Diagnosis of renal parenchymal diseases by a modified open kidney biopsy technique

Diagnostic work-up and specific causes of acute kidney injury

Acute kidney injury (AKI) is common in critically ill patients and associated with grim short- and long-term outcome. Although in the vast majority of cases AKI is multifactorial, with sepsis, shock and nephrotoxicity accounting for most episodes, specific causes of AKI are not uncommon. Despite remaining uncertainties regarding their prevalence in the ICU, prompt recognition of specific aetiologies of AKI is likely to ensure timely management, limit worsening of renal dysfunction, and ultimately limit renal and systemic consequences of AKI. The ability to recognize conditions that may be associated with specific aetiologies and the appropriate use of clinical imaging, biological and immunological tests, along with optimal assessment of the need for renal biopsies, should be part of routine ICU care. In this review, we summarize uncertainties, current knowledge and recent advances regarding specific types of AKI. We describe the most common specific causes as well as rare aetiologies requiring urgent management, and outline available tools that may be used during the diagnostic work-up along with their limitations.

Renal biopsy in high-risk patients with medical diseases of the kidney

The number of high-risk patients undergoing renal biopsy is likely to increase in the near future because of the increased use of anticoagulants for such conditions as atrial fibrillation, combined liver and kidney disease caused by hepatitis C, and the aging of the population. Nephrologists need to become increasingly familiar with evaluating such patients through both specialized management of percutaneous kidney biopsy and alternate methods of renal biopsy, which primarily consist of open (surgical) biopsy, transjugular (transvenous) biopsy, and laparoscopic biopsy. The indications, complications, and general approach to such patients are discussed. This is a US government work. There are no restrictions on its use.

Laparoscopic renal biopsy via retroperitoneal approach

Renal biopsy was performed in 17 patients using the balloon technique of endoscopy of the retroperitoneum. There was good exposure of the kidney and a sufficient amount of renal tissue was obtained in all patients with minimum postoperative morbidity. The preliminary results show that this method could become a safe and reliable alternative to open surgical biopsy.

Transjugular renal biopsy

A novel technique to obtain renal biopsy specimens from patients in whom percutaneous renal biopsy is contraindicated is described. After adaptation of equipment used for transjugular liver biopsy, 50 such patients underwent transjugular renal biopsy: specimens of renal tissue were obtained from 44 patients, and glomeruli were found in 38 specimens. No major complications were observed and histological examination of the biopsy specimens led to changed diagnosis or management in 13 patients. Transvenous renal biopsy should be considered when percutaneous biopsy is contraindicated or has failed.