1st Faculty of Medicine Charles University 1st Faculty of Medicine Charles University Department of Nephrology
peiskerova 04.01.2010

Information for patients

 

Renal biopsy

    The aim of renal biopsy (RB) is taking a sample of renal tissue (via a puncture). This sample is subsequently treated by special procedures and then examined using a microscope. RB is necessary if an autoimmune kidney disease (affecting both kidneys) is suspected. Sampling is effected from one kidney only. RB is indicated in order to assess histological affections in renal tissue and thus establish accurate diagnosis with a view to effectively treat the disease. Information gained from RB cannot be fully substituted by other investigation methods.  
    RB is an invasive procedure, therefore it may cause complications. In most cases RB is followed by a small haematoma to the renal tissue or its environs, which subsequently spontaneously reabsorbs. Only 1-2% of RB cause more serious complications, such as larger or painful haematoma, that must sometimes be treated by a vessel intervention (embolisation – angiotripsia) or surgical treatment. Rarely, RB may cause bleeding into urinary tract or infection of puncture site.

    RB cannot be performed as an outpatient procedure, hence a short-term hospitalization is necessary. The day before RB, blood and urine sampling for laboratory assessment is performed, in order to assure a safety of the procedure. The patient must be informed about reasons for RB, about risks and the course of the procedure. RB is performed at an operating theatre. Imaging and orientation of the kidney and the puncture site is realized using the ultrasound or X-ray. During the procedure the patient is in prone position. The kidney (usually the left one) is focused and the site of puncture anesthetized by trimecain. The biopsy is performed via a special biopsy needle (automatic gun-biopsy needle) which cuts off the kidney a small cylinder (long about 1-2 cm and large about 1,0 mm). Sometimes a second sample may be taken.

    Preliminary results of the RB are obtained during the first 1-2 days, however definitive results are known after about a week. In the end of the sampling the site of puncture is covered by a pressure bandage. The whole procedure of RB lasts about 30-60 minutes.   

    Renal biopsy is an irreplaceable method of diagnostics, mainly if a disease of glomeruli (glomerulonephritis) is suspected. In these cases, other (less invasive) diagnostic methods may bring non-specific results and non-execution of renal biopsy may lead to a false diagnosis and hence inadequate or insufficient treatment with unfavorable results, such as renal failure. In absence of complications after RB, the hospitalization lasts for 3 days. 30 days following RB no hard physical work should be done. 7 days following RB, bathing in hot water is forbidden as well as concussions (such as running, cycling..)

     Before the RB: 1. treating physician must be informed about the whole medical history, including drugs and possible allergies. 2. the patient must comply with recommended regime measures, mainly it is necessary to rest in supination during 24 hours following the RB. 3. sonography must be performed the day after RB, in order to detect possible hematoma of the kidney.

 

Central vessel catheter placement

 

    Central venous catheter is a long plastic catheter introduced via a large vein into the superior vena cava or right atrium for administration of fluids or medications, for measurement of central venous pressure or for blood-purification procedures, such as hemodialysis or plasmapheresis.

   A dialysis catheter is a catheter used for exchanging blood to and from the hemodialysis machine from the patient. The dialysis catheter contains two lumens: venous and arterial.  This is a confusing terminology, because both lumens are in the vein. The arterial lumen (typically red) withdraws blood from the patient and carries it to dialysis machine, while the venous lumen (typically blue) returns blood to the patient (from the dialysis machine).

    If a patient requires long-term dialysis therapy, a chronic dialysis catheter will be inserted. Chronic catheters contain a dacron cuff that is tunneled beneath the skin approximately 3-8 cm. The tunnel is thought to add a barrier to infection.

   The catheter is placed in one of the large veins. A common site is superior vena cava (SVC). An SVC catheter is placed by puncturing the internal jugular vein in the neck (most often on the right side), and the catheter is then advanced downwards toward the chest. Alternatively an SVC catheter can be inserted via subclavian veins right behind the clavicle (the collar bone), often on the right. If the access of SVC is difficult, the femoral veins can be used. This is an inferior option, however, because the groin site is more prone to infection and also because patient cannot sit upright.

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