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Renal biopsy

Key sources
The following summarized guidelines for the evaluation and management of renal biopsy are prepared by our editorial team based on guidelines from the Kidney Health Australia (KHA 2019).
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Guidelines

1.Diagnostic procedures

Patient positioning: consider using the supine anterolateral position for native renal biopsy in patients with obesity or respiratory difficulty.
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  • Needle selection

  • Image guidance

2.Inpatient care

Post-biopsy monitoring: keep the patient in hospital following a renal biopsy for strict bed-rest with frequent observations for 6-24 hours. Offer a 6-8 hours period of observation with same day discharge in low-risk patients.
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  • Management of post-biopsy bleeding

3.Patient education

Patient education, pre-biopsy
Educate and inform patients and their carers about renal biopsies including reasons for its use, risks and complications, pre- and post-biopsy management with particular regard to psychological issues such as anxiety. Provide education and information in a format suited to their learning needs.
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Consider following the process outlined below to establish methods of communication and interaction with patients undergoing renal biopsy, to adequately prepare them for the procedure and alleviate unnecessary anxiety throughout the process:
Situation
Guidance
Pre-biopsy
Establish a visit plan
Deliver information for self-management pre-/post-procedure
Conduct thorough consent process outlining risks and necessity for biopsy
Biopsy
Admission - explain expected schedule
Pre-procedure - explain restrictions/timing (moving, eating, voiding), contact caregiver
Recovery - check in with patient at expected time
Discharge - explain post-procedure care, notify caregiver
All - keep informed of delays, multidisciplinary communication to manage comorbid conditions
Post-biopsy
Deliver results as soon as possible

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  • Patient education (post-biopsy)

4.Preventative measures

Prevention of post-biopsy bleeding, discontinuation of antiplatelet and anticoagulant therapy: continue aspirin in patients with high cardiovascular risks, including patients with coronary stents (particularly within 3 months of bare metal stent or 12 months of drug-eluting stent insertion), symptomatic myocardial ischemia or peripheral vascular disease (including patients with a peripheral stent), or previous ischemic stroke.
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  • Prevention of post-biopsy bleeding (desmopressin)