What are the contraindications for renal biopsy?

Although renal biopsy is the "gold standard" for examining kidney disease, there are also many contraindications that need to be paid attention to. Today we will take you to learn about these 10 common contraindications in detail.

1. Obvious bleeding tendency

Renal insufficiency or combined with severe liver damage, blood system diseases and other coagulation or hemostasis disorders. In addition, recent use of anticoagulants or antiplatelet drugs will also affect coagulation and even cause obvious bleeding tendency, such as hemodialysis treatment, less than 24 hours after heparin anticoagulation.

2. People with mental illness cannot cooperate

Renal puncture biopsy requires the active cooperation of the patient. Those who cannot cooperate due to mental illness will not only reduce the success rate of renal puncture sampling, but may also increase the incidence of complications such as postoperative bleeding. Therefore, it is listed as an absolute contraindication.

3. Kidney infection

When combined with renal infectious diseases (such as acute pyelonephritis, renal abscess, perinephric abscess, renal tuberculosis, hydronephrosis, etc.), renal puncture biopsy can lead to the spread of infection and inflammation, thereby aggravating the condition. Therefore, renal puncture biopsy should be considered only after the infection is effectively controlled.

4. Solitary kidney

There is still controversy as to whether fox kidney is an absolute contraindication for renal puncture biopsy. Most people believe that renal puncture is too risky for patients with solitary kidney, and surgical complications may cause the patient's only kidney to lose function, so it is listed as an absolute contraindication for renal puncture. There are also different opinions that the current renal puncture technology is relatively mature and the safety of renal puncture is constantly improving, so renal puncture biopsy can be performed after strict preoperative preparation.

5. Kidney atrophy

For patients with renal atrophy due to chronic renal insufficiency and a long diameter of less than 8 cm, the incidence of renal puncture bleeding is extremely high, and the function of the atrophic kidney is greatly reduced. Even if a renal puncture biopsy can make a clear diagnosis, it has limited effect on the subsequent treatment of the disease and the disease itself due to obvious chronic lesions. Therefore, patients with a long diameter of less than 8 cm should not undergo renal puncture biopsy.

6. Severe uncontrolled hypertension

Patients with severe hypertension have poor vascular conditions, and renal puncture biopsy may increase the risk of bleeding. This was considered an absolute contraindication for renal puncture in the past. With the continuous improvement of renal puncture biopsy technology, blood pressure can be controlled within a relatively safe range, and renal puncture biopsy can be performed with adequate preoperative preparation.

7. Polycystic kidney disease

When patients with polycystic kidney disease undergo renal puncture biopsy, secondary infection may occur when the puncture needle punctures the cyst, so renal puncture biopsy is not recommended. However, in cases of solitary cysts and renal artery aneurysms, renal puncture biopsy can be performed under real-time ultrasound guidance to avoid space-occupying lesions.

8. Wandering kidney or kidney located too high

During renal puncture biopsy in patients with wandering kidney, the position of the kidney cannot be fixed, which increases the difficulty of the operation and the incidence of complications. If the kidney is too high, it is difficult for the puncture needle to safely penetrate the renal parenchyma to obtain samples, so renal puncture biopsy is not suitable.

9. Poor posture

Renal biopsy is not recommended for patients who are unable to maintain a prone position due to large amounts of pleural effusion, morbid obesity, or respiratory diseases.

10. Others

Renal puncture biopsy should be carefully considered in patients with horseshoe kidney, arteriovenous fistula, severe anemia, heart failure, severe cough, pregnancy, skin disease at the puncture site, elderly age, kidney tumors, etc.