A kidney biopsy in pediatrics—also called a renal biopsy—is a diagnostic procedure where a small sample of kidney tissue is removed and examined under a microscope. It helps identify the cause, severity, and progression of kidney diseases in children, especially when lab tests and imaging are inconclusive.
Indications
- Children with nephrotic syndrome not responsive to usual therapy with corticosteroids
- Progressive renal failure of obscure cause
- Undiagnosed hematuria
- Conditions, such as systemic lupus erythematosus (SLE)
- For evaluation of response to the therapy and prognosis of the disease
Equipment Needed
A sterile tray containing:
- Tru-Cut or Vim-Silverman needle with stylet
- 1% procaine or xylocaine injection
- Needle with syringe
- Antiseptic solution in a bowl
- Sterile gauze pieces
- Sponge holder
- Specimen collection container
- Pair of sterile gloves
- Center hole towel
Site for Biopsy
The usual site for biopsy is 2 cm below and median to the tip of the 12th rib (lower border)
Position Used
Prone position with head turned to a side, arms abducted, and forearms by the side of the head. A pillow or rolled up towel is placed under his abdomen.
Preparation of Child and Parents
- Explain the procedure, its consequences, and reason for performing to the parents and child as appropriate.
- Obtain a written consent from parents.
- Check out for the following:
- Every child fixed for kidney biopsy must have a plain X-ray of the abdomen, ultrasound, and an intravenous pyelogram (IVP) for ascertaining the position and size of the kidneys prior to the procedure.
- The child should be sedated prior to the procedure.
- Position the child as explained above.
Procedure
- Perform surgical hand scrub.
- Wear gloves.
- Paint the site with antiseptic solution.
- Infiltrate the site with 1% procaine injection.
- Then a 20-G long needle (about 8 cm) is inserted gradually in a sagittal plane parallel to the spine until it hits the kidney. The latter moves up and down with respiration, provided that it is in the depth to which has entered is marked and it is withdrawn.
- The track is anesthetized.
- Then, Tru-Cut or Vim-Silverman needle with stylet is introduced along the anesthetized tract, while the patient takes deep breath, till it pierces the kidney capsule.
- The position is confirmed by to and from movement of the needle with respiration.
- The stylet is removed, and the forked cutting needle is inserted to its full length.
- The child is asked to hold the breath, and the other needle is pushed deeper so that it covers fully the forked needle.
- The whole apparatus is now rotated a full circle (360°), leading to cutting in of the biopsy material from the kidney.
- Finally, the apparatus is withdrawn, and the puncture site is sealed with tincture benzoin.
Post procedure Care
- The child is kept in a supine position and observed for 24 hours.
- He should be encouraged to take enough fluids and normal diet after he is out of the sedation.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
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