Unique Kidney Biopsy Performed at University Hospital Martin
Doctors at the University Hospital Martin successfully performed a complex and unique kidney biopsy on a patient with a single kidney. The procedure involved a collaboration between the Transplant Center and the Radiology Clinic teams, highlighting the institution's commitment to providing specialized care.
The Transplant Center at the University Hospital Martin is not only focused on transplantations but also on clinical nephrology for non-transplanted patients. In cases where there is suspicion of a disease in a patient’s own kidneys, often glomerulonephritis, a biopsy is the only way to confirm the diagnosis and tailor appropriate treatment.
"Biopsy is an invasive procedure that has its risks, including bleeding, and in rare cases, it can even lead to the patient losing a kidney," explained Head of Department Prof. MUDr. Ivana Dedinská, PhD. Because of these risks, biopsies are usually not recommended for patients with a single kidney. However, an alternative is a transjugular biopsy, performed via a large neck vein.
"The risk of bleeding is lower with this method, but there is a high probability that the sample taken will not be representative and the pathologist will not be able to evaluate it," noted Nephrologist Ivana Dedinská.
Despite the challenges, the medical team at the University Hospital Martin managed to successfully obtain a representative sample from a patient with a solitary kidney. "The patient had a congenital condition – born with only one kidney. He developed health complications, and there was suspicion of rapidly progressing autoimmune disease, where the body's own cells were attacking the kidney, which could lead to complete failure," shared MUDr. Karol Graňák, PhD., Nephrologist from the Transplant Center, who is responsible for clinical nephrology at the center.
Taking a sample via the transjugular route proved to be much more challenging than the standard biopsy method. "In a transjugular biopsy, the challenge is to get through the venous system to the kidney's venous system. Even more complicated is that the sample is taken almost 'blindly.' When inserting the biopsy tool, it is not visible under the X-ray where the biopsy needle is heading, unlike with the standard method," explained MUDr. Karol Graňák.
Working in collaboration with MUDr. Martin Vorčák, PhD. from the Radiology Clinic at the University Hospital Martin, the team successfully obtained the sample. "The procedure is performed under sonographic and skiaskopic control by introducing an introducer into the neck vein, followed by instrumentation through the heart, through the inferior vena cava to the kidney veins," detailed Radiologist Martin Vorčák. "The transjugular kidney biopsy is usually performed from the right kidney. The peculiarity of this case was the condition of the patient with a single independent left kidney, where the procedure is technically more demanding due to the different venous anatomy. The procedure went without complications, with successful collection of a representative sample," he added.
The pathology examination confirmed a severe type of kidney involvement, allowing doctors to quickly administer the correct treatment and get the disease under control.
According to Prof. Ivana Dedinská, there are many patients with a solitary kidney, due to congenital developmental anomalies or loss of a kidney due to a tumor or other disease. "We are always trying to move forward and bring various new diagnostic and treatment options. Patients with one kidney are generally not consulted in centers regarding biopsies; their treatment is practically set blindly and they are not always treated correctly. Now they have a chance to get the right treatment," concluded Professor Ivana Dedinská.
In the Transplant Center at the University Hospital Martin, patients with non-transplanted kidneys make up to 70 percent of annual hospitalizations. Since its establishment, the medical staff has performed more than 90 biopsies of native kidneys using the standard method.