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Kidney Biopsy is a procedure in which a very tiny piece of the kidney is removed for examination under a microscope for diagnosis of the kidney disease. It may also inform us about prognosis (future course ) of the disease, severity of disease and suggest ways of treatment. The information given below is relevant for cases of native kidney biopsy.
Indications for kidney biopsy:
When urine shows high levels of protein, RBCs or other abnormalities like casts.
Unexplained acute kidney injury
Some cases of chronic kidney disease
renal transplant dysfunction
The procedure of kidney biopsy:
Patients consent is taken.
Blood group is checked.
Tests are done to see that the bleeding and clotting is normal
Ultrasonography to confirm that both kidneys are
normal or large,
more or less symmetrical,
there is no stone disease, tumour or cyst etc.
The person is made to lie down on his abdomen with the back facing up. After cleaning the area with antiseptics, the site of biopsy is injected with local anesthetic drugs. After a few minutes, a biopsy needle is gradually inserted till it is lying very close to the cortex of the kidney and the site is confirmed by USG. Then the trigger is pressed. This inserts the needle for a distance of 10-15 mm in the kidney and a piece of tissue (16 to 18 gauge in core diameter ) is trapped in the needle. The needle is then withdrawn and the site dressed in clean sterile gauze. It is pressed for a few minutes with compression of about 1to 2 kgs and patient then turned to lie on his back. His USG is checked for any bleeding after biopsy and shifted to the ward.
He is kept under observation for 24 hrs (sometimes only 6 hrs) for any complications. If none, he or she is discharged and called to attend the hospital with biopsy report.
Processing and transport of biopsy:
The tissue is sent in formalin/ glutaraldehyde or cold saline for different tests. It is usually seen by light microscope and immunofluorescent staining and if available, electron microscopy.
Risks of kidney biopsy:
The common risk is bleeding. It occurs in most cases but usually is insignificant. If a large amount of blood is lost, patient may require blood transfusion and rarely if bleeding is not controlled, the kidney may have to even be removed. Nowadays such occurrences are rare.
The biopsy site or kidney may get infected, lacerated and even deaths after biopsy have been reported. The risk of death is about 1in 1000 to 1 in 10000 at various centers.
For patients suffering from type II /adult onset diabetes :In type II diabetes, diagnosis is often late (after the disease has already been present for some time). In early days T2DM (short for the adult type of diabetes) are often without symptoms. Hence the delay in diagnosis. This means complications will be seen early after diagnosis. Foot Care :
Foot disease in diabetes may lead to difficulty in walking, pain and may lead to infections. If neglected amputation may be required.
Inspect feet with a mirror before going to sleep every night.
Use well fitting shoewear.
Do not walk bare feet even in the house.
Socks should be clean and correct size.
In case of deformities of feet, special shoes can be worn. Eye Care :
It is nowadays the commonest cause of blindness throughout the world. Continue Reading ~ Second Medical Opinion / Advice
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In the urine, the protein excretion is > 3.5 gm/day or in children, it is >50mg/kg of body weight. In most cases, the serum albumin is <3gm/dl (normal>4), and passage of lipids in the urine. The lipids in the blood increase and swelling of face and feet also occur. Causes of Nephrotic Syndrome:
In children, most cases are due to Minimal Change Disease, FSGS, MPGN etc. In adults, most cases are due to primary illness while upto 30% may be due to secondary illness. Clinical Features:
Apart from Edema, ther…
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The disease results from heightened reactivity of the airways in response to irritants, allergens, fumes and at times exercise. It is typically intermittent and a person feels well when there is no ongoing attack of asthma. Symptoms:
Symptoms of asthma are shortness of breath, difficulty in breathing, cough and whistling sounds during breathing. These symptoms may also be seen in a no of heart, lung or infective conditions. Hence the diagnosis is usually made by experienced doctors after a few episodes have occurred!
The important markers of the disease are rapid reversibility of the signs and symptoms with appropriate treatment or spontaneousl…