More Needling

Last week’s blog about biopsies didn’t feel complete to me. Comments from readers indicate they felt the same way. This week, I thought I’d explore some of the issues they asked about.

The question most often asked was, “Does it hurt?” This is a tricky one since each person is unique. Let’s see what Mount Sinai had to say,

“Numbing medicine is used, so the pain during the procedure is often slight. The numbing medicine may burn or sting when first injected.

After the procedure, the area may feel tender or sore for a few days.

You may see bright, red blood in the urine during the first 24 hours after the test. If the bleeding lasts longer, tell your provider.”

Some readers have reported that they had, indeed, experienced soreness – but not necessarily pain – for several days after the procedure. On a personal note, I can sometimes have soreness from my insulin injections. Again, people are different.

Another reader wanted us to know that it was possible for a kidney biopsy to go wrong. I turned to Johns Hopkins to see what I could learn,

“As with any procedure, complications can happen including:

• Bruising and discomfort at the biopsy site
• On-going bleeding from the biopsy site, in the urine, or inside the body
• Puncture of nearby organs or structures
• Infection near the biopsy site

If the kidney biopsy is done with the aid of X-ray, the amount of radiation used is small. Therefore, the risk for radiation exposure is low.

If you are pregnant or think you may be, tell your healthcare provider. Talk to your healthcare provider about the risks to the fetus from being exposed to an X-ray. Pregnancy is not always contraindication for having a kidney biopsy. It may be important to maintain the health of the mother. Special precautions may be taken to protect both the mother and the fetus during a kidney biopsy.

You may not be able to have kidney biopsy if you have an active kidney infection, certain bleeding conditions, uncontrolled high blood pressure, or have only one working kidney.

There may be other risks depending on your specific medical condition. Be sure to raise any concerns with your healthcare provider before the procedure.”

I believe the reader in question had an infection. I can’t stress enough that although these readings report what most people experience, each of us is unique, different, and may have slightly different reactions.

As far as preparation for a kidney biopsy, The National Kidney Foundation covered that one:

“For most kidney biopsies, patients are advised to not take over-the-counter pain medicines such as aspirin, ibuprofen (Advil®, Motrin®), naproxen (Aleve®), or other medicines that may cause thinning of the blood for 2 weeks prior to the test. These medicines can change the way the blood clots and raise the risk of bleeding. For the same reason, you will likely be instructed to stop taking certain supplements such as fish oil.

Blood and urine samples are usually taken before the kidney biopsy to make sure you do not have an infection or other condition. Your doctor may also want you to change other medications before the biopsy. You may be told you should not eat or drink for eight hours before the procedure.”

I thoroughly enjoyed their use of the word ‘most’. However, I did wonder why a kidney patient would be taking NSAIDS [Nonsteroidal anti-inflammatory drugs] in the first place since they can harm your kidneys, even your transplanted kidneys.

I wasn’t that clear about the connection between bleeding and fish oil. Never fear! Mayo Clinic to the rescue,

“While generally safe, getting too much fish oil can increase your risk of bleeding and might affect your immune response. It’s not clear whether fish oil is safe for people who are allergic to seafood. Take fish oil supplements under a doctor’s supervision.”

All right, what have I left out? Let me think for a moment. Of course! Some readers wanted to know if they needed to be hospitalized for a kidney biopsy. Interestingly, some will. But most people will just need to be observed for a few hours before they go home to rest for a day or two.

I kept reading that the actual procedure takes only 15 minutes but with the preparation and the immediate after care, it takes an hour. Something else that was repeated on site after site was that that it’s preferred you don’t drive for a day or two after the procedure or operation.

A procedure refers to a medical intervention that doesn’t break the skin, while an operation does. For example, a closed [needle] biopsy is a procedure while an open biopsy is a surgery. Also, most readers thought a kidney biopsy was only used to evaluate the health of a kidney transplant. The Cleveland Clinic explained that there are other uses for a kidney biopsy,

“A kidney biopsy helps doctors identify the cause of kidney problems so they can treat the condition effectively. It can reveal scarring, inflammation (swelling), and protein deposits that cannot be identified with other tests, such as ultrasounds or blood and urine tests.”

Unfortunately, it can take anywhere from two to ten days to receive the results of the biopsy. It depends upon how many tests were being performed on the sample. As for whether or not you can go to the toilet after the test, the answer is no. You’ll be handed a bed pan. That’s so the doctor and/or nurse can see if you’re passing blood in your urine and, if so, how much. You’ll probably receive a blood transfusion if your overall blood loss is deemed too much.

I think I’ve covered everything I didn’t in last week’s blog. I urge you to remember that each patient is unique. That’s what is meant by ‘precision medicine.’ Your doctor will be the best person to make these decisions and discuss them with you.

Until next week,

Keep living your life!