At present, renal biopsy is becoming more and more a routine examination among inpatients in nephrology specialties, which has led to a great improvement in the diagnostic accuracy and therapeutic efficacy of the majority of kidney disease patients. It can be said that the development of renal pathology examination is a leap in the development of nephrology. At present, the results of renal pathology examination have become the golden indicator for the diagnosis of kidney diseases. It is no exaggeration to say that renal biopsy is the eyes of nephrologists. However, in addition to economic reasons, many kidney disease patients still have misconceptions about kidney biopsy, and are afraid of kidney biopsy, or even refuse it, thus misdiagnosing, blindly treating and missing accurate diagnosis and treatment opportunities, which is really heartbreaking. Therefore, I think it is necessary for the majority of kidney disease patients to understand kidney biopsy correctly.
First, the significance of kidney biopsy DD why kidney biopsy
Generally speaking, the screening program for kidney disease includes urine routine, kidney ultrasound and blood sampling for kidney function, which is the so-called non-invasive test. If proteinuria, hematuria and abnormal kidney function are found, which leads to the diagnosis of kidney disease. We believe that such a diagnosis can only be considered a clinical diagnosis, and it is not enough to be satisfied with such a diagnosis, which is inaccurate. It can be said that the diagnosis lacking renal biopsy is inaccurate and incomplete. Why?
Due to the wide variety of renal diseases, complex etiology and pathogenesis, the clinical manifestations of many renal diseases are not completely consistent with the histological changes of the kidney. For example, the clinical manifestation of nephrotic syndrome, the pathology can present as microscopic lesions, mild lesions, mild thylakoid hyperplasia, membranous nephropathy, membranoproliferative nephritis, focal segmental sclerosis and other changes, and the treatment options and the outcome of the development of the disease vary greatly. In addition, the histopathological changes of renal disease are inconsistent in different periods of development. For example, the same IgA nephropathy can manifest pathologically in almost all stages of development from near normal renal tissue to sclerosis of most glomeruli. Therefore, understanding the histomorphological alterations of the kidney provides an important basis for clinicians in judging the condition, treating the disease and estimating the prognosis. To summarize, the significance of kidney biopsy is mainly as follows.
1, clarify the diagnosis: more than one third of patients have their clinical diagnosis revised.
2.Guiding treatment: the clinical treatment plan of nearly one-third of patients was modified.
3.Estimate the prognosis: the prognosis of patients with kidney disease can be evaluated more accurately.
4.Sometimes in order to understand the effect of treatment or to understand the progress of pathology (such as crescentic nephritis, lupus nephritis and IgA nephropathy, etc.) repeat renal pathology examination is also required.
Second, the indications for kidney biopsy: (what conditions need kidney biopsy?)
In order to clarify the diagnosis, guide the treatment or judge the prognosis, and when there is no contraindication to puncture, all kinds of primary, secondary and hereditary renal parenchymal diseases (especially diffuse lesions) can be kidney puncture.
1.Primary renal diseases.
(1) acute nephritis syndrome, renal function is rapidly deteriorating, when acute nephritis is suspected, should be punctured as soon as possible; according to the treatment of acute nephritis for 2 to 3 months without improvement should do renal puncture.
(2) Primary nephrotic syndrome, treatment first, kidney puncture when hormone rule treatment is ineffective for 8 weeks; or puncture first and treat differently according to pathological type.
(3) Asymptomatic hematuria, deformed red blood cell hematuria when the clinical diagnosis is unclear, asymptomatic proteinuria, proteinuria persistently >1g/d when the diagnosis is unclear should do renal puncture.
2.Secondary or hereditary renal disease.
Renal puncture should be done when clinical suspicion cannot be confirmed, when the clinical diagnosis has been confirmed, but the renal pathological information is important for guiding treatment or judging prognosis.
3. Acute renal failure.
Puncture should be done promptly when the cause cannot be determined by clinical and laboratory tests (including acute exacerbation of renal function in chronic kidney patients).
4, transplanted kidney.
The cause of significant renal function decompensation is unclear, or severe rejection reaction to decide whether to remove the transplanted kidney, or suspected recurrence of the original kidney disease in the transplanted kidney.
Third, the contraindications to kidney biopsy: (which cases can not kidney biopsy)
1, absolute contraindication: obvious bleeding tendency.
2, relative contraindications: mental abnormalities or unable to cooperate; isolated kidney, atrophic kidney or one side of the kidney function has been lost; active pyelonephritis, renal tuberculosis, hydronephrosis or pus, renal abscess or perirenal abscess; renal aneurysm or renal tumor; polycystic kidney or large cysts in the kidney; late pregnancy, severe obesity or severe ascites; uncontrolled heart failure, severe hypertension; severe anemia, hypovolemia.
Fourth, the patient’s questions about kidney biopsy
1.Is kidney biopsy painful?
This is one of the reasons why many patients are afraid of kidney biopsy. In fact, kidney biopsy requires anesthesia, and most hospitals currently use local anesthesia, and as long as the patient cooperates correctly, the whole process is only a few seconds, and the pain is minimal. There is no need to be afraid of kidney puncture. Our department has been the first in China to carry out painless kidney biopsy for several years, that is, a brief general intravenous anesthesia, and wake up soon after the puncture is completed, almost painless. Especially for children and highly nervous patients, it greatly reduces patients’ fear of kidney biopsy.
2.Can only one side of the kidney be punctured for a comprehensive diagnosis?
Many patients question: Can a kidney biopsy make a comprehensive diagnosis by puncturing only one side of the kidney? In fact, kidney disease is a diffuse lesion, as long as the kidney biopsy material is good (generally require to obtain more than 10-15 glomeruli) can meet the diagnostic needs. Of course, this is closely related to the puncture technique. In fact, a part of patients in our department had bilateral renal biopsies, which also proved the consistency of renal lesions.
3.Does kidney puncture destroy the kidney?
There are about 1 million kidney units in each kidney, and usually only 15 kidney units are taken by puncture, so it will not destroy the kidney.
4.What are the possible risks of kidney puncture?
(1) Sarcopenic hematuria: the incidence in our department is less than 1%.
(2) Perirenal hematoma: the incidence is only about 30%, bed rest, braking, no serious adverse consequences.
(3) Low back pain: the incidence is low, and it lasts about half a month and mostly disappears.
(4) Accidental injury to other organs: real-time ultrasound-guided puncture is extremely unlikely. It has not occurred in our department.
(5) Other: arteriovenous fistula, renal rupture, infection, etc., the incidence is very low and has not occurred in our department.
The occurrence of the above complications is related to the level of puncture.
In summary, renal puncture biopsy is not terrible, renal biopsy technology is improving day by day, high safety, renal biopsy has become a routine examination of kidney disease patients, the majority of kidney disease patients need to correctly understand renal biopsy, early puncture, early diagnosis, early treatment, so as not to delay the timing of treatment, to avoid unnecessary medication caused by drug side effects, while reducing the unnecessary economic burden.