Should You Consider a Kidney Biopsy for Unexplained Renal Dysfunction?

Question about kidney disease?

Hello Dr.
Chen, I have been experiencing renal insufficiency for about 4 years now.
I have undergone an ultrasound examination, and the kidney size was normal.
Currently, I am undergoing regular follow-up checks.
My creatinine levels are around 1.7, and my blood urea nitrogen is around 24.
I have intermittent proteinuria.
The medications I am taking include (1) Diovan and (2) Calcium carbonate.
Since I am unsure of the exact cause of my condition, I previously asked my attending physician whether a biopsy is necessary to determine the cause for targeted treatment.
The attending physician stated that a biopsy would not be very helpful, as the treatment methods would remain unchanged after the examination.
They advised that regular follow-up checks are sufficient.
Do you recommend a biopsy? Thank you.

pan, 30~39 year old female. Ask Date: 2007/01/28

Dr. Chen Qiunan reply Urology

Hello Pan, based on the information you provided, there are no obvious signs of glomerulonephritis.
Generally, kidney diseases can be classified as primary or secondary.
Primary kidney diseases mostly refer to primary glomerulonephritis.
If there is proteinuria or hematuria, treatment with corticosteroids or immunosuppressive medications may be necessary.
Secondary kidney diseases are often caused by systemic conditions affecting the kidneys, with common examples including diabetes, hypertension, systemic lupus erythematosus, hyperuricemic nephropathy, and malignancies such as multiple myeloma.
Treatment of the underlying disease is essential for improving kidney function.
Other conditions such as congenital or idiopathic renal atrophy, pyelonephritis, kidney stones, and drug-induced nephrotoxicity can also lead to impaired kidney function, but monitoring or treating their complications is usually sufficient.
Since you do not have significant proteinuria, hematuria, or acute kidney function deterioration, your physician advised that monitoring is all that is needed, as there would be no change in treatment unless you develop the aforementioned conditions.
Of course, if you wish to determine the cause, a kidney biopsy may be necessary, but it carries certain risks and should be considered carefully.
If you have any questions, feel free to consult at the hospital.
Thank you, and I wish you health and happiness.

Reply Date: 2007/01/28

More Info

When considering whether to proceed with a kidney biopsy for unexplained renal dysfunction, it is essential to weigh the potential benefits against the risks and to understand the context of your specific situation. A kidney biopsy is a procedure where a small piece of kidney tissue is removed for examination under a microscope. It can provide valuable information about the underlying cause of kidney dysfunction, particularly when the cause is unclear.

In your case, you have been experiencing renal dysfunction for about four years, with creatinine levels around 1.7 mg/dL and blood urea nitrogen (BUN) levels fluctuating around 24 mg/dL. Additionally, you have noted intermittent proteinuria, which can be indicative of kidney damage or disease. The medications you are currently taking, such as Diovan (an antihypertensive) and calcium carbonate (often used for phosphate binding in chronic kidney disease), suggest that you are under management for kidney-related issues.

The decision to perform a kidney biopsy often depends on several factors:
1. Severity of Renal Dysfunction: If your kidney function is significantly impaired (e.g., a creatinine level above 1.5 mg/dL), a biopsy may be considered, especially if there are signs of glomerular disease (e.g., significant proteinuria).

2. Duration of Symptoms: Since you have had chronic renal dysfunction for several years, understanding the underlying cause could be crucial for management. A biopsy might provide insights that could alter your treatment plan.

3. Response to Treatment: If your kidney function has been stable or only mildly declining, and if your current treatment regimen is effectively managing your blood pressure and other symptoms, your physician may feel that a biopsy is not immediately necessary.

4. Potential for Change in Management: Your doctor mentioned that the results of a biopsy might not change your treatment approach. This is a critical point; if the treatment would remain the same regardless of the biopsy results, the risks associated with the procedure may outweigh the benefits.

5. Risks of the Procedure: A kidney biopsy is generally safe, but it does carry risks, including bleeding, infection, and damage to surrounding structures. These risks must be considered, especially if your kidney function is already compromised.

6. Alternative Diagnostic Tools: Sometimes, other imaging studies or laboratory tests can provide sufficient information about kidney health without the need for a biopsy. For instance, urine tests, blood tests, and imaging studies can help assess kidney structure and function.

In conclusion, while a kidney biopsy can provide valuable information, it is not always necessary, especially if the potential findings would not change your management. It is crucial to have an open discussion with your nephrologist about your concerns and the rationale behind their recommendation. If you feel uncertain or want a second opinion, consulting another nephrologist could provide additional insights into your condition and whether a biopsy is warranted. Ultimately, the decision should be made collaboratively, considering your specific clinical context, preferences, and the potential risks and benefits of the procedure.

Similar Q&A

Should You Consider a Kidney Biopsy for Unexplained Proteinuria?

Hello, doctor. I am the patient who previously inquired about "unexplained proteinuria" (I have had persistent protein in my urine for 3-4 years and am currently managing it with Aprovel and Persantin). Over the past year, during follow-up visits, my proteinuria levels ...

Dr. Wu Hongjie reply Internal Medicine
The following are common reasons for performing a kidney biopsy: At onset: 1. Clinical pure proteinuria > 3 grams/day, along with suspicion of other possible lesions within the kidneys. 2. Nephrotic syndrome occurring outside of childhood (proteinuria > 3 grams/day). Inte...

Should Kidney Issues Be Addressed by a Urologist?

Hello, doctor. My classmate has a suspected case of facial edema. After further inquiry, she mentioned that she has had kidney issues since the ninth grade. She consulted a traditional Chinese medicine practitioner and took herbal medicine for six months but stopped. After five y...

Dr. Chen Zhirong reply Urology
Hello Mandy: Your concern is the unclear boundary between nephrology and urology. In fact, the kidneys serve as the body's filters. When the filters fail to function properly, they cannot effectively remove waste from body fluids, leading to an excess of fluid retention. Thi...

Understanding Proteinuria: Should You See a Nephrologist?

Hello Doctor, during this year's employee health check, I found (+) urine protein and (+/-) occult blood. I have had similar test results in the past, but after several rechecks, they disappeared. However, I occasionally test positive again, and sometimes my white blood cell...

Dr. Yang Jun reply Internal Medicine
Hello: In response to your question, the presence of proteinuria can be classified into functional proteinuria and pathological proteinuria. Functional proteinuria may occur due to urinary tract infections, fever, infections, or during a woman's menstrual period, and it typi...

Understanding Renal Hydronephrosis: Insights on Biopsy Results and Follow-Up

Hello, Director! In October 2018, a routine health check revealed renal hydronephrosis, leading to hospitalization at a teaching hospital for further examination, including IVU, abdominal CT, and MRI. It was determined that an extrinsic tumor was compressing the ureter. A needle ...

Dr. Du Shixi reply Urology
Hello: A biopsy is simply a procedure to obtain small tissue samples to assist in diagnosis. If no malignancy is detected, the usual approach is regular monitoring. However, it cannot be guaranteed that there is absolutely no malignancy, which is why continued follow-up is necess...