Transplant and kidney-biopsy ?

[kristina]

I have a neighbour who told me that their family-member is going to donate a kidney
and they are going through the usual procedure of being checked-out for suitability.

They said the specialist might take a kidney-biopsy to do some further checks
and I would like to ask if this is a normal procedure which all kidney-donors go through,
and therefore it is nothing to worry about ?

Thanks from Kristina.

[jeannea]

I don't think that is normal for all donors. But if they have a reason, it could be necessary. Sounds awful.

[lmunchkin]

I don't know, but arent biopsies done to rule out problem or to determine what problem is?

That all sounds strange to me, but what do I know.

lmunchkin
 

[Riki]

it seems reasonable to me, if they want to be sure there isn't anything wrong with the kidney.  I'd think a biopsy would be the best way to be sure all is well, though it is rather invasive

[kristina]

Thanks for your kind replies, I appreciate them very much.

I only thought about this question,
because of my very bad experience of having had a kidney-biopsy done in 1972
and the fact that having a kidney-biopsy is a serious medical procedure.

I wonder whether the donors are really made aware of this.

They may want to willingly help someone by donating a kidney
but it carries risks before, during and after the transplant.

There does not seem to be much data on life-donor kidney-biopsies
and the recovery of the donor.

I do hope my neighbour's family have no trouble.

Thanks again from Kristina. 

[lmunchkin]

Me too, Kristina.  Just seems a bit odd, unless there is reason for it, like something giving them indication for biopsy.  There maybe more to this story than what has been told.  At least theyr'e willing to do this Kind Act!

lmunchkin
 

[Poppylicious]

Is this over here in the UK Kristina?  I didn't have to have a kidney biopsy to donate and it wasn't something that was mentioned at all during the process (at the beginning I was given a long spiel about what I could expect and a biopsy wasn't one of those things.)  I have read that a biopsy may be performed in the time between a kidney being removed from the donor and transplanted into the recepient, but I don't think that's usual either (I may be wrong.)

But yay! for your neighbour's family member!

[Riki]

I would hope that biopsy procedures have changed a bit since 1972, unless it was an open biopsy that you had, Kristina.. I don't think they do them that much anymore.

[kristina]

lmunchkin, thanks for your kind reply.
 
I have since done a little research on the Internet and it would appear
that when a donor’s kidneys appear from the tests marginal,
a nephrologist might want a biopsy as an additional check
before they make their decision to go ahead with a transplant.

Poppylicious, yes, it is in the UK (London).

First of all I do hope you and blokey have a successful recovery
and everything works out for the best for the two of you.
Thanks for your reply and best wishes for your recovery.

Riki, I naturally think about biopsy seriously because of the terrible experience
I had in 1972 when my kidney-biopsy was taken.
 
I have just found out on a medical site that a kidney-biopsy
for people with Connective Tissue Diseases like Lupus (SLE) and Mixed ConnectiveTissue Disease (MCTD)
is a very serious matter because of post-biopsy-bleeding (PBB).
 
It raises the question of what might happen to a person
who goes to a specialist with a kidney problem and the specialist says they should have a biopsy,
but what has not been established is that the person has a Connective Tissue Disease.
 
These types of diseases are often very difficult to diagnose.
My Lupus (SLE) was only diagnosed in 1995 and my MCTD was only diagnosed in 2003.

So, the patient goes for a biopsy and no one knows
that this is a very serious situation for the patient to be in.

I was lucky to have survived my kidney-biopsy in 1972 but I was told then by a Professor
that I should never have another kidney-biopsy done due to these terrible complications and PBB.

I also read that there are two types of biopsy, a needle-biopsy and a wedge-biopsy,
but I have no idea why these would be used
and what effects they might have on any patient, apart from PBB.

Thanks for your kind replies, Kristina. 

[RichardMEL]

Kristina,

Please do not take this the wrong way but you talk a lot about your biopsy (and other experiences) in the early 70's. That was *40* years ago.

Much has changed. Please keep that in mind.

Also regarding post-biosy bleeding and how serious it is. Yes, it is serious. It is also a fairly minor(I understand) occurance. I have had 3 kidney biopsies since my diagnosis - once on one of my original kidneys in 1997 and the other two on my transplanted kidney in December and January so nearly a year ago.

Each time I was warned about the (small) chance of bleeding. This is why we press down for 4 hours and not move after the procedure. They were always careful to monitor.

