Clinical Guideline

RENAL BIOPSY
SETTING Bristol Royal Hospital for Children
FOR STAFF Registered Nurses/Practitioners and Non-Registered Nurses/ Nurse
Practitioners under direct supervision of a Registered nurse
PATIENTS Paediatric patients requiring a renal biopsy
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Guidance
A renal biopsy is a procedure in which a sample of kidney tissue is obtained. Microscopic
examination of the tissue can provide information needed to diagnose, monitor or treat a renal
disorder. Specific nursing management as described below is required in conjunction with the
general pre and post-operative care nursing guideline. Significant risk is of bleeding from
biopsy site/via urethra.

Pre Biopsy
• Obtain a pre-biopsy urine specimen, perform urinalysis and keep for post-biopsy
comparison
• Baseline observations to include weight, height, blood pressure (BP) and vital signs

Post Biopsy
• Patient must lie flat on their back for a minimum of 6 hours (or until directed by medical
staff). Patient may require continued bed rest for up to 24 hours post-biopsy if
complications develop
• Observations: Assess and record as follows:
o Vital signs: Pulse, respiration rate and BP
 ¼ hourly for 1 hour
 Then if stable ½ hourly for 3 hours
 Then if stable 1 hourly for 2 hours
 Subsequent 4 hourly observations if indicated
 Temperature 3-4 hourly
o Biopsy site: Watch for any signs of bleeding, oozing, redness or swelling
 On return to the ward
 Repeat hourly for six hours or as condition dictates
o Urine sample colour: need minimum one urine sample without new onset/
increased frank blood post-biopsy:
 Keep specimen each time to compare colour with pre biopsy
sample
 Report if urine appears more blood stained
o Document and inform renal team of any concerns
• Encourage oral intake as directed by renal team and keep strict fluid balance. If patient
unable to tolerate adequate oral fluid intake, intravenous fluids should be considered
• Administer prescribed medication as per Trust policy and monitor effect. For simple
analgesia use paracetamol, not ibuprofen (NSAIDs)
• Post-transplant biopsy patients are to stay overnight regardless of what time the
procedure was undertaken

Version 4.1 From May 2023- May 2026 Author(s): Renal nursing team, Dr M Mraz Consultant Paediatric Nephrologist,

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 Red flags: Signs/Symptoms that warrant seeking urgent medical
review
Contact renal registrar (bleep 2938 or ext 28337/28717) or consultant paediatric nephrologist
via switchboard if:

• Frank blood in urine (newly appeared)

• Pain not responding to paracetamol
• Tachycardia
• Hypotension

Nurse-led discharge
On discussion with the medical team, clarify if the patient fits nurse-led discharge criteria:

Criteria Action / rationale

Clarify for nurse-led discharge Discussion with Medical team Yes/ No
All observations satisfactory for Check for signs of infection Yes/ No
patient

Apyrexial

Blood pressure within normal Check signs of hypertension

limits for child (check with medics /hypotension
for limits set)

Adequate fluid intake and fluid Keep strict fluid balance Yes/ No
balance
Child has remained flat for 6 To reduce risk of bleeding Yes/ No
hours

Check biopsy site Check no signs of bleeding, Yes/ No

Check urine
All documentation up to date
oozing, redness or swelling
Need minimum one urine Yes/ No
sample without new onset /
increased frank blood post-
biopsy
As per UHBW documentation Yes/No

Version 4.1 From May 2023- May 2026 Author(s): Renal nursing team, Dr M Mraz Consultant Paediatric Nephrologist,

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 Appendix x – Evidence of Learning from Incidents

The following table sets out any incidents/ cases which informed either the creation of this
document or from which changes to the existing version have been made.

Incidents Summary of Learning

Table A
REFERENCES

RELATED General Pre and Post-Operative Care Nursing Guideline

DOCUMENTS Peripheral Cannula Nursing Guideline & Record of Care
AND PAGES Central Venous Catheter Clinical Guidelines
Medicines Code Chapter M9: Administration of Medicines
InfoKid Renal Biopsy Information Sheet

AUTHORISING BCH Nurse Practice Group

BODY

SAFETY Risk of bleeding and infection

QUERIES AND Renal team ext 28337
CONTACT Children Critical Care Outreach Team Bleep 2968

AUDIT
REQUIREMENTS

Version 4.1 From May 2023- May 2026 Author(s): Renal nursing team, Dr M Mraz Consultant Paediatric Nephrologist,

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 Plan Elements Plan Details

The Dissemination Lead is: Nurse Practice Group

Is this document: A – replacing the A

same titled, expired guideline, B –
replacing an alternative guideline, C –
a new Guideline:

If answer above is B: Alternative

documentation this guideline will
replace (if applicable):

This document is to be disseminated Renal team

to:

Method of dissemination: Via DMS

Is training required and how will this

be delivered:

Document Change
Control

Date of Version Lead for Type of Description of Revision

Version Number Revisions Revision
May 2023 4.1 Nurse Practice Minor Reviewed, minor formatting changes
Group

Version 4.1 From May 2023- May 2026 Author(s): Renal nursing team, Dr M Mraz Consultant Paediatric Nephrologist,

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