Essentials of Clinical Nephrology (Shorouk Press, Cairo, 2000, ISBN ...

Indications:
For all adults with nephrotic syndrome, children with steroid resistant
nephrotic syndrome and patients with renal impairment of unknown etiology.
Precautions and Technique:
Assure that the patient has two functioning kidneys, a normal
coagulation profile (bleeding, clotting, prothrombin time), controlled blood
pressure and gave an informed consent.
Patient lies in prone position with a pillow under the rib cage pressing the
kidney back to posterior abdominal wall. Skin over the right kidney is sterilized
and lower pole of the kidney is localized in deep inspiration by real-time
ultrasound. Local anaesthetic is injected subcutaneously and along the biopsy
track. Under ultrasound guidance a tru-cut biopsy needle is introduced while
the patient is holding his breath in deep inspiration and core of kidney tissue
is obtained from the cortex of the lower pole. Two cores are usually taken for
light, immunofluorescent and electron microscopy. Firm pressure is applied
over biopsy site for 10 minutes. After biopsy the patient should be kept in
supine position for at least four hours with observation every 30 minutes for
pulse, blood pressure and for haematuria. The patient should be kept in bed
for 24 hours with no strenuous activity for two weeks.
Complications:
1. Peri-renal haematoma which is extremely common but of significance
only in 1% of cases.
2. Bleeding which could be microscopic or gross with clot retention.
3. Intra-renal A-V fistula which usually closes spontaneously.
E. RADIOLOGIC EXAMINATION OF THE KIDNEY AND THE URINARY
TRACT
During the last decade a great progress has been achieved in imaging
techniques of the kidney and urinary tract. We have to select the procedure
which is the simplest, least invasive, most informative and which saves time
for the patient.
1. Ultrasonography (U.S.)
Ultrasound examination of the kidney and urinary tract is either through
B-mode scan, Doppler flow examination of renal vessels or duplex ultrasound
scanning.