Justė Čemerkaitė1, Marija Ramanauskaitė1, Simona Liolytė1
1Lithuanian University of Health Sciences, Medical Academy, Faculty of Medicine
Introduction: kidney biopsy is a procedure in which a piece of kidney tissue is taken with the help of a long thin biopsy needle. Kidney biopsy requires extensive examination of the biopsy material, including light microscopy, immunohistochemistry, or immunofluorescence, immunoperoxidase, and electron microscopy. A kidney biopsy is performed to clarify the diagnosis of suspected kidney disease, to determine the degree of kidney damage, to select the necessary treatment. This article reviews the types of kidney biopsy, the indications for the procedure, the contraindications, the technique of the procedure, the complications of the procedure, and the kidney damage caused by Covid-19 disease.
Aim: to review the sources of scientific literature related to types, indications, contraindications, performance techniques, complications of kidney biopsy and kidney biopsy findings in patients with COVID-19.
Methods: scientific literature sources were searched in PubMed, Cohrane Library databases. During the literature review, articles related to types, indications, contraindications, performance techniques, complications of kidney biopsy and kidney biopsy findings in patients with COVID-19 were selected. Certain keywords were used for the search of the most relevant articles.
Results: several types of kidney biopsy are distinguished: transjungular kidney biopsy, percutaneous kidney biopsy, and laparoscopic kidney biopsy. Percutaneous kidney biopsy is usually performed under ultrasound control. The main indications for kidney biopsy are nephrotic syndrome of unknown origin, acute nephritic syndrome, and acute kidney injury of unknown origin. The most commonly mentioned contraindications are small kidneys, having only one kidney, multiple kidney cysts or kidney tumors, irreversible bleeding diathesis, severe uncontrolled hypertension, hydronephrosis, active kidney or perirenal infection, anatomical changes in the patient, biopsy around the skin, skin infection around absence of a qualified medical specialist. Bleeding-related complications or pain usually occur after a kidney biopsy. Arteriovenous fistula or (in worst case) death is much less common. Kidney biopsy of Covid-19 patients usually reveals acute tubular damage and collapsing glomerulopathy.
Conclusions: despite the complications associated with the procedure, a kidney biopsy is needed to make an accurate diagnosis of the disease, to determine the degree of kidney damage, and to select the appropriate treatment. The use of new technologies such as ultrasound and automated biopsy needles has simplified and improved the success and safety of the procedure and led to a reduction in the risk of complications. To date, there is disagreement about the underlying pathogenetic mechanism leading to acute renal injury in SARS-CoV-2 infection, and more detailed studies are needed.
Keywords: kidney biopsy, post biopsy complication, bleeding, transjungular kidney biopsy, percutaneous kidney biopsy, laparoscopic kidney biopsy, COVID-19.