Author: Leo
Key words: renal biopsy
² the significance of renal biopsy, mainly in the following aspects ⑵:
① clear the pathological changes of renal disease and pathological type, combined with the clinical diagnosis of the final disease;
② according to pathological changes, pathological types and severity of the development of treatment programs;
③ according to pathological changes, pathological type and severity to determine the prognosis of patients;
④ by repeated renal biopsy, to explore the law of the development of the kidney disease to determine the correct treatment or not, to continue to implement the treatment plan or provide a basis for the amendment.
² below we talk about under what circumstances need to undergo renal biopsy surgery ⑵:
1, atypical acute glomerulonephritis: a typical acute glomerulonephritis for the self-limiting disease, do not need a clear diagnosis of renal biopsy. But when the rapid deterioration of renal function, clinical manifestations similar to rapid progressive nephritis, renal biopsy should be diagnosed as soon as possible. Or renal function has been stable, but the clinical treatment of 2 - 3 months after no improvement, should also be early line of renal puncture, a clear diagnosis.
2, acute nephritis syndrome: refers to the acute progressive deterioration of renal function, in a few weeks to months the development of oliguria or anuria without renal failure ⑶, this syndrome is diverse, rapid progress, if not timely treatment, prognosis Very poor, so should be clear pathology diagnosis, and then develop a treatment program.
3, primary nephrotic syndrome: senile nephrotic syndrome, or with hematuria, hypertension, renal dysfunction in nephrotic syndrome.
4, acute renal failure: a variety of acute renal failure, if the clinical reasons are unknown, as long as there is no contraindication, should be early line of renal puncture.
5, secondary glomerular disease: a variety of secondary disease in other organs or systemic diseases as a part of the glomerular disease ⑴, are recommended first renal puncture, a clear diagnosis and pathological type Decide the treatment plan.
6, transplanted kidney: renal transplantation in renal function was significantly reduced when the cause is unclear; when the transplanted kidney rejection, clinical treatment is not good, it is difficult to decide whether to remove the transplanted kidney; when suspected kidney disease in the original Transplantation of the kidney appears, are feasible renal biopsy grafts.
As a invasive examination, there is a certain risk of renal puncture, in fact, any patient with a choice of renal biopsy, is a trade-off process. At present, the recognized renal puncture contraindications have ⑵:
1. Isolated kidney once the more serious complications, will lead to loss of the patient's only kidney without contralateral kidney compensation.
2. Obvious bleeding tendency No matter what the cause of bleeding tendency, are not appropriate for renal biopsy.
3. Severe high blood pressure in the presence of bleeding can significantly increase the chance of bleeding after the patient to extend the time to stop bleeding. As the blood pressure when the renal puncture should be under 160 / 90mmHg.
4. Mental illness In some mental illness, the patient may not be able to cooperate with the renal puncture, or renal puncture can induce some mental illness.
5. Poor posture obesity, a large number of pleural effusion or the patient's condition is not allowed to move, turn over and so on, there should not be renal biopsy.
6. Kidney infections include a variety of infections, such as active pyelonephritis, renal abscess, hydronephrosis, renal tuberculosis, perirenal abscess.
7. kidney tumor in the puncture site can not escape a variety of tumors, should not be renal biopsy.
8. kidney position is too high or walk the kidney is too high or walk the kidney in any case breathing sufferers, the patient's kidney can not reach the twelve ribs or can not be fixed position. Puncture needle can not safely reach the kidney, then should not be kidney puncture.
9. Chronic renal failure chronic renal failure has no need for pathological examination, and, due to a large number of renal fibrosis, causing a significant increase in the risk of bleeding.
10. other heart failure, shock, severe anemia, pregnancy, aging, etc., there should not be renal biopsy.
² Notes on renal biopsy ⑵:
1, for patients who have been hemodialysis, at least 24 hours before renal biopsy to stop dialysis, or line without heparin dialysis. For some patients with hypercoagulable conditions such as nephrotic syndrome and other patients, often in the renal puncture before the use of anticoagulant therapy, 2 to 3 days before renal puncture, to be disabled a variety of anticoagulant drugs and platelet inhibition drugs. Generally 3 days before and after renal biopsy intramuscular injection of vitamin k1 needles to prevent bleeding.
2, patients need to be supine after 24 hours, it is necessary to practice in the supine state before the puncture of the urine, in order to avoid the habit of not being used in bed and urinary incontinence and other unnecessary operation.
3, renal puncture generally take prone position and in the abdomen pad a height of about 250px pillow, to ensure that patients can tolerate this position. Patients need to learn to hold their breath in this position, it is best to practice the end of inspiratory end breath, breath end breath and inspiratory suffocation, usually about 20 seconds.
4, after the kidneys, need to sandbags oppression, belly binding and other means of compression puncture site to prevent bleeding. Postoperative supine 24h, can not force activities, to be stable condition, no naked eye hematuria can be under the activities. In the circumstances permit, the patient should be as much as possible to drink water, increase urine output, reduce blood clots blocked urinary tract occurred.
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