Renal Biopsy


Renal biopsy means that a small amount of kidney tissue is extracted after that pathological and laboratory analysis is performed.

Sometimes your doctor cannot decide whether your kidney is cancerous or benign, despite all the tests. In such a case, they may want to take a small piece of your kidney.

If there is a strong clinical suspicion that the mass in the kidney is malignant after all diagnostic tests have been performed, the next step will be the nephrectomy which means that all or part of your kidney is surgically removed.

Although kidney biopsy is performed in certain cases, this is not very common.

For example, if your kidney cancer has been metastasized at the time of diagnosis, a biopsy can be performed to identify the subtype of your cancer and select an appropriate systemic treatment accordingly.

For more information about the metastasis of Kidney Cancer, you can read:
Kidney Cancer Basics: Metastasis


It can also sometimes be used to measure the effectiveness of the treatment given by renal biopsy.

1. Purpose of Kidney Biopsy

A kidney biopsy is performed to diagnose any disease that may impair your normal kidney function.

For more information about the functions of kidney, you can read:
What Kidneys Do?


There are many functions normally performed by the kidneys in daily life. Some of them can be listed as;

  • Filtering of toxic and waste materials such as urea from blood and producing the urine
  • Removing excess fluid and salt in the body
  • Ensuring the balance of acid-base and chemicals such as sodium, potassium or calcium in the body
  • Production and secretion of erythropoietin, a hormone stimulating red blood cell production from bone marrow
  • Production and secretion of calcitriol, a hormone that regulates calcium absorption and blood calcium levels
  • Regulation of blood pressure
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Your doctor may decide to perform a kidney biopsy if the tests show signs of deterioration of one or more of your kidney functions.

The reasons your doctor ordered this procedure may be:

  • To find the cause of abnormally high waste products in the blood
  • To decide whether a renal mass is benign or malignant
  • To find the cause of hematuria, defined as the presence of urine in the blood
  • To investigate the underlying cause of proteinuria, which means high levels of protein in the urine
  • To create a treatment plan for the kidney with the disease

2. Types of Kidney Biopsy

Usually, a kidney biopsy can be performed in the hospital as an outpatient procedure. Although it varies from hospital to hospital, this can be done with the help of CT or USG in the radiology department.

There are two main types of renal biopsy.

Percutaneous biopsy is the most commonly used procedure. The doctor sends a thin biopsy needle through the skin to the kidney to remove a small sample of the mass from it.

In the open biopsy procedure, the doctor makes a small incision in the skin and takes small tissues from the areas of the diseased kidney.

a. Percutaneous biopsy

Typically, percutaneous biopsies are performed by a physician and take approximately 1 hour.

You will wear the gown provided by the hospital just before the procedure. Your doctor may then give you a sedative medication through the IV line in order to make you relax.

However, in percutaneous biopsy procedures, you do not normally need to have any general anesthesia, so you are awake during the entire procedure.

You are asked to take a position to lie on your stomach. Thus, access to your kidneys for biopsy can be provided more easily. You are also provided with a pillow or towel because you need to remain in this position and stay still for about half an hour.

In the next step, your doctor will inject a local anesthetic agent at the site of the biopsy will be taken. He then sends the special needle to be used for biopsy from this region to your kidney. In the meantime, imaging methods such as CT or USG can be used in order to reach the exact desired location. 

Your doctor asks you to take a deep breath and hold it while he will take the sample tissue from your kidney. This process takes approximately 35 to 40 seconds. You may then experience discomfort while taking a biopsy and extracting the tissue.

There are two types of percutaneous biopsies:

  • Fine needle aspiration biopsy: With this method, your doctor uses a thin, small needle to extract tissue from your kidney. There is a syringe at the end of the needle.
  • Needle core biopsy: This method is usually preferred for obtaining larger tissue samples. During this procedure, your doctor will extract larger sample tissue from your kidney with a spring-loaded needle.

After the biopsy is completed, if there is bleeding in the biopsy area, the pressure is applied until bleeding stops. The bandage is then applied over the incision site.

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b. Open biopsy

Depending on your health status and medical history, your doctor may recommend an open biopsy for you.

This biopsy method is generally recommended if any bleeding or clotting problem has already occurred in your kidney, in your history. If you have a single kidney, an open biopsy method is generally preferred.

If an open biopsy is to be performed, you should undergo general anesthesia. When you are unconscious, your doctor makes a small incision and takes the sample tissue from your kidney. Some of these open biopsies may require incisions of about 6 inches long.

An open biopsy can also be performed by laparoscopy. In such a case, your doctor can take a biopsy sample through a small and long tube with a small incision.

