RENAL UNIT PROTOCOL FOR
THE NURSING CARE & MANGEMENT OF A RENAL BIOPSY
APPROVAL/ADOPTION Renal Documentation Committee
DATE FOR REVIEW October 1st 2006
DISTRIBUTION All Renal Nursing Staff; Renal Medical Staff
RELATED POLICIES Hitchhikers Guide to the South West Thames
AUTHOR/FURTHER INFORMATION Rachel Addy 0208 296 4841
THIS DOCUMENT REPLACES
TOPIC Renal investigations
SUB TOPICS Renal Biopsy
CARE GROUP Renal in-patients
A percutaneous renal biopsy may be carried out for a number of reasons,
including establishment of the exact underlying renal disease, to offer a
prognosis of longer-term kidney function, as an aid to determine therapy, and to
monitor kidney transplant function/rejection.
Indications for biopsy include:
• Acute renal failure with no obvious cause
• Chronic renal failure with normal sized kidneys and no obvious
• Some patients with proteinuria and haematuria
• Renal transplant dysfunction (Stein et al, 2004)
Bleeding is the primary complication of a renal biopsy (EdRen, 2004). The
incidence can be minimised by assessment of coagulation, full blood count,
avoidance of aspirin and non-steroidal anti-inflammatory drugs one week before
the scheduled biopsy, stoppage of heparin one day prior to the procedure and
detailed ultrasound imaging prior to biopsy to assess kidney size and anatomy.
Post biopsy bleeding can occur in three sites:
• Collecting system – leading to microscopic/ or gross haematuria.
• Underneath renal capsule, leading to pressure and pain.
• Bleeding into perinephric space
Renal Nursing and Medical Staff
The policy provides the rationale of the procedure and outlines the nursing care
and management of the patient pre, peri and post renal biopsy.
The patient should have the opportunity to discuss the benefits and risks of the
procedure before written consent is obtained.
The biopsy is usually performed with real time ultrasound under local
anaesthetic. The optimum time for a renal biopsy is in the morning so that
relevant emergency services are available should they be needed (Stein et al,
Following the procedure, a pressure dressing is applied and the patient is asked
to remain flat in bed. The following post-biopsy observations are recommended:
• ¼ hourly pulse and blood pressure – 1 hour
• ½ hourly pulse and blood pressure – 2 hours
• 1 Hourly pulse and blood pressure - 4 hours
• 4 Hourly pulse and blood pressure - as per inpatient regime
There should be observation of haematuria and the first urine sample post-biopsy
should be tested for blood. The biopsy site should be tested regularly for
bleeding and tenderness. The patient can be asked to assess their pain on a
verbal scale of 1-10 where nought equals no pain and 10 equals excruciating
Any abnormal observations should be reported to the nurse in charge and doctor
Following a survey of all renal units in the UK, Richardson (2004) found that the
most common practice following biopsy was supine bed rest for 3-6 hours and
non-supine bed rest for 0-2 hours. Recommendations for nursing care are
• Supine bed rest for 6 hours
• Followed by normal bed-rest for another six hours.
• In-patient observation to last for 24 hours (if the biopsy has not been carried
out as a day-case).
Day case biopsies
There is a weekly day case biopsy list carried out on Wednesday mornings.
Whether a biopsy can safely be performed as a day case will be at the discretion
of the responsible consultant.
Consider patient for day case procedure (native and transplant) if all of following
criteria are met:
• INR < 1.2, APTTR < 1.2, platelets > 150, BP < 140/90, Hb > 10
• not on anticoagulation
• aspirin stopped for 7 days
• 2 kidneys, > 10 cm
• not obese
• eGFR > 30
• there is a responsible adult at home to support and care for patient
during first 48 hours post discharge from hospital.
Patient should not be day case if the procedure is within first six weeks of
transplant, or if there is delayed graft function. Biopsy to be performed by
midday at very latest. There must be 6 hours minimum of observation. Admit
patient if any instability with observations, macroscopic haematuria, or significant
A nurse will be booked and post biopsy observations will be in the procedure
Biopsies should be booked into the Procedures Room on Beacon ward, and
specified at the time as daycase. This should allow definite date to be given to
Two monthly prospective audit data will be collected by a Specialist Registrar.
3. References and further reading
Donovan, K (2004) Undertaking Renal Biopsy as a Day Case Procedure. British
Journal of Renal Medicine. Vol.9 - No.1.
EdRen 2004 Renal biopsy guidelines. www.EdRen.org, Edinburgh.
Hall, C et. al (2004) Achieving Best Practice - A Review of 301 Renal Biopsies.
British Journal of Renal Medicine. Vol.9 - No. 2.
Marwah D.S. Korbet SM. (1996) Timing of complications of percutaneous renal
biopsy: What is the optimal period of observation. American Journal Kidney
Parish A.E. (1992) Complications of percutaneous renal biopsy: A review of 37
years experience. Clinical Nephrology 38: 135
Stein, A., Wild, J., Cook, P. (2004) Vital Nephrology. Roche Products Ltd.
Whittier WL and Korbet SM (2004) Timing of Complications in Percutaneous
Renal Biopsy. J Am Soc Nephrol 15: 142-47