renal biopsy, the removal of kidney tissue for microscopic examination. It is conducted to establish the diagnosis of a renal disorder and to aid in determining the stage of the disease, the appropriate therapy, and the prognosis. An open biopsy involves an incision, permits better visualization of the kidney, and carries a lower risk of hemorrhage. A closed or percutaneous biopsy performed by aspirating a specimen of tissue with a needle requires a shorter period of recovery and is less likely to cause infection. Contraindications to percutaneous biopsy include bleeding disorders, uncontrolled hypertension, and presence of a single kidney. ▪ METHOD: Before biopsy, the procedure is explained and the patient is medically evaluated and tested for bleeding or coagulation time. Aspirin or coumadin therapy is discontinued for a period of time determined by the primary care provider. Informed consent is obtained. The patient’s blood is usually typed and crossmatched with two units of donor blood that are held for a possible transfusion until there is no threat of bleeding after the procedure. An open biopsy is generally carried out in the operating room, but the percutaneous procedure may be performed in the radiology department or the patient’s room. The location of the kidney, determined by a plain x-ray image, dye contrast study, or fluoroscopic or ultrasound examination, is marked on the patient’s skin in ink for a needle biopsy. The patient is then placed prone over a sandbag and soft pillow with the body bent at the level of the diaphragm, the shoulders on the bed, and the spine in straight alignment. A local anesthetic is injected, and the physician inserts the biopsy needle in the lower pole of the kidney, because this area contains the smallest number of large renal vessels. The needle is quickly withdrawn, and, after pressure is applied to the site for 30 to 60 minutes, a pressure bandage is applied. The patient is turned and kept supine and motionless for the next 4 hours. The dressing, blood pressure, and pulse are checked every 5 to 10 minutes for the first hour, then at frequency determined by institutional protocols. Excessive drainage, decreased blood pressure, tachycardia, or elevated temperature is reported to the physician. Fluids are forced to the maximum allotted for the patient’s condition. The amount and character of urinary output are noted, and the physician is informed if hematuria occurs. The patient is kept in bed for at least 24 hours and is cautioned not to lift any heavy objects for 10 days or to take any anticoagulants until the primary care provider gives permission. ▪ INTERVENTIONS: The nurse offers an explanation of the procedure, prepares and positions the patient for the percutaneous procedure, and, on its completion, provides care and emotional support. ▪ OUTCOME CRITERIA: A biopsy is the most accurate measure for determining the nature and stage of a renal pathological condition.
