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  • • 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, vasculitis).

      • 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:

    • • Nephrotic syndrome.

      • Glomerulonephritis.

      • Vasculitis.

      • Systemic lupus erythematosus or other systemic disease.

    • 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.

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• 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.

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Absolute

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  • • Solitary, ectopic, or horseshoe kidney.

    • Bleeding diathesis.

    • Uncontrolled hypertension.

    • Abnormal kidney vascular supply or arteriovenous malformation.

    • Kidney tumor.

    • Large kidney cysts.

    • Kidney abscess.

    • Pyelonephritis.

    • Patient who is unwilling or unable to cooperate (insufficient sedation when indicated).

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Relative

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  • • Severe obesity.

    • Hydronephrosis.

    • Small kidney (as seen in end-stage kidney disease, for example).

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• Consider open biopsy in cases in which relative contraindications are present.
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Equipment

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  • • Ultrasound.

    • 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.

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  • • Before the procedure obtain following tests:

    • • Complete blood count.

      • Prothrombin time.

      • Partial thromboplastin time.

    • Patient should have nothing by mouth as indicated by sedation protocol.

    • No nonsteroidal anti-inflammatory drugs for 1–2 weeks prior to procedure.

    • Obtain informed consent prior to procedure.

    • Review indications, procedure, and risks with patient ...

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