Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • 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. ++Table Graphic Jump Location|Download (.pdf)|Print• 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. +++ Absolute + • 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). +++ Relative + • Severe obesity.• Hydronephrosis.• Small kidney (as seen in end-stage kidney disease, for example). ++Table Graphic Jump Location|Download (.pdf)|Print• Consider open biopsy in cases in which relative contraindications are present. +++ Equipment + • 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. + • 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 and ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.