Having a transplant kidney biopsy: your questions answered

This leaflet will explain the following.

• What a biopsy is.

• Why you need a biopsy of your transplant kidney.

• What treatment you may need.

• What happens before, during and after the biopsy.

• The risks of having a biopsy.

• How to care for yourself afterwards.

We hope this leaflet answers some of the questions you may have. 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, in this case your transplant kidney. We take the biopsy using a specially designed needle.

Why do I need a biopsy?

• Your kidney is consistently not working at a satisfactory level; or

• Your kidney is suddenly not working as well as it had been or should be.

Your doctor knows how well your kidney is working by:

• the creatinine level measured in your blood; and

• sometimes the protein level measured in your urine.

Scans and x-rays can help tell us what is happening. However, the only way to know for sure what is happening to your transplant kidney, is to have a piece of its tissue examined in the laboratory. This will help your doctor make the correct diagnosis and treatment. Treatment may include treatment for rejection or medication changes.

What are the alternatives?

We will always try to find out why your kidneys are not working properly with tests that are less invasive than a kidney biopsy. However, sometimes only a kidney biopsy can give us the information we need to:

• make a correct diagnosis, and

• make sure you are on the correct treatment.

You can decide not to have a kidney biopsy. If you do, your doctor (consultant) will agree with you how best to treat you, without the information a biopsy will provide.

What treatment will I need?

If your biopsy result shows that you need treatment, this may include a steroid injection into a vein. The injection takes 1 hour to give. You will need 1 injection each day for 3 days. It may be possible for you to go home between these treatments.

Your doctor may also change your cyclosporin / tacrolimus / sirolimus medication. This could be because your biopsy results show that a different medication would suit your kidney better.

We will explain other less used treatments to you at the time.

Where is the biopsy done?

We do most biopsies in our clean procedure room next to Marlowe Ward, at Kent and Canterbury Hospital. Sometimes, biopsies are done in the X-ray Department.

Will I have to stay in hospital?

You will be admitted to Marlowe Ward at Kent and Canterbury Hospital early on the day of your biopsy.

• If it is a non-urgent biopsy you will usually be able to go home the same day, generally 6 to 8 hours after your procedure.

• In urgent cases it may still be possible for you to go home the same day. However, you may have to stay in hospital until either:

  • your biopsy results are available; or

  • you have completed any necessary treatment.

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). We will tell you in advance if you need to stay in hospital overnight.

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 need to stay overnight, make sure you bring the necessary items with you to your appointment.

What if I am taking warfarin, aspirin, or other blood-thinning medications?

• If your biopsy is a planned routine procedure, you must stop taking aspirin or clopidogrel 5 days before your procedure.

• If you have an urgent biopsy and have not stopped your aspirin or clopidogrel, your procedure can still go ahead. It is more important that diagnosis of rejection is caught early.

• If you are taking blood-thinning medications (anticoagulants) you must tell your nurse / doctor.

What happens before I have my biopsy?

• We will take blood samples in the clinic, or we may ask you to have them taken 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.

• When we admit you to the ward:

  • we will check your blood pressure;

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

  • take further blood samples.

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

• One of the kidney doctors will explain to you what the biopsy involves and the possible risks. They will ask you to sign a consent form agreeing to have the biopsy.

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 will happen during my biopsy?

You will have your biopsy in the clean procedures room, next to Marlowe Ward. You will remain awake throughout the procedure.

• You will lie on your back.

• Your doctor will use an ultrasound scan to find the exact location and position of your transplant kidney.

• We use an antiseptic solution to clean your skin. We will drape sterile towels around the cleansed area.

• We will give you an injection of local anaesthetic to numb your skin and the area around your transplant kidney.

• You must keep still while we introduce the biopsy needle through your skin into your transplant kidney. Two small samples are usually taken. This part of the procedure is very quick, but we may need to repeat it to get enough of a sample for analysis.

Will the biopsy hurt?

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

What are the risks of a kidney biopsy?

Any medical or surgical procedure carries risks.

• The main risk with 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.

• Occasionally, and only with very heavy bleeding into the urine, we will use a urinary catheter. A urinary catheter is a small tube placed into the bladder through the urethra. The catheter allows bladder irrigation and prevents large blood clots from forming in the urine.

• Local data tells us these are the risks of other serious complications.

  • Heavy bleeding needing a blood transfusion happens to approximately 1 in 300 patients.

  • Intervention to stop ongoing bleeding, is needed for approximately 1 in 300 patients.

  These statistics are taken from over 300 transplant biopsies carried out by East Kent Hospitals over 5 years.

• Data published in medical literature tells us that death is a very rare. We did not find any deaths linked to the procedure in our local data.

What happens immediately after my biopsy?

• We will apply a small dressing to the skin of your biopsy site.

• You will need to lie as flat as possible on your back in bed for 4 hours. After 4 hours, you will sit up for 2 hours, before moving around for a further 2 hours before your discharge.

• We will regularly check your blood pressure, pulse, and biopsy site.

• If you become aware of bleeding or pain, please tell your nurse.

• You need to provide a urine sample, so we can check for any signs of blood.

It is important that you follow the above steps, as these will reduce the risk of and / or alert your doctors and nurses to bleeding complications.

What happens in the days following my biopsy?

• Please rest once you arrive 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).

• Do not to do anything too physically strenuous for 2 weeks after your procedure. This includes:

  • contact sports, such as horse riding, football, rugby and boxing; or

  • any heavy lifting.

  If you do, it could dislodge the blood clot around the biopsy site and lead to bleeding.

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

• If you stopped taking anticoagulants, discuss with your kidney doctor when to restart them.

• Contact Marlowe Day Case Area or the transplant nurses for advice, if you:

  • feel dizzy;

  • see blood in your urine; or

  • have severe back pain after returning home.

• If you have any questions about your biopsy, please contact the transplant nurses.

  • Marlowe Day Case Area
    Telephone: 01227 783100

  • Transplant Nurses
    Telephone: 01227 866443

When can I drive again?

Arrange for somebody to collect you from the hospital. Do not to drive yourself home after your procedure, or travel home by public transport. If you do not have a friend or relative who can drive you home, please tell the nurse looking after you. We will make necessary arrangements with Patient Transport Services.

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

When do I get my results?

• In urgent cases your biopsy report is made available to the doctor in 24 to 48 hours.

• In non-urgent cases we usually give you your results at your next transplant clinic appointment.

Ask 3 Questions

There may be choices to make about your healthcare. Before making any decisions, make sure you get the answers to these three questions:

• What are my choices?

• What is good and bad about each choice?

• How do I get support to help me make a decision that is right for me?

Your healthcare team needs you to tell them what is important to you. It’s all about shared decision making.

What do you think of this leaflet?

We welcome feedback, whether positive or negative, as it helps us to improve our care and services.

If you would like to give us feedback about this leaflet, please fill in our short online survey. Either scan the QR code below, or use the web link. We do not record your personal information, unless you provide contact details and would like to talk to us some more.

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• Patient Voice Team
  Telephone: 01227 868605
  Email