What is the role of biopsy in the workup of hematuria?

Updated: May 10, 2020
  • Author: Sanjeev Gulati, MD, MBBS, DNB(Peds), DM, DNB(Neph), FIPN(Australia), FICN, FRCPC(Canada); Chief Editor: Craig B Langman, MD  more...
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A kidney biopsy is rarely indicated in the evaluation of isolated asymptomatic hematuria. Relative indications for performing a kidney biopsy in patients with hematuria are as follows:

  • Significant proteinuria

  • Abnormal renal function

  • Recurrent persistent hematuria

  • Serologic abnormalities (abnormal complement, ANA, or dsDNA levels)

  • Recurrent gross hematuria

  • A family history of end-stage renal disease

In most patients, a renal biopsy either is normal or reveals minor changes, such as thin glomerular basement membranes, focal glomerulonephritis, or mild mesangial hypercellularity. In a minority of patients, histologic findings, together with historical or serologic data, may point to specific conditions.

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