What is the role of renal biopsy in the workup of acute kidney injury (AKI)?

Updated: Dec 24, 2020
  • Author: Biruh T Workeneh, MD, PhD, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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A renal biopsy can be useful in identifying intrarenal causes of AKI and can be justified if the results may change management (eg, initiation of immunosuppressive medications). See the image below.  A renal biopsy may also be indicated when renal function does not return for a prolonged period and a prognosis is required to develop long-term management. In as many as 40% of cases, renal biopsy results reveal an unexpected diagnosis.

Acute cellular or humoral rejection in a transplanted kidney can be definitively diagnosed only by performing a renal biopsy.

Photomicrograph of a renal biopsy specimen shows r Photomicrograph of a renal biopsy specimen shows renal medulla, which is composed mainly of renal tubules. Features suggesting acute tubular necrosis are the patchy or diffuse denudation of the renal tubular cells with loss of brush border (blue arrows); flattening of the renal tubular cells due to tubular dilation (orange arrows); intratubular cast formation (yellow arrows); and sloughing of cells, which is responsible for the formation of granular casts (red arrow). Finally, intratubular obstruction due to the denuded epithelium and cellular debris is evident (green arrow); note that the denuded tubular epithelial cells clump together because of rearrangement of intercellular adhesion molecules.

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