Nephrologists often encounter this dialogue:

"There are a lot of protein in your urine. Now the reason is not very clear. You'd better have a kidney biopsy. "

"biopsy! Or in the kidney, it's terrible. "

"Doctor, let me take some medicine. In fact, I don't feel sick. "

So, what is the "kidney biopsy" that sounds so "horrible"? What are you afraid of?

Why do you want to do a kidney biopsy?

Kidney is the most important excretory organ of human body, which is responsible for filtering blood, collecting all kinds of garbage and excess water in the body, and excreting it out of the body through urine to maintain the cleanliness and stability of the internal environment. Generally speaking, it is a "garbage disposal center".

It is the most "bullying" organ. Whether it is infection, poisoning, ischemia, drugs, metabolic waste or other diseases, it will eventually cause kidney damage.

Renal damage may be caused by blood or urine protein, but its internal causes are varied, and its severity, progress speed, treatment methods and final prognosis are very different. At the same time, the kidney has strong compensatory ability and often has no symptoms in the early stage; When the real symptoms appear, it is too late. Once the glomerular disease develops to the "hardening" stage, it loses the possibility of reversal.

Therefore, it is the "gold standard" for the diagnosis of renal diseases to find a way to take a little tissue from the kidney and examine it by pathological means such as microscope and immunohistochemistry.

Ultrasound-guided puncture biopsy is the most mainstream biopsy method at present.

Is there any damage in the kidney biopsy?

Answer: naturally.

Hematuria, almost 100% will appear. Most cases are only microscopic hematuria, that is, hematuria that can only be seen through examination. Less than 5% of them may have hematuria visible to the naked eye. Generally, it is necessary to extend the bed rest time without special treatment. It will disappear after a few days, and some will last for 2-3 weeks; It may even be a few days after puncture to bleed and hematuria. If there is a lot of bright red hematuria, accompanied by blood clots, or low back pain and colic, or unable to urinate, we should be very alert to massive renal hemorrhage, and need further examination, or even surgery to block renal blood vessels or remove kidneys.

Perirenal hematoma, as its name implies, is renal hemorrhage after puncture, part of which is discharged through urine and part of which accumulates around the kidney. Most of them are small hematomas, which can be absorbed by themselves without any treatment. Large hematoma, about 1.9%, can have obvious symptoms, such as low back pain, abdominal pain, nausea and vomiting, and even affect breathing. At this time, doctors and nurses should be informed to observe heart rate and blood pressure, recheck blood routine and do B-ultrasound. If a large hematoma is diagnosed, it is necessary to strictly limit activities, replenish water and transfuse blood, and even require surgical treatment. If the blood pressure and other conditions are stable, the large hematoma will absorb itself within three months.

Arteriovenous fistula, as the name suggests, can still be used. Arteries and veins were originally two independent vascular systems. Because of the man-made injury during renal puncture, the natural barrier between arteries and veins was directly opened, and a fistula was formed. Arterial blood enters the vein directly through the fistula. Most of them occur in patients with hypertension and chronic renal failure. Similarly, most of them can be closed and repaired by themselves, but there are also cases of long-term nonunion. There are often no symptoms in clinic. In severe cases, hematuria, perirenal hematoma, hypertension, low back pain, heart failure and decreased renal function may occur. Arteriovenous fistula can be found by B-ultrasound, and arterial embolization can be used if necessary.

Incidentally, kidney biopsy, like other invasive examinations, will have an indispensable procedure, conversation and signature. Many people will think that this is just a doctor's "shirking responsibility" or "scaring people", or even a broken jar. In fact, telling patients what may happen during and after surgery is to let them have psychological expectations for any situation, so as not to panic or even lose trust and miss the best response measures.

Although kidney biopsy has potential risks, are those who resolutely refuse biopsy really just worried about these possible injuries? What concerns do they have?

This "kidney" is not the other's "kidney". Many people are worried about "kidney dialysis", especially the attitude of men or parents towards boys, which is mainly a misunderstanding of "kidney". "Kidney" in traditional medicine is one of the five internal organs, which is not the same as "kidney" in modern anatomy, but more of a functional concept. It's just that Western medicine borrowed this word when it entered China. Among the five internal organs, "kidney governs essence", a popular understanding, is related to "sex and fertility". Then the "cost" of piercing the "kidney" is considerable.

Excessive medical treatment is mainly due to the subjective experience of "I have nothing uncomfortable". Indeed, as mentioned above, due to the strong compensatory ability of the kidney, not all kidney diseases will cause edema, hypertension, gross hematuria and other discomfort; More often, urine protein is accidentally found during physical examination, or serum creatinine is elevated. There is no psychological preparation for being "sick". I need to be hospitalized suddenly, and I need to take a big risk for a traumatic examination. Naturally, I will feel panic and "exaggeration".

"Can my disease be cured after renal biopsy?"

"A friend had a kidney biopsy, but he still had to take medicine. As before, the problem is still not good! "

This is a normal reaction of people: since we have paid such a big price, we always need corresponding benefits. After the operation, the disease will always get better. In fact, "renal biopsy" is only a means of examination, but also has its limitations: we only take samples from a huge sample for examination. After pathological diagnosis, our diagnosis and treatment plan may be more targeted and more effective in saving renal function; Sometimes you can only tell patients that your kidney disease is irreversible. Cruel as it is, it is a fact. Kidney biopsy is not everything.