Indications for Renal Biopsy

Indications for biopsy are considered in this order, and the

first one that applies to a specimen is regarded as the main
one:

 first, nephrotic syndrome

 second, acute renal failure
 third, chronic renal failure
 fourth, hematuria
 fifth, asymptomatic proteinuria
• There are only a few indications for renal biopsy.
One indication is presence of protein in the urine, called proteinuria,
which may be asymptomatic, and detected by chance or a deliberate
search, or may be associated with edema and other features that are
collectively called the nephrotic syndrome. Another is presence of
blood in the urine, called hematuria. Others are states of reduced
renal excretory function, called acute renal failure or acute renal
impairment, and chronic renal failure or chronic renal impairment.
The diagnosis of poststreptococcal
glomerulonephritis rarely requires a renal biopsy:
• In the first week of symptoms, 90% of patients will have a depressed
CH50 and decreased levels of C3 with normal levels of C4.
• Positive rheumatoid factor (30–40%), cryoglobulins and circulating
immune complexes (60–70%), and ANCA against myeloperoxidase
(10%) are also reported.
• Positive cultures for streptococcal infection are inconsistently present
(10–70%), but increased titers of ASO (30%), anti-DNAse (70%), or
antihyaluronidase antibodies (40%) can help confirm the diagnosis.
However, atypical features in the early phase of APSGN that
suggest the need for renal biopsy include the following:
• Absence of the latent period between streptococcal infection and acute
glomerulonephritis
• Anuria
• Rapidly deteriorating renal function
• Normal serum complement levels
• No rise in antistreptococcal antibodies
• Extrarenal manifestations of systemic disease
• No improvement or continued decrease in the glomerular filtration rate at 2
weeks
• Persistence of hypertension beyond 2 weeks
Atypical features in the recovery phase that mandate a
renal biopsy include the following:
• Failure of glomerular filtration rate to normalize by 4 weeks
• Persistent hypocomplementemia beyond 6 weeks
• Persistent microscopic hematuria beyond 18 months
• Persistent proteinuria beyond 6 months