Nephrotic syndrome biopsy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yazan Daaboul, Serge Korjian, Mehrian Jafarizade, M.D [2]

Ultrasound-guided renal biopsy for visualization under light microscopy, immunofluorescence or immunoperoxidase, and electron microscopy is usually recommended for patients with nephrotic syndrome.^[1] Renal biopsy provides diagnostic and prognostic benefit. However, guidelines that define the timing and the circumstances to perform renal biopsy are not present. In minimal change disease, the most common primary cause of nephrotic syndrome in children, and in diabetic nephropathy, the most common secondary cause of nephrotic syndrome in adults, renal biopsy is not generally recommended and is not routinely performed.^[2] Nonetheless, patients who present with unknown or unsure etiology of nephrotic syndrome are recommended to undergo renal biopsy for definitive diagnosis.^[2]

• Kidney biopsy is the gold standard test for the diagnosis of nephrotic syndrome.^[3]
• This method will reveal the exact cause of proteinuria.

Relative contrandications of the kidney biopsy:

• Single kidney,
• Anatomic kidney abnormalities,
• Small size kidneys (less than 9 cm), indicative of end stage renal disease
• Renal tumor
• Multiple, bilateral cysts
• Active infection in the kidney or on the skin over the biopsy side
• Uncorrectable bleeding diathesis
• Severe uncontrolled hypertension

• Hydronephrosis
• Uncooperative patient

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