I am *not* dismissing what the specialist told you at all. I would like you to keep in mind that procedures and experience has moved on in the past 40 years. I never really worried when I was being biopsied and it was a pretty easy experience. Not fun mind you but not that hard either.. If it helps with a diagnosis that could help with treatment then it is definitely a good thing - but NOT something done lightly (one junior doc wanted to do a 3rd biopsy on me in April but I pushed back and the senior team agreed with me in the end).

This brings me to the biopsy of donor kidneys. This does seem unusual to me, but I would see it this way I think - if indications of an issuie were detected in a potential donor I think it would be good to know if something bad is happening via biopsy as it could affect the donor (let alone any potential for transplant).  However, it's a decision for the donor if they go through with it. I think if it was me I would do it if there was any indication of a potential issue I'd want as much info as possible. Some others may not want to, or not take the risk, and that of course is their choice.

Just my two cents.

[kellyt]

None of my testing donors (or my actual donor) had kidney biopsy's.  I don't know how "rare" this is, but it sounds like they just want to rule something out.  They will only discuss that with the prospective donor, though.  It wouldn't be something I would be worried about if I were him/her or whoever.  It has a slight risk of bleeding, but they will more than likely spend 24 hrs in the hospital to watch for that.  As a recipient I personnally welcomed any test they felt was necessary for my donor.  However, if my donor had questioned or changed her mind to donate due to a test such as a kidney biopsy that would have been her choice and I would have accepted it, although I would have been disappointed.  But they could look at it this way, if they see or suspect something is wrong with the kidney and just want to rule that out, it would be in his/her best interest to do the biopsy just in case there is something he/she needs to take care of.

Good Luck!

[rsudock]

My living donor DID NOT do a biospy either...I have never heard of this!

[kristina]

Hello, Richard, I am so sorry for the misunderstanding,
it just goes to show how difficult it is sometimes to communicate over the Internet
instead of talking “face to face” .

What I mean is this:
Of course you did not have any difficulty with your kidney biopsies
because you don’t suffer from a genetically inherited
variation of diseases like Lupus/SLE/MCTD as I do.

For you to lie down after a biopsy for 4 hours is good enough -
I had to lie down for over a week because of great complications with PBB
which endangered my fragile kidney-function which had only just recovered a little
to a fragile function after my kidney failure in 1971,
when I was found in a coma with uraemia.

The data, that a kidney-biopsy should be avoided if a patient suffers from Lupus/SLE/MCTD
has only been established in 2008, which is not that long ago.

So, I was very lucky indeed to have survived my kidney-biopsy in 1972
and had been told by the Professor who undertook my kidney-biopsy,
that I must avoid any further kidney-biopsies because of the complications I had suffered.
That was many years before my diagnosis (1995 & 2003) of a genetically inherited variation of Lupus/SLE/MCTD.

My concern is about donors who to do the “Christian good deed”
and donate a kidney/have a biopsy taken, and suffer undiagnosed from Lupus/SLE/MCTD,
because they might find themselves in great medical difficulty afterwards.

Interestingly I cannot find any data, how well or bad donors fare after donating
and I find that a little odd and alarming because we do care about patients in ESRF
but we should also care about the future-welfare of donors as well.

Added to that, doctors in the UK are not requested to take the Hippocratic Oath any longer,
so it is difficult to say where their allegiance lies?

Thank you kellyt and rsudock.

I agree with you, my neighbour’s family-member
might have some underlying medical problem which might have given cause to this suggestion.

Thanks again from Kristina.

[noahvale]

^
 

[kristina]

Welcome back, Noah Vale, and many thanks for your scientifically based support !
It is very much appreciated !

I am very glad that you have given us these few links to check out.

I have also found in my research, that patients who suffer from a disease like Lupus/SLE/MCTD etc.
are also prone to great complications when undergoing Dialysis and/or Transplant.

That is why it is so important for me to try everything to keep "my two little fighters" going :
I have no other alternative.

Another point I wish to make is, how important it is for me
to find a healthy symbiosis between me and a doctor,
whereby I would receive medical help and the doctor progresses in their learning/research.

I only have strong objections, when I am expected to become a research-item,
without having any chance to have my health being looked after,
as happened to me on too many occasions.

Thanks again for sharing your research and experience with us, Noah Vale,
it is very much appreciated.

Kind regards from Kristina.