RENAL BIOPSY

Patients are admitted on day of procedure, or earlier if less fit. Must be arranged in advance via ultradound sec or by discussin with radiologist who has a list. If deemed suitable for day care, can be assessed by Clinical Nurse Practitioner. If admitted to general wards to be assessed by medical staff.

Pre-procedure:   

	aspirin/clopidogrel stop 1 week in advance; other NSAIDs omitted on the day
	warfarin stop AT LEAST 2 days in advance if indication permits.  Some patients will need iv heparin until day of biopsy
	all medications including anti-hypertensives and anti-anginals to continue (usually patients' own supply)
	pathology request form must be filled in by renal team and attached to front of notes. Do same with consent form if obtained in advance
	Fluids only for 2 hours prior to procedure but no need to fast

Investigations and observations

Ensure no major change in condition or therapy (seek advice if there is)

• BP should be <160/90

Recent results for the following must be available:

	FBC (Hb must be > 80 g/l, Pts > 100x1012/l)
	coag screen ( PT and APTT must be within 3 seconds of control value)
	Group and save
	U & E in patients on dialysis, or if uraemic
	if any values are outwith these ranges the Registrar and the radiologist should be informed

Consent:

May be obtained in OPD. Should be attached to front of notes, with pathology request form. Inform of small risk of bleeding, very small risk of requiring intervention (including  surgery). See Patient Info.

Edinburgh: Consent form should be attached to front of notes, with pathology request form

Post-procedure:

	bed rest 6hrs: first 2h lying flat
	pulse and BP: Half-hourly  for 2 hours then hourly  for 2 hours At 6h, then 6-hourly to 24h if still an in-patient
	advise patient to drink plenty
	pain relief: paracetamol is adequate in most instances
	assess and document: biopsy site presence/absence of haematuria (macroscopically  only) dialysis or uraemic patients: check [K] the following day
	Aspirin  and warfarin can be restarted the following day if uncomplicated
	Discuss reintroduction of heparin if patient at high risk of thrombosis

Discharge:

At the agreed time if all the above satisfactory. Minimum is 6h if suitable for day-case biopsy, see below. In all cases,

	patient must have passed urine
	6h or final BP must have been recorded
	patient must have been given a number to call if problems (renal ward or doctor)
	results usually given at an outpatient appointment in the near future
	returning to work and other activities: a day or two off work is usually enough. Heavy manual activities should be avoided for a few days. No other special precautions are required.

Day case biopsies

These are suitable if the following conditions can be met

Diabetes mellitus does not automatically exclude day case biopsy as there is no requirement to fast.
Patients must have an appropriately early biopsy.

Urgent biopsies - warn renal pathologist

Out of hours procedures - contact the consultant pathologist first

Further information

Patient information explaining renal biopsy is available from EdRenINFO

Angela Webster and Paul Allan were the main authors for this page. It was updated in July 2002 by Anne Petherick, and reviewed September 2003 and November 2006. It was last updated Thursday, November 30, 2006.

NOTE that the accuracy of any statements in this information CANNOT be guaranteed. It is published in the belief that it is correct, and we endeavour to keep it so - but we do make mistakes. Furthermore, over some subjects there are differing opinions, or differing degrees of certainty. We have usually not attempted to discuss these here because the aim has been to provide an immediate and brief guide. In all areas, prior medical knowledge is assumed. The EdRenHANDBOOK is not suitable for use by those without such a background. Contact us by email or at the address given at the foot of the contents page with any comments or corrections.