benefits of doing a biopsy are always considered carefully for each individual patient and serious complications are extremely rare.

The main risk is that your transplant kidney might bleed after the biopsy. Although serious bleeding is very rare, we observe you closely for 6 hours after the biopsy. The nursing staff will check your pulse, blood pressure and urine colour and will look at the biopsy site. From these frequent checks, the nursing staff can quickly tell if there are any possible signs of bleeding.

• Minor bleeding with blood in the urine may occur in up to 2 in 100 people after a biopsy – this usually settles quite quickly.
• Bleeding which requires a check and then may require a blood transfusion – 1 in 100 people.
• More severe bleeding requiring a procedure to stop the bleeding may very rarely be needed – 1 in every 1000 people.
• There may be some mild discomfort over the biopsy site, which can be treated with pain relief medication e.g. paracetamol.
• A haematoma (a clot of blood/ bruise above the kidney) may occur – this usually settles on its own.
• Other very rare complications include damage of another organ at the time of the biopsy (less than 1 in 1000 people), loss of the kidney (1 in 2000 people) or death (exceptionally rare).
• Occasionally we may not obtain kidney tissue or it may be insufficient to make a diagnosis (about 1 in 10 biopsies).

How do I prepare for the transplant 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 procedure.

Most transplant kidney biopsies are undertaken as a day case procedure, although in some cases it may be done as part of an inpatient stay. You should bring any medication that you take regularly. If you take anticoagulants e.g. warfarin, aspirin or clopidogrel these should be stopped before the procedure.

Please let the team know you are taking this medication and your kidney doctor will discuss this with you. You are advised not to drive home after the procedure.

What will happen?

You will be admitted to the day case unit or the ward and the doctor will 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.
• Agreed to have it performed.

The transplant kidney biopsy is performed in the Ultrasound Department or ward procedure room. You will be asked to lie on your back and have an ultrasound scan to check the position of your transplant to assist the doctor in the biopsy.

You will be covered in sterile towels. The skin will be cleaned and then numbed with an injection of local anaesthetic into the skin over your transplant kidney. There may be some slight discomfort. Once the skin is numb, a special biopsy needle is inserted through the skin to take the biopsy. This may be repeated 2 or 3 times. The biopsy should not hurt, but may be slightly uncomfortable. Most people feel only a slight pushing sensation. Afterwards a dressing is placed over the site and a further scan of the transplant kidney is done to check for any immediate problems.

You will be required to lie flat on the bed for four hours with a further two hours sitting in bed. You will be encouraged to drink plenty, but must not get up to go to the toilet. You will need to use either a urine bottle or a bedpan to pass urine during this time of monitoring. The nursing staff will check your pulse and blood pressure regularly. It is possible that your urine may be bloodstained. Any bleeding will normally have stopped by the time you go home. However if it continues you will be observed overnight as a precaution. You should normally be allowed to get up if everything is all right and, if the biopsy was planned as a day case, go home later the same day.

What happens afterwards?

If the biopsy is urgent then we can often obtain a preliminary result within 48 hours.

If you have to start treatment for rejection then you will be treated on the ward, as this treatment is given via a drip.

If you do not require treatment via a drip then you will be allowed home.

Before you go home you will usually be given an outpatient appointment for clinic if you do not already have one.

If new medication has been prescribed, you may have to wait until it has been dispensed by the Pharmacy before you are discharged. If you get any discomfort from the biopsy site, you should take mild pain relief medication, such as paracetamol, for about 24 – 48 hours after the biopsy. (AVOID aspirin or anti-inflammatory agents such as Ibuprofen and Diclofenac.)

It is sensible to take things easy for the next 5 days. You should not drive for 1 or 2 days and should avoid heavy lifting and strenuous exertion for 7 days. You can shower or bathe as normal once you are home. If you need a certificate for your work, this will be provided. If you notice any bright red (fresh) blood or clots in your urine, feel any new discomfort or severe back pain, or become faint after you have gone home, you should contact the renal ward at Hull Royal Infirmary for advice (01482) 674980.

Please note that a transplant kidney biopsy only removes tiny pieces of kidney. The slides that are made from the biopsy are often 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 telephone number (01482) 674110 / 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.