Indications
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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.
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• 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.
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• 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:
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• 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. |
Contraindications
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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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• Severe obesity.
• Hydronephrosis.
• Small kidney (as seen in end-stage kidney disease, for example).
| • Consider open biopsy in cases in which relative contraindications are present. |
Patient Preparation
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