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Biopsy: kidney
Introduction
- Sampling the kidney parenchyma.
Uses
- To determine the pathology causing kidney dysfunction (eg in acute renal failure Kidney: acute renal failure, renal infiltrative disease including neoplasia, less commonly hematuria Hematuria and proteinuria Proteinuria).
- If treatment will be altered by the results (eg in patients with glomerular disease or acute renal failure).
- If prognosis is altered by the results (eg differentiating reversible from irreversible tubular necrosis).
- To establish patient response to treatment or progression of renal disease.
Advantages
- Allows accurate diagnosis, prognosis and clinical decisions.
Disadvantages
- Not useful in cases of chronic renal failure Kidney: chronic kidney disease/end-stage renal disease.
- Relatively high complication rate.
- Contraindicated in patients with coagulopathies, hypertension, hydronephrosis, large or multiple renal cysts Kidney: perinephric/perirenal pseudocysts, perirenal abscess, extensive pyelonephritis Pyelonephritis, and masses or adhesions interfering with the proposed biopsy site.
Thorough clinical evaluation of the patient is required before the procedure.Do NOT perform if unlikely to change treatment or prognosis.
Technical problems
- Patient immobilization is required using sedation or preferably general anesthesia.
Alternative techniques
- Ultrasonography Ultrasonography: kidney provides information on renal architecture.
- Intravenous urography Radiography: intravenous urography helps in evaluating renal structures and qualitatively assesses excretory function.
- Renal scintigraphy Scintigraphy: renal for GFR evaluates individual kidney function.
- Contrast CT Computed tomography (CT) or MRI Magnetic resonance imaging: basic principlescan provide additional detail on renal architecture.
- Fine needle aspirate Fine-needle aspirate may be useful for diagnosing some conditions, eg renal lymphoma.
Time required
Preparation
- 10-30 minutes depending on the technique chosen.
Procedure
- 10-60 minutes depending on the technique chosen.
Decision taking
Criteria for choosing test
- Percutaneous (blind - challenging, but most feasible in cats and small dogs).
- Percutaneous, ultrasound guided Biopsy: ultrasound-guided (allows targeting of a specific lesion and is potentially feasible with the patient under sedation).
- Through a key-hole flank grid incision (if ultrasound guidance is not available).
- Laparoscopic Laparoscopy (allows enhanced kidney visualization + magnification, choice of biopsy site and monitoring of hemorrhage, but requires expensive equipment and steep learning curve).
- Surgical (wedge biopsy Kidney: surgical approach, if a larger sample is required; allows kidney visualization and choice of biopsy site; enables assessment and treatment of hemorrhage).
A trucut needle can also be used to obtain biopsy samples at open surgery.
Risk assessment
- Balance value of procedure results against risk of complications.
Requirements
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Preparation
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Technique
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Aftercare
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Lansdowne J L, Mehler S J, Bouré L P (2012) Minimally Invasive Abdominal and Thoracic Surgery: techniques. Compend Contin Educ Pract Vet 34 (5), E2 PubMed.
- Mayhew P (2009) Surgical Views - techniques for Laparoscopic and Laparoscopic-Assisted Biopsy of Abdominal Organs. Compend Contin Educ Pract Vet 31 (4), 170-6 PubMed.
- Vaden S L (2005) Renal Biopsy of Dogs and Cats. Clin Tech Small Anim Pract 20 (1), 11-22 PubMed.
- Vaden S L, Levine J F, Lees G E et al (2005) Renal Biopsy: A Retrospective Study of Methods and Complications in 283 Dogs and 65 Cats. JVIM 19 (6), 794-801 PubMed.
- Groman R P, Bahr A, Berridge B R et al (2004) Effect of serial ultrasound guided renal biopsy on kidneys of healthy adolescent dogs. Vet Radiol Ultrasound 45 (1), 62-69 PubMed.
- Rawlings C A, Howerth E W (2004) Obtaining quality biopsies of the liver and kidney. JAAHA 40 (5), 352-358 PubMed.
- Vaden S L (2004) Renal biopsy: methods and interpretation. Vet Clin North Am Small Anim Pract 34 (4), 887-908 PubMed.
Other sources of information
- Hotston Moore A, Ragni R A (2012) Diagnostic Laparoscopy. In: Clinical Manual of Small Animal Endosurgery. Hotston Moore A, Ragni R A (eds), Wiley-Blackwell, Oxford.
- Tillson D M, Tobias K M (2012) Kidneys. In: Veterinary Surgery Small Animal. Tobias K M (ed), Saunders, Philadelphia, pp 1944-1961.
- Chew D J, DiBartola S P, Schenck P A (2011) Canine and Feline Nephrology and Urology.Elsevier Saunders, Philadelphia.
- Lees G E, Bahr A, Sanders M H (2010) Performing Renal Biopsy. Clinician's Brief April 14.
- Holt P E (2008) Urological disorders of the dog and cat. Manson Publishing, London.
- Fossum T W (2007) Surgery of the Kidney and Ureter. In: Small Animal Surgery. 3rd Edition, Fossum T W (Ed), Mosby, S. Louis, pp 635-662.
- Rawlings C A, Bjorling D E, Christie B A (2003) Kidneys. In: Textbook of Small Animal Surgery. Slatter D E (ed), 3rd edition, Saunders, Philadelphia, pp 1606-1619.