Indications for renal biopsy in chronic kidney disease

Abstract

Renal biopsy carries small but definite risks The place of renal biopsy in unexplained acute renal failure and nephrotic syndrome is well established Renal biopsy may help to decide management in systemic diseases such as monoclonal immunoglobulin production and systemic lupus erythematosus In chronic renal disease with significant proteinuria, biopsy may be justified to guide decisions on immunosuppressive therapy Antihypertensive drug regimens that reduce proteinuria (typically angiotensin-converting enzyme inhibitors and angiotensin receptor blockers alone or in combination) reduce the subsequent rate of progression towards end-stage renal failure, irrespective of the histological diagnosis In suspected glomerulonephritis with haematuria but no proteinuria, there is no evidence that any form of treatment will alter the prognosis, whatever the precise histological diagnosis. Such patients must be followed long-term as a proportion develop evidence of progressive renal disease and may at that stage warrant further investigation.