Open-renal biopsy in uremic patient
Abstract
Results of 100 consecutive open-renal biopsy examinations are presented. In each case adequate tissue was obtained for light, fluorescent, and electron microscopy. In the nonuremic patient the mortality rate was 0 per cent; however, when azotemia had been poorly controlled or when such factors as abnormal bleeding tendencies complicated the patient's course, the mortality rate was as high as 4 per cent. To minimize the incidence of complications, paraoperative precautions relating to the uremic patient are outlined.
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Cited by (16)
Laparoscopic renal biopsy
1998, Kidney InternationalLaparoscopic renal biopsy.
Renal biopsy continues to be a pivotal tool and frequently indispensable diagnostic procedure in the clinical assessment of proteinuria and or unexplained renal disease. Laparoscopic renal biopsy has recently been reported as an alternative to open renal biopsy.
Thirty-two patients who had proteinuria and/or renal insufficiency underwent laparoscopic renal biopsy at our center. The indications for biopsy included failed percutaneous biopsy (N = 3), morbid obesity (14), solitary kidney (5), chronic anticoagulation/coagulopathy (6), religious consideration (refusal of potential blood transfusion) (2), multiple bilateral renal cysts and body habitus (1 case each). The kidney was approached via a laparoscopic retroperitoneal route (retroperitoneoscopy) using a two port technique. The lower pole of the kidney was localized using blunt dissection, laparoscopic cup biopsies were performed, and hemostasis was achieved using standard techniques.
All biopsies were successfully completed laparoscopically with sufficient tissue obtained for histopathological diagnosis in all cases. Mean estimated blood loss was 25.9 ml (range 5 to 100). None of the patients required parenteral narcotics during the perioperative period. Operative time ranged from 0.8 to 3.0 hours (mean 1.5). Mean hospital stay was 1.7 days (range 0 to 7). Sixteen patients were treated as outpatients. Patients returned to normal activity at a mean of 1.7 weeks (range 0.3 to 3.0) postoperatively. In one patient, the spleen was inadvertently biopsied without consequence. An additional patient developed a postoperative 300 cc perinephric hematoma that resolved without the need for intervention. One postoperative mortality occurred on postoperative day seven secondary to a perforated peptic ulcer in a patient undergoing high-dose steroid therapy for lupus nephritis.
Laparoscopic renal biopsy is a safe, reliable, minimally invasive alternative to open renal biopsy for patients in whom a closed percutaneous approach is either a relative or absolute contraindication, which can be performed on an outpatient basis.
Laparoscopically assisted percutaneous renal biopsy
1993, Journal of UrologyWe performed laparoscopically assisted percutaneous renal biopsy on 4 patients with azotemia or renal dysfunction who were believed to be unsuitable candidates for percutaneous renal biopsy. Tissue adequate for diagnosis was obtained in all 4 cases. Complications included subcutaneous emphysema in 1 patient and a small splenic capsular tear in 1, which was managed laparoscopically and did not require transfusion. Bleeding from the renal biopsy occurred in 1 patient and was easily managed laparoscopically. We recommend laparoscopically assisted percutaneous renal biopsy as an alternative method of renal biopsy in patients who can tolerate general anesthesia and who are not candidates for percutaneous renal biopsy.
Percutaneous renal biopsy of the solitary kidney: A contraindication?
1992, Journal of UrologyWe recently were presented with a patient from the nephrology service, with the request to perform open renal biopsy because of a solitary functioning kidney. We performed the open biopsy and the patient subsequently had a wound infection, leading us to question the recommendation in the literature stating that a solitary kidney is an absolute contraindication for percutaneous renal biopsy. In a review of the literature from 1951 to 1990, a total of 19,459 percutaneous renal biopsies has been reported with an overall complication rate of 2.1 to 10.8%, the majority (90%) of which did not require definitive treatment. Only 13 nephrectomies (0.06%) were required secondary to complications. The overall mortality rate was 0.08%. We reviewed 157 percutaneous renal biopsies done at this institution from 1985 to 1990 with a minor complication rate of only 5% and no major complications or loss of kidney function. The mortality rate was 0. Based on our study and a review of the literature, both showing an extremely small percentage of permanent loss of kidney function or mortality, we propose that a solitary kidney no longer be recommended as an absolute contraindication to percutaneous renal biopsy.
Acute renal failure due to perirenal hematoma complicating open renal biopsy
1984, Journal of UrologyDiminished renal concentration and excretion of intravenous radiographic contrast medium are cardinal findings in perirenal hematoma. However, despite a high incidence of perirenal hematoma after renal biopsy acute renal failure has not been described in this setting. A case of oliguric acute renal failure owing to perirenal hematoma after open biopsy of a solitary kidney is reported.
Role of renal biopsy in end stage renal failure
1978, UrologyThe role of renal biopsy in 46 patients with end stage renal failure was assessed. Renal tissue was obtained by open renal biopsy in 24 patients, by needle biopsy in 5, and at bilateral nephrectomy in 17. In 4 patients the renal biopsy specimens showed advanced changes that could only be diagnosed as “end stage kidney.” In 42 patients (91 per cent), a precise renal diagnosis was made I n 20 patients (43 per cent) the prebiopsy clinical impression differed from the histologic diagnosis. In the 29 patients undergoing renal biopsy, minor postoperative morbidity occurred in 5. We conclude that a renal biopsy in patients with end stage renal failure will result in a change in clinical diagnosis in a significant number of patients and can be performed with low morbidity.
Open renal biopsy technique Results in 202 patients
1978, UrologyTwo hundred five cases of open renal biopsy using a muscle-splitting technique have been performed over the past seven years. Eighty-seven per cent were done under local anesthesia. Tissue for routine histology, immunofluorescence staining and electromicroscopy were obtained in all cases. Morbidity was low, and there were no deaths attributed to the procedure.