I. Preoperative treatment norms
1. Indications and contraindications for renal biopsy.
The indications for renal puncture biopsy method are mainly.
① Consider diffuse lesions, such as renal damage caused by various types of glomerulonephritis, nephrotic syndrome, systemic diseases such as systemic lupus erythematosus, diabetes mellitus, polyarteritis nodosa, amyloidosis, etc.
②Unexplained hematuria should be diagnosed by renal puncture biopsy when non-glomerular origin hematuria is excluded.
③Unexplained and persistent proteinuria.
④Those who are considered to have tubular-interstitial lesions by all clinical examinations.
⑤In cases of renal insufficiency, when there is difficulty in diagnosing and determining the treatment plan, especially when the disease is acute in onset and acute progressive nephritis is suspected, early renal aspiration biopsy should be performed to confirm the diagnosis and facilitate the development of a treatment plan.
(6) When chronic pyelonephritis is suspected, but chronic nephritis cannot be excluded, and there is insufficient clinical evidence for differential diagnosis.
(7) If there is suspected rejection after kidney transplantation, or if the diagnosis is rejection and treatment is ineffective, or if the original nephropathy is suspected to have recurred, kidney aspiration biopsy should be performed.
(8) For other conditions, such as unexplained hypertension, continuous renal aspiration biopsy should be performed to correct the diagnosis and revise the treatment plan.
Contraindications for renal puncture biopsy are.
(1) Those with bleeding tendency, such as those treated with anticoagulant drugs, with systemic bleeding disorders, renal failure with bleeding tendency, hemodialysis, and those prone to bleeding due to heparinization.
(②People with severe arteriosclerosis due to vascular factors such as advanced age, hypertension (those with blood pressure above 160/110 mmHg), renal aneurysm, etc.
③It is not recommended when there is tuberculosis or abscess in the kidney or when there is infection in the adjacent organs.
④Nephron tumor and polycystic kidney are not suitable.
⑤It is not recommended for those with independent kidney or severe kidney shrinkage.
(6) Those whose systemic condition does not allow it, such as those who are pregnant, overly obese, old and frail, mentally abnormal or extremely uncooperative, and those with large amount of ascites, etc.
2.Pre-operative preparation.
① Thought preparation, including conversation with the patient himself and the patient’s family, detailed introduction of the purpose, significance, method and advantages of the operation to the patient and his family, so that the patient fully understands and appreciates the purpose and risks of the operation.
②Preoperative routine examination:
(1) Infection screening: hepatitis B, hepatitis C, syphilis, H IV. If positive results are found, kidney tissue will be stained with the appropriate antigen;
(2) Coagulation screening: clotting time, platelet count, prothrombin time, antithrombin III activity and D2 dimer assay;
( 3) Liver and kidney function tests, cardiac function tests if there is cardiovascular disease;
(4) Respiratory training. Intramuscular injection of lithotripsy 1ku 30 min before surgery, escort the patient to the ultrasound room.
(3) Surgical consent form, sign the surgical consent form on the basis of full communication with the patient and his family, the surgical consent form should not copy the template, but must be modified on the basis of the template with the specific condition of the patient, so as to meet the actual patient, the consent form should be read in full by the signatory or read in full by the doctor to the signatory, so that the signatory really knows the meaning and risk of the operation.
II. Intraoperative treatment specification
1.Patient position: The patient is asked to lie prone on the operating table, with a pillow on the upper abdomen, so that the kidney is placed on the back and slightly lateral.
2, patient anesthesia: 2% lidocaine local anesthesia
3.Puncture method: local anesthesia with 2% lidocaine layer by layer to the renal peritoneum, after B-ultrasound positioning, under the surveillance of B-ultrasound, the puncture needle is inserted layer by layer to reach the peritoneum of the kidney, and the patient is instructed to hold his breath when breathing calmly, shoot to cut and take the material, and pull out the puncture needle, after the patient’s kidney biopsy, the local wound is pressed for several minutes, and then bandaged with lap band and pushed into the ward on a flat cart.
Three, postoperative treatment norms
1. Absolute bed rest for 1 d after surgery, routine application of antibiotics and hemostatic drugs for 3 d.
2. Blood pressure and pulse should be measured every half hour, and the measurement can be stopped after 4 hours of stable blood pressure. If the patient’s blood pressure fluctuates greatly or is low, it should be measured until it is stable, and symptomatic treatment should be given.
3.After 24 hours of lying down, if the condition is stable and there is no visual hematuria, remove the lap band before moving to the ground. If the patient has sarcoid hematuria, the bed time should be extended until the sarcoid hematuria disappears or is significantly reduced. If necessary, give intravenous hemostatic drugs or blood transfusion.
4. Ask the patient to drink more water after the operation in order to discharge the contrast agent and a small amount of clot as soon as possible. During bed rest, the patient should be asked to rest quietly and reduce the movement of the body to avoid wound bleeding, and at the same time, the patient should be carefully observed to see if there is any bleeding from the wound and to enhance life care.
5. Hematuria: About 60 to 80% of patients have varying degrees of microscopic hematuria, and some patients may have carnal hematuria. In order to make a small amount of bleeding discharged from the kidneys as soon as possible, in addition to absolute bed rest, the patient should be asked to drink a lot of water, and the change of urine color should be observed each time to determine whether the hematuria is gradually aggravated or reduced. In case of obvious hematuria, bed rest should be prolonged, and hemostatic drugs should be given intravenously in time, and blood transfusion should be given if necessary.
6. Perirenal hematoma: The incidence of perirenal hematoma is about 60-90%, which is generally small, without clinical symptoms, and mostly absorbed within 1-2 weeks. Larger hematoma is rare, mostly caused by kidney tear or penetration to large medium vessels, especially arteries, mostly occurring on the day of puncture, manifested as abdominal pain, lumbago, pressure pain at the puncture site or slightly inflated than the opposite side, pressure pain and rebound pain in the abdomen on the puncture side, blood pressure drops in severe cases, red blood cell pressure product drops, B ultrasound or X-ray examination can be further confirmed, generally take conservative treatment, if the bleeding does not stop, surgical treatment can be performed.
7. Low back pain and lumbar discomfort: Most patients have mild ipsilateral low back pain or lumbar discomfort, which usually lasts about 1 week. Most patients can take general painkillers to reduce pain, but patients with combined perirenal hematoma have severe lumbar pain and can be given narcotic painkillers to relieve pain.