Lawrence Nguyen
1 
, Sami Souccar
2 , Jonathan E. Zuckerman
3, Joline L. T. Chen
1,4 , James Katrivesis
5 , Nadine Abi-Jaoudeh
5, Lisa X Lee
6 , Uttam Reddy
1 , Afshan Baraghoush
7 , Debra E. Morrison
8 , Xiaodong Li
2 , Beverly Wang
2 , Wei Ling Lau
1* 1 Division of Nephrology, Department of Medicine, University of California, Irvine, CA, USA
2 Department of Pathology, University of California, Irvine, CA, USA
3 3Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
4 4Nephrology Section, Long Beach Veteran Affairs Healthcare System, Long Beach, CA, USA
5 5Department of Radiological Sciences, University of California, Irvine, CA, USA
6 Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, CA, USA
7 Department of Medicine, University of California, Irvine, CA, USA
8 Department of Anesthesiology, University of California, Irvine, CA, USA
Abstract
Native kidney biopsies are high-risk for bleeding complications due to the vascularity of the kidney and the inability to compress the biopsy site within a deep retroperitoneal location. Recommended parameters to minimize bleeding risk include a platelet count above 100 x 109 /L, hemoglobin above 10 g/dL, systolic blood pressure <140 mm Hg, and minimizing the number of biopsy cores. In this paper we present patient cases to discuss management of other factors pertinent to kidney biopsy planning including interruption of anticoagulation, treatment of anxiety which can elevate blood pressure, and use of Doppler. Undiagnosed chronic kidney disease can affect triaging of tissue to light, immunofluorescence and electron microscopy, as sclerosed glomeruli are difficult to visualize in fresh cores. It is recommended to have a back-up retrieval protocol in place to obtain immunofluorescence and electron microscopy results, in the event that only limited kidney tissue was acquired for light histology. A collaborative effort between nephrology, interventional radiology and pathology is essential to optimize the diagnostic yield while minimizing bleeding risk with kidney biopsies. Of paramount importance is physician judgment of whether there is an acceptable balance of benefits/risks to proceed with a kidney biopsy.