Renal Biopsy

Renal Biopsy

KIDNEY BIOPSY PATIENT LEAFLET
This leaflet provides information about a kidney biopsy. Please read it and talk to your nurse or doctor if you have any further queries.

WHAT IS A KIDNEY BIOPSY?
A kidney biopsy is a procedure in which a very small sample of tissue is taken from one of your kidneys using a special needle under local anaesthetic. The sample is then sent to the histology lab for tests to ascertain the cause of your kidney disease.

WHY DO I NEED A KIDNEY BIOPSY?
A biopsy might be needed to help find out what is wrong with your kidneys and to determine your best treatment.

WHAT HAPPENS BEFORE THE BIOPSY?
You will be contacted a few days before the biopsy for a pre-assessment clinic to have some routine blood and urine tests and an MRSA (Methicillin Resistant Staph Aureus) skin swab. You will also be required to do a Covid Lateral Flow Test the day before your planned procedure. To obtain a test kit you can contact 119 or the gov.uk website. Please retain the test kit and bring it along with you on the day of the biopsy as proof of your negative status. If you test positive, please do not come to the ward and contact us as soon as possible.

You should tell your doctor before the day of the biopsy if you are taking any medications to thin your blood or make your blood less likely to clot. Certain medications like blood thinning or anticoagulant drugs would increase the risk of bleeding after a kidney biopsy, therefore they need to be stopped before the biopsy. More specifically, we usually advise to stop Aspirin or Clopidogrel 7 days before a kidney biopsy (with view to restarting the drug again 7 days after the kidney biopsy). Warfarin, Apixaban, Rivaroxaban, Edoxaban and other blood thinning drugs would usually be stopped 5 days before a kidney biopsy. Your renal consultant will communicate the details that apply to you.

As you should not eat for 2 hours before biopsy, this may interfere with your usual meal intake and thus your medications may need to be adjusted. If you take insulin four times daily, keep your long-acting insulin (e.g. Lantus, Detemir) at the usual dose but OMIT the short-acting insulin (e.g. NovoRapid, Apidra) BEFORE the meal you are missing. If you take insulin twice daily (e.g. Humulin I), REDUCE your MORNING dose to half if you miss breakfast or lunch. If you take Gliclazide, please OMIT the morning dose if you miss breakfast or lunch. Please do not hesitate to ask for more specific advice from the consultant or your GP.

If there are any abnormalities in your blood tests or your urine test is suggestive of an infection, you will be contacted by a member of the team and the biopsy will be postponed till a later date when you have cleared the infection.

WHAT HAPPENS ON THE DAY OF THE BIOPSY?
On the morning of the biopsy, you can have an early light breakfast. We aim to admit you to the renal ward Aconbury 3 in Worcestershire Royal Hospital. For many people, this will be a day-case admission with view to your going home later after you have completed bed-rest for 6 hours after the biopsy. Some people would be advised to stay overnight to the next morning, such as those who live further away like Herefordshire, or those who live on their own at home. In such cases we would advise you to bring an overnight bag with your regular medication.

The nurse will place a cannula in the vein and may take additional blood tests. The doctor will explain the procedure to you and go through the consent form as well. You would lie on your front with a pillow underneath your tummy as the kidneys are on the back. The aim is to take a sample from one kidney (usually the left one) with a help of an ultrasound scanner which allows the doctor to control the position of the biopsy needle in real time. After cleaning the skin with an antiseptic, the doctor will inject a local anaesthetic which works as a painkiller to make the area numb. Thus, when the biopsy needle is passed, you may feel pressure but should not feel pain. Please ask for more local anaesthetic if you feel pain. Usually, two samples are taken to have enough tissue for analysis. This is sent to a specialised laboratory in Birmingham, and it usually takes about a month to get a final result back (in very urgent cases, preliminary results may be available within 72 hours). It takes about 30-40 minutes to carry out the biopsy procedure from start to finish. We do not routinely give sedation but it can be considered if you are very nervous about the procedure. After the biopsy is completed and a dressing has been applied to the wound, you will be asked to slowly turn over to lie on your back. The nurses will help you with any of your personal care needs including toileting during this time. You would be offered something to eat like a sandwich after about an hour. The local anaesthetic will wear off at some point and you could consider taking regular Paracetamol for a couple of days

WHAT HAPPENS AFTER THE BIOPSY?
After the biopsy, you will be asked to lie on your back for a minimum of 6 hours. This is to reduce the risk of bleeding. Your blood pressure and pulse rate will be checked frequently in the first two hours and then less frequently over the next four hours. Your urine will be checked for blood. You might feel some pain or discomfort as the effect of the local anaesthetic begins to wear off. This is usually relieved by use of simple analgesia. You should be able to eat and drink normally and be able to go home after 6 hours if your observations are stable and there is no bleeding.

However, some people may need to stay overnight and the need to stay will be explained by the renal consultant.

WHAT ARE THE POSSIBLE COMPLICATIONS?
A kidney biopsy is considered a relatively safe procedure however as with any medical treatment or procedure, there can be complications. Bleeding is the commonest complication following a renal biopsy. This is usually minor and will stop on its own. Transient microscopic blood in the urine (usually not visible to the eyes) is common after a kidney biopsy. This is usually insignificant. Rarely, this bleeding may be severe enough to require a blood transfusion. Very rarely, an urgent radiological procedure may be required to stop the bleeding. Although this is very uncommon, the kidney may have to be removed if we are unable to stop the bleeding. Other complications include pain and discomfort, rarely, injury to abdominal organs and failure to obtain a sample/insufficient sample, infection or an allergic reaction to the local anaesthetic or dressing used.

WHAT HAPPENS WHEN I GO HOME?
You should not drive yourself back home, please arrange someone to drive you.

If you normally live on your own, it is advisable to have someone stay with you overnight. Please do let us know in advance if this is not possible as it would require an overnight stay.

Avoid any strenuous activity, exercise, manual work or heavy lifting for 2 weeks after the biopsy.

There is usually a small dressing over the biopsy site which can be safely removed the following day and you can have a bath or shower as normal.

ARE THERE ANY WARNING SIGNS I NEED TO KNOW?
Contact Aconbury 3 (Renal) ward (Tel 01905 760074 Mon-Fri, 9am-5pm) if you develop any of these symptoms:

• If the site becomes excessively bruised or a lump appears over the site
• If you have pain that is not relieved by simple painkillers or is getting worse
• If you see notice bright red blood in your urine that you haven’t seen before
• If you feel faint, light-headed, short of breath or dizzy

If you feel extremely unwell or it is out of hours (after 5pm weekdays or on the weekend) please attend the A&E department. If these symptoms should occur during the weekday and before 5pm, you can call Aconbury 3 (Renal) ward directly.

WHEN WILL I GET THE RESULTS OF THE BIOPSY?
The tissue sample is usually sent off to Birmingham for analysis and takes a few weeks for the full result to come back. A follow up outpatient clinic will be arranged for you by your renal doctor where your result and possible treatment options will be discussed with you.

FOR FURTHER INFORMATION
National Kidney Foundation www.kidney.org.uk

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you. 

Feedback
Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: [email protected]

Opening times:
The PALS telephone lines are open Monday to Thursday from  8.30am to 4.30pm and Friday: 8.30am to 4.00pm. Please be aware that a voicemail service is in use at busy times, but messages will be returned as quickly as possible.

If you are unable to understand this leaflet, please communicate with a member of staff.  

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