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Kidney biopsy is an essential diagnostic procedure in the field of nephrology. Kidney disease has a noticeable effect on a patient's general health and can also be detected by the blood and urine tests taken. Imaging tests (renal ultrasound, CT scan and nuclear magnetic resonance imaging) provide information for diagnosing kidney disease, but the essential and indisputable test to be able to reach a diagnosis of kidney disease is a kidney biopsy.
This consists of extracting a very small sample of kidney tissue, just a millimetre or so in size, with a special needle. The needle is guided by ultrasound and under local anaesthetic with or without sedation, depending on the characteristics of the patient.
The sample obtained is processed by the Pathological Anatomy Department for observation using optical microscope, fluorescence microscope and electronic microscope techniques. This enables different parts of the kidney to be observed: the glomerulus, the tubule, and the blood vessels. Special liquids can also be used to reveal infections and toxicity produced by different medicines.
This is very useful both for diagnosing disease in the kidneys themselves, as well as a test to monitor a kidney transplant.
Although a kidney biopsy is not without complications worth mentioning, they occur rarely and can be resolved. Urine may contain blood, for example, although this generally stops by itself. Renal haematoma may also occur, which also does not require treatment. Accidental communication between an artery and a vein may also occur, which can be repaired via catheterization to close the anomalous communication.
Kidney biopsy is a common procedure in the Nephrology Department and complications occur in around 1-2% of cases, which are subsequently resolved. It is therefore considered a safe routine procedure.
Analytical testing provides a lot of information which enables the origin and severity of the kidney disease to be established. A kidney biopsy allows a microscopic study that is often essential. Genetic testing also provides very important information.
These tests serve to determine the origin of the kidney disease. There are many causes that may be genetic or acquired via a bacterial or viral infection, or resulting from a metabolic disease (diabetes) or an autoimmune disease such as lupus.
In addition to blood and urine tests, a kidney biopsy and/or a genetic analysis, imaging tests can also be useful.
A kidney biopsy may produce minimal bleeding that almost always stops by itself. If it doesn't, it can be controlled using an interventional radiology procedure, whereby the kidney is catheterised to close the area of bleeding. Genetic testing is increasingly used to decrease the need for a kidney biopsy. However, kidney biopsy continues to be the main diagnostic method for kidney disease.
Spinal taps are used to extract samples from the cerebrospinal fluid, which is a substance that surrounds the brain and spinal column and protects them from possible injuries. This contact means that when there is a process that affects these body parts, the liquid is altered and we can detect it by analysing it.
Using cerebrospinal fluid, we can measure pressure and take samples to perform different tests.
Thanks to these tests, several diseases can be diagnosed, such as neurological disorders and infections that affect the brain or bone marrow.
Spinal taps, or lumbar punctures, involve taking a sample of cerebrospinal fluid through the puncture with a needle in the lumbar area.
It is usually done with patients in the foetal position: lying on their sides with legs flexed so the knees touch the chest. Sometimes, the puncture is done with the person sitting and leaning forward.
Once the patient is in place, the area where the puncture is to be done is cleansed and disinfected. After administering anaesthesia, the puncture is performed between the two lumbar vertebrae with a spinal needle.
After this, we measure the pressure of the cerebrospinal fluid and take the sample, which will be from 1 to 10 ml.
The needle is then removed, the puncture zone cleaned and a bandage placed over the puncture area. Sometimes patients need to lie down for a while.
Spinal taps are the least aggressive way to get a sample of cerebrospinal fluid. Study of this liquid is essential to detect certain diseases that affect the brain and the spinal cord.
The stress test, also called ergometry, involves performing physical exercise with an exercise bike or a treadmill. Thanks to this technique, the specialist can diagnose or study an illness that has already been diagnosed that might not manifest itself when the patients are resting.
It is used to diagnose cardiovascular and respiratory diseases that usually do not manifest in resting conditions or to study the progress and condition of an illness that has already been diagnosed.
Before performing the stress test, two electrocardiograms must be taken, one with the patient lying down and the other with the patient standing up.
Afterwards, the test is performed during which the patient must exercise on a treadmill or exercise bike. As the test progresses, the difficulty increases gradually, in accordance with an established protocol. The duration of the test is 6 to 12 minutes, during which continuous electrocardiographic monitoring is taken and hypertension is measured several times.
During the test, the specialist should be especially careful at the point of maximum effort to detect angina and difficulties breathing or finishing the test.
Changes in the heart beat and blood pressure can sometimes appear
This test is performed to check if there are alterations in the motility (movements) of the stomach and the small intestine when fasting and after eating.
The gastrointestinal manometry allows us to detect changes in the movement of the oesophagus, as well as making sure the oesophageal sphincter opens and closes properly to allow food to pass properly from mouth to stomach. It is also useful for assessing the condition of the inner oesophageal sphincter and making sure it closes properly in people who suffer from acidity, heart burn, retrosternal pain or repetitive pneumonia. It also allows us to check the results of some treatments, surgical or otherwise, that affect stomach motility.
Firstly, a thin tube is inserted through the mouth that connects to a device that records the movements, a.k.a. motility, of the small intestine. We then check the device is placed properly using an x-ray.
During the test, patients should be lying down on a bed and given a light meal that they can easily swallow.
This test lasts an average of 6 hours.
Once the test is done, the professional interprets the results in order to define or discard a diagnosis.
