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A kidney biopsy is a procedure to take a sample of kidney tissue. This procedure can be done for a variety of purposes, such as detecting kidney problems, checking the condition of the kidneys, and monitoring the effectiveness of treatment for kidney disease.

The kidneys are a pair of organs that have an important function to filter and remove waste products, minerals, fluids and toxins from the body through urine.

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When there is impaired kidney disease, various complications can arise, from the build-up of waste in the body to damage to the central nervous system. In order to find out the cause of kidney problems and determine the appropriate treatment, one of them can be done with a kidney biopsy.

A kidney biopsy is a procedure for taking a sample of kidney tissue for analysis under a microscope. Through this tissue sample, the doctor can find out the patient's kidney condition. Apart from being used for diagnosis, a kidney biopsy can also be used to evaluate the treatment of the kidneys.

Types of Kidney Biopsy

Kidney biopsy can be done by three methods, namely percutaneous biopsy, open biopsy, or laparoscopic biopsy. The method used will be adjusted to the patient's condition and the patient's own decision.

The following are kidney biopsy methods and their explanation:

Percutaneous biopsy

This method is the method most often used to collect kidney tissue samples. A percutaneous biopsy is performed by inserting a needle through the surface of the skin over the kidney. In the process, an ultrasound or CT scan is used to help the doctor direct the needle to a specific area of ​​the kidney.

Open biopsy

This method is usually the choice for patients who have failed to perform a percutaneous biopsy or who need more tissue samples. An open biopsy is performed by making an incision in the skin so that the kidney can be directly accessed for tissue removal.

Laparoscopic biopsy

Laparoscopic biopsy is done by making a small incision in the skin near the kidney area. Through this incision, the doctor will insert a laparoscope, which is a small tube-shaped instrument with a camera.

This biopsy can be an option for patients who have blood clotting disorders or only have one functioning kidney.

Kidney Biopsy Indications

Kidney biopsy is commonly used to diagnose nephrotic syndrome, acute nephritic syndrome, or acute renal failure with no clear cause. However, a kidney biopsy can also be performed on someone who has the following conditions:

  • Has hematuria or bloody urine
  • Experiencing albuminuria or proteinuria, which is a condition when it is known that there is excess protein in the urine
  • Has problems with kidney function, which causes the buildup of waste products in the blood
  • Have had a kidney transplant that didn't work well

Some of the objectives of a kidney biopsy are:

  • Diagnosing diseases or conditions involving the kidneys, and which cannot be identified by blood or urine tests
  • Planning treatment for diseases or conditions involving the kidneys
  • Determines the stage or progression of kidney disease
  • Monitoring the effectiveness of treatments for kidney disease
  • Monitor the follow-up condition after a kidney transplant or find out why the transplanted kidney is not working properly

Kidney Biopsy Warning

A kidney biopsy should be performed as indicated or according to the judgment and advice of a doctor. To undergo a kidney biopsy, the patient must be fully informed of his health condition so that the risk of complications can be reduced. The patient also needs to undergo several examinations before the biopsy is performed.

Kidney biopsy may be postponed or even canceled if, from the doctor's consideration or examination, the following conditions are found:

  • An immune system disorder, multiple sclerosis, or other conditions that can cause bleeding difficult to control
  • Severe hypertension, which cannot be controlled with antihypertensive drugs
  • Kidney infection
  • Skin infection in the biopsy area
  • Polycystic kidney disease (PKD)

Apart from the above conditions, doctors also do not recommend kidney biopsy in patients who have end-stage chronic kidney disease, have only one functioning kidney, have kidney deformities, or have kidney swelling due to urine accumulation (hydronephrosis).

During the kidney biopsy procedure, the doctor may perform several additional procedures, such as blood transfusions or surgery to repair damaged blood vessels. However, this rarely happens.

Before Kidney Biopsy

Before undergoing a kidney biopsy, the doctor will ask a number of questions to the patient regarding the complaints experienced, history of illnesses that have been suffered, drugs used, and history of allergies to anesthetics, latex, or other drugs.

If the patient is taking a blood thinner, such as aspirin, the doctor will ask the patient to stop using the drug.

After that, the doctor will perform a physical examination to make sure the patient is in good health. The doctor will also do a blood test or urine test to make sure the patient is not experiencing an infection or other condition that can increase the risk of complications.

