Having a kidney biopsy: your questions answered

This leaflet aims to answer any questions you may have about your kidney biopsy. If you have any further questions or concerns, please speak to a member of your healthcare team.

What is a biopsy?

A biopsy is the removal of a small piece of tissue from an organ of the body, for example the kidney. This is done using a special needle.

A biopsy is only taken from one kidney, as the sample will show what is happening in both kidneys.

Why do I need a biopsy?

If your kidneys are not working properly, we need to find out why. Sometimes the only way to do this, is to take a biopsy from one kidney and examine it in the laboratory. This will help us make the correct diagnosis.

Where will I have my biopsy?

Most biopsies are done in the clean procedure room next to Marlowe Ward at Kent and Canterbury Hospital. Occasionally, biopsies are taken in the X-ray Department. All the necessary details will be on your appointment letter.

Will I have to stay in hospital?

Most patients can go home on the same day as their biopsy, usually 8 hours after their procedure.

However, for safety reasons, some people will need to stay in hospital for 1 night after their biopsy. This includes those with low kidney function (eGFR <20 ml / min) and in certain other situations. Your usual doctor will tell you in advance if you need to stay overnight.

What are the risks of a kidney biopsy?

Any medical or surgical procedure carries risks.

The main risk with having a kidney biopsy is bleeding into the urine or around the kidney. Around 1 in 10 people will see blood in their urine after their biopsy, but this usually clears quickly.

If you have very heavy bleeding into the urine, we may need to place a urinary catheter. A urinary catheter is a small tube placed into the bladder through the urethra. This allows bladder irrigation and prevents large blood clots from forming in the urine.

East Kent Hospitals have local data, taken from over 1000 biopsies carried out by the Trust over 5 years. The data tells us that the risks of other serious complications are as follows.

• Heavy bleeding needing a blood transfusion, happens in approximately 1 in 50 cases.

• Intervention to stop ongoing bleeding happens in approximately 1 in 75 cases. The intervention is usually done by an interventional radiologist.

Data published in the medical literature tells us that death is a very rare but recognized complication of a kidney biopsy. However, East Kent Hospitals did not find any deaths attributed to the procedure in our data.

What happens if I choose not to have a kidney biopsy?

We will always try to find out why you kidneys are not working properly with tests that are less invasive than a kidney biopsy. Sometimes, however, only a kidney biopsy can give us the information we need to make a correct diagnosis and ensure you are on the correct treatment. If you decide not to have a kidney biopsy, your doctor (consultant) will agree with you how best to treat you without the information a biopsy will provide.

Do I need to bring anything with me?

• Please bring a list of your medications and any medications you may need on the day of your biopsy.

• You may wish to bring something to read.

• If you are staying overnight, please bring any items you may need. For example, pyjamas, slippers, and a toothbrush and toothpaste.

What if I am taking anticoagulants (blood thinners)?

If you are taking any of the following medication, you need to stop taking these before your biopsy.

• Aspirin

• Clopidogrel

• Dipyridamole

• Warfarin

• Apixaban

• Rivaroxaban

• Dabigatran

Please discuss the timing of this with your kidney doctors. Tell your usual anticoagulant clinic if you stop taking your warfarin.

What happens before I have my biopsy?

• Blood samples may be taken in the clinic or at your GP surgery. These are to make sure that it is safe to do the biopsy.

• Only eat a light breakfast on the morning of your biopsy.

• If you have diabetes, please tell the nurse looking after you on the ward.

• After you have been admitted to hospital, we will:

  • check your blood pressure

  • insert an intravenous (IV) cannula into one of your veins; and

  • take further blood samples.

• A kidney doctor will make sure that you understand what the biopsy involves and explain the risks to you. The doctor will ask you to sign a consent form, agreeing to have the biopsy.

• You will be asked to put on a theatre gown and to go to the toilet to empty your bladder before your procedure.

Why do I need to sign a consent form?

All patients must give permission before they receive any type of:

• medical treatment

• test; or

• examination.

Consent is usually given when you sign the consent form before your treatment. We may ask you to give your consent verbally (spoken rather than written consent).

• You must give your consent voluntarily.

• The hospital must give you all the information you need to make a decision about your treatment. This is so you can give us informed consent.  Please speak to staff if:

• staff have not given you this information; or

• they have but you still have questions. 

• You must be capable of giving consent. This means you understand the information given to you, and can make an informed decision.

When we ask you to give consent, please use this time to ask any questions you may still have. For more information, please go to the NHS Consent for Treatment web page. Remember, you can withdraw your consent for treatment at any time.

What happens during my biopsy?

The biopsy is performed in the clean procedures room next to Marlowe Ward. You will be awake throughout your procedure.

• You will lie on your front and a couple of pillows may be placed under your stomach. This allows the doctor easy access to your kidneys, which are in the back of your abdomen (stomach) on either side.

• The doctor checks the position of your kidneys using an ultrasound scan. An antiseptic solution is used to clean your skin.

• Sterile towels are draped around the cleansed area. An injection of local anaesthetic is given, to numb your skin and the area around your kidney.

• You need to hold your breath and keep still. The doctor passes the biopsy needle through the skin into your kidney.

• The doctor usually takes two small samples. This part of the procedure is very quick, but the doctor may need to repeat it to get a enough sample for analysis.

Will the biopsy hurt?

You may feel a slight stinging from the injection of local anaesthetic. You may also feel some pressure from the biopsy needle. However, the procedure should not be painful. If you feel anything more than a little discomfort, please tell your doctor straightaway.

What happens immediately after my biopsy?

The doctor will cover the biopsy site with a small dressing.

You will be asked to lie as flat as possible on your back in bed for 4 hours. After this, you will be sat up for the next 2 hours, before moving around the ward for another 2 hours.

During this time, a nurse will regularly check your blood pressure, pulse, and biopsy site. If you become aware of bleeding or pain, please tell the nurse looking after you.

The nurse will ask you for a urine sample, so they can look for any signs of blood. It is important that you do this, as it will reduce risk of and / or alert the doctors and nurses to any bleeding complications.

What happens in the days following my biopsy?

Please rest once you return home.

It is quite normal to have some discomfort around your biopsy site during the first week. You may need to take over-the-counter pain relief (such as paracetamol) for this.

For at least 2 weeks, do not:

• do anything too physically strenuous; or

• carry out any heavy lifting.

Doing either of these could dislodge the blood clot around the biopsy site and lead to bleeding. Strenuous activities include contact sports, such as horse riding, football, rugby, and boxing.

You should be able to return to normal light activities 4 days after your biopsy.

If you have stopped taking your anticoagulants, ask your kidney doctor when to restart them.

Please contact Marlowe Day Case Area on 01227 783100, if you:

• feel dizzy

• can see blood in your urine; or

• have severe back pain after returning home.

When do I get my results?

• In urgent cases, your biopsy result is available to the doctor looking after you on the ward within 48 hours.

• In non-urgent cases, patients usually have an outpatient appointment at the hospital within 4 weeks of their biopsy. You will discuss your results at this appointment.

When can I drive again?

Arrange for somebody to collect you from the hospital after your procedure. Do not to drive yourself home after your procedure, or to travel home by public transport.

If you do not have someone who can drive you home, please tell the nurse looking after you. They will make necessary arrangements with Patient Transport Services.

Do not start driving again until you feel comfortable. You need to be able to perform an emergency stop safely.

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