The process of placing the probe is uncomfortable and can cause nausea, which disappears when the probe is in the right position.
It is a diagnostic test for patients with heart disease, or suspected heart disease, who have heart beat disorders, known as "arrhythmias." This technique allows us to know the type and severity of the arrhythmias, the place in the heart where they originate from and the disorders they produce, meaning we can better focus treatment.
To conduct an electrophysiological study, it is necessary for patients to have fasted, and they must be conscious, sedated and lying down. Once in the examination room, local anaesthesia is applied to the area of the skin where the puncture will be performed, which is usually the groin, the arm or the neck.
Through the veins or arteries where the puncture has been made, several catheters (very thin, long, flexible cables) that go to the heart, always under radioscopic control, are inserted. The catheters are used to constantly record the electrical activity of the heart from inside. They also serve as pacemakers, when they are connected to an external stimulating device. Sometimes it is necessary to administer a drug during the test to diagnose arrhythmia.
The duration of the study depends, and once the test is performed, the patient must rest in bed for a few hours.
It is common for patients to notice palpitations at many moments during the examination, as they may be caused by catheters or by the medication administered. Sometimes it may be necessary to apply an electric shock to solve a sudden problem. Most of the time the patient will only feel a slight discomfort in the puncture area, and bruising may occur, which will normally disappear on its own. Other complications related to the procedure (phlebitis, venous or arterial thrombosis, vascular complications requiring surgery, haemorrhages requiring transfusion, cardiac perforation with difficulty breathing, pulmonary or systemic embolism) are uncommon, although some of these are serious and require urgent action. The risk of death is highly unlikely (1 in 3,000).
Other risks or complications that could appear, given the clinical situation and personal circumstances.
Given your clinical condition, the benefits from performing this test far outweigh any possible risks. If complications appear, the medical and nursing staff on hand are qualified and able to try to solve them.
Endoscopy with endoscopic capsule is used to study the intestines. In order to perform this exploration, patients must swallow a small capsule that travels naturally through the gut. As it makes its way down, this capsule collects images that are studied later.
To do this test, sensors are placed in the abdomen of the patient along with a belt with a recorder with a battery. The patient then takes the capsule with some water. The study will last 8 hours, during which the person having the test done cannot perform any activities that involve stretching, abrupt physical exertion, bending or carry out any physical activity.
The capsule comes out with the patient’s stool, but the images it has taken are saved on the recorder that the patient is wearing on a belt.
The patient must inform the doctor of all medication he/she is taking, in order to make any necessary adjustments. Also remember to follow the instructions of the professionals relating to what solids and liquids to consume before and after the test.
During the procedure, patients cannot go near areas with strong electromagnetic fields, such as amateur radio equipment or magnetic resonance imaging.
Once the endoscopy with capsule is done, patients must check their stools to make sure the capsule has been expelled properly.
The aim of the electrocardiogram is to determine any damage to the heart and the effects of medication and devices on the circulatory system’s main organ, as well as being very useful in detecting and analysing cardiac arrhythmias, acute episodes of coronary artery disease and myocardial infarction. It can also be used in preoperative examinations, especially in medium- and high-complexity surgery, if there are risk factors such as ischemic heart disease, diabetes, stroke, heart failure or renal dysfunction.
To carry out the test, the healthcare professional connects the wires of the electrocardiogram to the skin of the patient using adhesives or suction cups called "electrodes", which are connected to the ankles, wrists and chest in order to detect electrical impulses from different parts of the body.
During the electrocardiogram, the patient must be lying down, relaxed and silent, with normal breathing and with their arms and legs still. Occasionally, the doctor may ask the patient to hold their breath for a few seconds.
The electrocardiogram records electrical activity from the surface of the heart, thanks to electrodes that are stuck to the body. This record of electrical activity is then copied onto paper that is then interpreted by a professional based on the patient’s symptoms and clinical history.
It is a simple, fast test that causes no discomfort or pain. It poses no risk to patients.
The computed tomography, also known as a "CT" or "CAT scan", is a test that gives morphological information on different types of tissues: bones, lungs, brain, liver, blood vessels and soft tissues etc.. This test lets us diagnose cardiovascular diseases, infections, musculoskeletal disorders, cancer and infections, as well as track progress and plan medical and surgical treatments, if necessary.
In order to do the test, the patient must lie down on the CT stretcher. The patient then moves through the interior of the device. Depending on the part of the body being examined, the patient may be aware of this movement or not.
While this radiological exploration is taking place, a contrast medium (iodine) is administered into a vein, though the patient will not even notice this as it is completely painless. You will be accompanied at all times by health professionals who will be on hand to help you and answer any questions you have.
Once the test has been completed, the radiologist, who is a specialist in CT scans and other radiological exams, will interpret the images and provide a report for the specialist who requested the test.
There is no risk involved, unless the patient is intolerant or especially sensitive to any of the components of the contrast substance.
However, there may be risks if the patient has some illnesses, but this will depend on each individual case. In addition, there are the risks for certain people, that are common to all radiological explorations with contrast:
Fibrocolonoscopy, or colonoscopy is an exploration that is performed to examine the large or small intestine or, if necessary, the final part of the small intestine.
If you are a diabetic patient, check with your doctor to find out about the medication guidelines you should follow.
The duration of this test is usually no longer than 30 minutes, as long as no therapeutic treatments are performed.
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