What is the role of renal biopsy in the workup of proteinuria?

Updated: Mar 25, 2020
  • Author: Beje Thomas, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Renal biopsy should be considered in adult patients with persistent proteinuria (usually, above 1 g per day), because the diagnostic and prognostic information yielded is likely to guide the choice of specific therapy.

In children, most cases of nephrotic syndrome are due to steroid-sensitive minimal-change disease. The clinician may reasonably assume this to be the diagnosis and give a trial of therapy, reserving biopsy for unresponsive cases.

In adult patients who have isolated proteinuria of less than 1 g/day and no other indicators of renal disease, the renal prognosis is good and the need for specific treatment is unlikely. Most nephrologists would treat these patients with nonspecific measures (see Treatment) and would proceed to biopsy only if the degree of proteinuria increases or if the patient undergoes progressive renal decline.

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