Kidney biopsy

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The (percutaneous) kidney biopsy is a medical procedure introduced in 1951 that can be performed if nephrotic syndrome is suspected . The nephrologist Hans Bellin (1969) is considered to be the first to describe it . A kidney biopsy involves taking tissue from the kidney with a biopsy needle . Indications for a biopsy can be proteinuria , hematuria , acute kidney failure , systemic lupus erythematosus , malfunctioning of a kidney transplant, or chronic renal failure . A biopsy from one of the two kidneys or from the donor kidney may also be indicated to monitor the course of treatment and in the event of a transplant rejection .

Occasionally, the transcutaneous removal of a kidney stone (in the case of nephrolithiasis ) with biopsy forceps for further stone analysis is called a kidney biopsy.

Indications and contraindications

Acute kidney failure and chronic kidney failure as well as all other nephropathies are considered possible indications for confirming the diagnosis .

However, one must also think about the extrarenal syndromes according to Wilhelm Nonnenbruch , i.e. kidney failure without kidney disease . A biopsy is contraindicated here . When Kardiorenalsyndrom , when Hepatorenalsyndrom and when Pulmorenalsyndrom the histological (will histological ), the microscopic or anatomical analysis be inconspicuous. Such an extrarenal kidney syndrome (Nonnenbruch syndrome) will always be present if the quotient of glomerular filtration rate and cardiac output (GFR / CO) is normal. For this reason, for example, the suspicion of diabetic nephropathy is a relative contraindication for a kidney biopsy, especially since standardized histological findings are not to be expected here. Such a kidney puncture (or puncture biopsy ) is therefore often unnecessary. Numerous other contraindications are described and must be observed. Even if there are no therapeutic consequences, tissue removal is dispensed with.

execution

It used to be called a kidney blind puncture . Today, a distinction is made between the percutaneous biopsy ( punch biopsy ) and the lower-risk fine needle biopsy , although an aspiration needle is pierced through the skin ( i.e. percutaneously or transcutaneously ). Today, the biopsy is performed with ultrasound support and a semi-automatic biopsy device. After local anesthesia, the procedure takes about 20 minutes. Following the biopsy, the patient must remain strictly bed rest for 24 hours under inpatient supervision . Of complications are bleeding and injuries described by neighboring organs. Occasionally, arteriovenous fistulas can occur, especially in children . The lethality was given (1970 by Linus Geisler ) as 2 per thousand . Every organ puncture counts as bodily harm according to Section 223 of the Criminal Code ; According to the patient rights law , the advantages, disadvantages and alternatives must be comprehensively explained .

In rare cases, the biopsy can also be performed openly surgery (for specimen excision ) or minimally invasive ( laparoscopic ). Even the transjugular access is recommended as a rarity, i.e. a procedure with a central venous catheter through one of the two throttle pits and then via the internal jugular vein and via both vena cava through the renal vein ( renal vein ) into the kidney tissue to be examined.

Examination of the fabric material

By histological and electron microscopic examination of the recovered tissue sample , the diagnosis is through a Nephropathologen instead. In addition, a can immunohistochemical diagnostic done; then one speaks of the triple diagnosis . The processing of the biopsy takes three to five days. In urgent cases, a diagnosis can biopsy within three hours following receipt of the biopsy sample ( Bioptat provided). Today, the assessment (especially in the case of transplant rejection) is based on the Banff classification .

literature

  • Rüdiger Waldherr, Karl Schärer: "Kidney Biopsy", in: Karl Schärer, Otto Mehls (Ed.): Pediatrische Nephrologie , Springer-Verlag, Berlin, Heidelberg 2002, ISBN 978-3-642-62621-0 , pp. 49-56 .

Individual evidence

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  8. Zahra Siejek: importance and risks of biopsy in the diagnosis of kidney disease , Dissertation , University of Bochum , Bochum 2003, p. 11
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  14. Linus Geisler : Internal Medicine II , 10th edition, Kohlhammer study books, Wilhelm Kohlhammer Verlag , Stuttgart, Berlin, Cologne, Mainz 1970, ISBN 3-17-007038-X , p. 63.
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  26. Jörg Dötsch, Lutz T. Weber (Ed.): Kidney Diseases in Childhood and Adolescence , Springer-Verlag, Berlin 2017, ISBN 978-3-662-48788-4 , pp. 258-260.