Laparoscopy used a camera to view the inside of the abdomen. From a small incision, this special camera is sent into the abdomen and the biopsy sample from the kidney can be removed correctly with visualization.

3. After Renal Biopsy

After a renal biopsy procedure, you will need a period of time for recovery and observation. You can go home when your doctor determines that you can safely leave the hospital.

This process may vary greatly depending on your health condition, your doctor’s practice, and your reaction to the biopsy procedure.

a. Leaving the hospital

Usually, after the biopsy, you will be taken to a room where your vital signs can be observed and you can rest.

It is recommended that you lie on the bed without moving in this process.

Although it varies from hospital to hospital, on average this whole process takes between 6 and 8 hours.

During this time period, a nurse or doctor will regularly check important life-related parameters, including your blood pressure and pulse.

CBC and urine tests are also performed to determine if there is any internal bleeding or other problem.

If you feel pain in the biopsy area, you may also be given medicine to relieve this pain.

If your vital signs such as blood pressure and pulse are stable, you will be allowed to leave the hospital. This follow-up process, which is thought to allow you to leave the hospital safely, takes a period between 12 hours and 24 hours after the biopsy procedure.

b. Post-hospital process

It is normal to have light blood in your urine for up to 24 hours after the biopsy procedure. However, if such a condition persists for more than 24 hours, you should consult your doctor.

You can continue your daily diet after the biopsy procedure. Your doctor will probably recommend bed rest from 12 to 24 hours. In this process, you should avoid strenuous activities or heavy lifting for up to 2 weeks.

It is also recommended that you avoid any activity that includes bouncing such as jogging, aerobic exercises, for a period of 2 weeks. If you feel any pain in your biopsy area that is bothering you, you can take painkillers to relieve your pain.

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4. Possible Renal Biopsy Risks

A renal biopsy will provide your doctor with very accurate and clear information about any abnormality or disease in your kidney. In this way, you can get the most appropriate treatment for the problems you have.

One of the most important complications after the renal biopsy is possible infections. However, this is extremely rare. After the biopsy, you are strongly advised to pay attention to any symptoms that may indicate infection. Some of these symptoms can be listed as;

  • Light blood or clot in urine for more than 24 hours
  • Urination problems
  • Chills or fever
  • Pain in biopsy area which increases in intensity
  • Complaints such as redness, swelling or discharge in the biopsy area
  • A feeling of faint or weak

In addition to the infection, kidney biopsy also has the potential to damage nearby organs and tissues, as well as all other biopsy procedures.

5. What Should be Done to Prepare for Kidney Biopsy?

Usually, you do not need to make too much preparation for kidney biopsy.

As with all other biopsy procedures, you should tell your doctor about the medications, over-the-counter medications, and herbal supplement that you are taking.

It is very important that you discuss with your medical team and your doctor about stopping these drugs or reducing their dosage before the biopsy.

If you regularly use medications that affect the kidney biopsy procedure, your doctor may provide special instructions.

Drugs that may affect the renal biopsy process;

  • Anticoagulants
  • NSAIDs (aspirin, ibuprofen, etc.)
  • Herbal or dietary supplements
  • Any drug that may affect blood clotting

In addition, if you are pregnant or think you are pregnant, be sure to share it with your doctor.

You may also need to give a urine sample prior to kidney biopsy. In this way, it can be understood whether there is any urinary tract infection.

A renal biopsy requires fasting from food and drink at least a period of 8 hours before your procedure.

If you have been given a sedative medication to take at home before the procedure, you must not come to the hospital using a vehicle.

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6. Renal Biopsy Results

During the procedure, the sample taken from your kidney is sent to the laboratory for analysis.

The pathologist, who is an expert in this field in the laboratory, examines the tissue sample to determine if there are any problems.

The tissue sample taken from your kidney is stained with various dyes and then examined under a microscope. The pathologist investigates whether there is any scar or deposit in the tissue.

Any abnormal condition such as an existing infection or tumor can also be detected.

Generally, after about one week, the pathologist will send a detailed report about the tissue he or she is examining to your doctor. If there is no deposit or defect in your kidney, your kidney may be considered healthy.

For more information about the Kidney Cancer, you can read:
Kidney Cancer Basics: What is the Kidney Cancer?


However, if the results are different from normal tissue, a kidney biopsy is considered abnormal. There are several situations that can cause this. Although kidney cancer is the most important of these, other conditions can be listed as follows;

  • kidney infection
  • restrictions or weaknesses in the flow of blood to the kidneys
  • connective tissue diseases
  • rejection of a kidney transplant
  • complicated urinary tract infection
  • numerous other diseases that have a negative effect on kidney function

After this process, your doctor may find the result sufficient to decide the treatment or order additional tests to achieve a clearer result.

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