• Persistent or recurrent gross hematuria of glomerular
origin (ie, not related to urinary infection or bladder abnormalities).
• Persistent, nonorthostatic proteinuria.
• Nephrotic syndrome.
• Younger than 18 months or older than 8 years.
• As a result of systemic disease (eg, systemic lupus erythematosus
or other collagen vascular disease, vasculitis).
• As a result of glomerulonephritis (low C3, hypertension, hematuria,
or decreased renal function).
• Corticosteroid-resistant nephrotic syndrome.
• Acute nephritis.
• As a result of systemic disease (systemic lupus erythematosus,
• Normal C3.
• Low C3 for > 8 weeks (unlikely to be postinfectious nephritis).
• With nephrotic syndrome.
• With deteriorating kidney function.
• When the cause of acute kidney insufficiency is not apparent,
consider obtaining a biopsy in selected cases:
• Obtain biopsy in selected cases of chronic kidney insufficiency
to establish diagnosis, prognosis, and risk of recurrence.
• Follow up on prior biopsy in chronic kidney disease to establish
disease progression, severity, and prognosis.
• Kidney transplant with rise in creatinine.
• In many cases of kidney disease, laboratory
evaluation of the blood and urine fails to yield a specific diagnosis.
• Occasionally, a clinical syndrome or constellation of laboratory
findings might narrow the differential diagnosis; examples include the following:
• Post-streptococcal glomerulonephritis (acute onset, transient hypocomplementemia, recent streptococcal infection).
• Systemic lupus erythematosus (positive antinuclear antibody and anti-ds-DNA antibodies, hypocomplementemia, joint pains, and rashes).
• Minimal change nephrotic syndrome (nephrosis in a school-age
child without azotemia, hypocomplementemia, or other complications).
• In these instances, a kidney biopsy might not be required.
• However, in most cases, a tissue specimen is required to establish a specific etiology.
• Solitary, ectopic, or horseshoe kidney.
• Bleeding diathesis.
• Uncontrolled hypertension.
• Abnormal kidney vascular supply or arteriovenous malformation.
• Kidney tumor.
• Large kidney cysts.
• Kidney abscess.
• Patient who is unwilling or unable to cooperate (insufficient
sedation when indicated).
• Biopsy needle (in general, automated, spring-loaded system preferred).
• Biopsy tray (sterile drapes, scalpel, syringes and needles for
injecting local anesthetic, gauze).
• Specimen container with saline, on ice.
• Before the procedure obtain following tests:
• Patient should have nothing by mouth as indicated by sedation
• No nonsteroidal anti-inflammatory drugs for 1–2 weeks prior
• Obtain informed consent prior to procedure.
• Review indications, procedure, and risks with patient ...
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