Even though pregnancy is not a contraindication, it is still necessary for patients who are pregnant to notify the doctor, so that the doctor can further consider whether the condition of the mother and the fetus is safe to undergo a kidney biopsy.

For patients undergoing kidney biopsy with open biopsy or laparoscopic method, the doctor will ask the patient to fast 8 hours before the procedure. In addition, if the patient is afraid during the procedure, the doctor can give a sedative.

Kidney Biopsy Procedure

Each kidney biopsy method has a different stage of the procedure. The full explanation is as follows:

Percutaneous biopsy procedure

In a percutaneous biopsy, kidney tissue is removed using a needle that is inserted through the skin closest to the kidney. To orient the needle, the doctor will use the help of an ultrasound or CT scan.

The following are the steps that a kidney doctor takes in the percutaneous biopsy method:

  • The doctor will identify the area where the needle will be inserted with the help of an ultrasound or CT scan.
  • The doctor will clean the skin area that has been determined, then give local anesthesia so that the patient does not feel pain when the needle is inserted.
  • The doctor will make a small incision on the surface of the skin to allow the needle to enter.
  • After the needle is inserted, the patient will be asked to take a deep breath so the doctor can take a tissue sample.
  • The doctor can perform multiple needle insertions until enough kidney tissue samples are needed
  • Once a tissue sample has been obtained, the doctor will remove the needle and then press on the area to stop the bleeding.
  • The doctor will put a bandage on the biopsy area.

Open biopsy procedure

An open biopsy is performed by making a large incision in the skin near the kidney. This procedure requires general anesthesia (general anesthesia), so the patient will fall asleep and feel no pain during the procedure.

After the anesthetic has worked, the doctor will perform an open biopsy in the following steps:

  • The doctor will make an incision to access the kidney directly.
  • After the kidney is visible, the doctor will determine which part of the kidney to take a tissue sample.
  • The doctor will take the sample, then insert it into a small tube.
  • After the sample is taken, the doctor will close the incision with stitches.

Laparoscopic biopsy procedure

A laparoscopic biopsy is performed using a special instrument in the form of a camera tube called a laparoscope. The doctor will make a small incision in the skin to provide access to the device. Like open biopsy, laparoscopic biopsy also requires general anesthesia (general anesthesia).

The following are the steps for a laparoscopic biopsy:

  • The doctor will make a small incision in the abdomen or back to insert a laparoscope.
  • After the laparoscope is entered, the doctor will dispense gas to swell the abdominal cavity, so that the kidneys can be seen more clearly through the monitor.
  • The doctor will insert a cutting tool to take a tissue sample.
  • After the kidney tissue sample is taken, the doctor will remove a laparoscope and cutting tools, then remove the gas.
  • After the biopsy equipment and gas are removed, the doctor will close the incision with stitches.

After a Kidney Biopsy

After undergoing the kidney biopsy procedure, the patient will be taken to the treatment room to rest and reduce the effect of anesthesia, for about 4–6 hours. The doctor will monitor the patient's blood pressure, pulse, temperature and breathing.

Generally, patients can be allowed to go home on the same day. However, the patient must first undergo a urine test and blood test to make sure there is no bleeding or other complications.

After the biopsy, the patient's urine will usually contain a small amount of blood. This is normal. However, if the bleeding is too much, the patient needs to immediately notify the doctor so that he can be treated as soon as possible.

Even after being discharged, the patient still needs to rest completely for 1–2 days. Patients are also advised not to do strenuous activities first, such as lifting heavy weights, for at least 2 weeks after surgery.

Risk of Kidney Biopsy

Kidney biopsy is generally safe. However, it does not mean that this procedure has no risks at all. Following are some of the risks that can occur after undergoing a kidney biopsy:

  • Bleeding, redness and swelling at the biopsy area
  • Infection in the biopsy area
  • Bloody pee
  • Pain in the biopsy area
  • Arteriovenous fistula, which is the formation of an abnormal connection between two blood vessels that can occur as a result of injury from the biopsy needle
  • Hematoma

Contact your doctor immediately if you experience any of the following symptoms after a kidney biopsy:

  • Cannot urinate, but continues to feel like urinating
  • Feeling sick or hot when urinating
  • Urine is dark red or brown
  • The bandage covering the biopsy area is wet with blood or pus
  • Fever
  • Feeling weak
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