A kidney biopsy is a medical test, where a small sample of tissue is removed from your kidney with a needle. The sample is then sent to the pathology department where it is examined under a microscope.

A kidney biopsy helps to assess and diagnose the problem, if any, in your kidney. Kidney biopsies are usually done for one of three reasons.

1. To find out why a kidney is not functioning properly.
2. To get a sample of a mass on a kidney.
3. To assess a kidney before a kidney transplant.

The importance of a kidney biopsy is that it allows for the kidney cells to be assessed by a pathologist to help make a correct diagnosis and plan any necessary treatment.

There is no other procedure that will give your doctor the same information as a kidney biopsy.

A kidney biopsy is usually a safe procedure. Potential complications are uncommon and include:

• Some people experience pain, which is usually not severe and can be controlled with simple painkillers.
• Bleeding or bruising around the puncture site which should settle down by itself.
• There is a small risk of minor internal bleeding after the biopsy. The risk is around 1 in 20 and will usually settle down by itself. The nurse will monitor your blood pressure and pulse during and after the procedure and you will stay in hospital for up to five hours after the procedure so that we can monitor you.
• Some people pass blood in their urine after a biopsy. This will usually settle on its own within a few days. If you continue to pass blood for more than 1 week or if you pass a lot of blood, then contact the Imaging department to ask for assessment and advice. If you become unwell out of working hours, then attend A&E. The number for the Imaging department can be found on your appointment letter.
• Occasionally people will have a significant bleed, in which case it may be necessary to do a further procedure to try to stop the bleeding. This will occur in approximately 1 in 50 people.
• There is a very small risk of death. This risk is less than 1 in 1000.

You will need to have a blood test a few days before the procedure to check that you are not at increased risk of bleeding and that it will be safe to take the biopsy. This may be arranged to take place at your GP surgery. 

You can continue taking your normal medication. If you are on any medication that thins the blood we ask you to call the Imaging department using the number on your appointment letter. We may need to adjust your medication before undergoing this procedure. These may need to be stopped to keep the risk of bleeding to a minimum. This medication includes but is not limited to; aspirin, clopidogrel, warfarin, rivaroxaban, dabigatran and apixaban. 

Please arrange for someone to collect you from the hospital and take you home by car, as we advise you not to use public transport. You are not permitted to drive for 24 hours post-procedure and we would like someone to stay with you at home in the first 24 hours. Please inform the department if this is not possible, as we will need to identify alternative arrangements.

• You should eat nothing for six hours before your appointment. You may drink water until the time of your appointment.
• You will arrive at Gate 19 and be accompanied into our day case area.
• You may take your normal medication unless instructed otherwise. It would be useful to bring a list of your usual medications.
• Please inform us if you are allergic to anything. n You will be asked to change into a hospital gown and a small plastic tube (cannula) may be put into your arm.
• A radiologist (x-ray doctor) will discuss the procedure with you. You will be given an opportunity to ask questions. If you want to go ahead with the procedure you will be asked to sign a consent form.
• Once all the checks have been performed and consent signed, you will be taken to the procedure room on the trolley. There will be a nurse and a radiologist with you throughout the procedure.
• The radiologist will use an ultrasound machine to look at your kidney to find the correct area to take the biopsy from.
• Your skin will be cleaned with an antiseptic solution and covered with sterile drapes.
• The radiologist will then inject a local anaesthetic into the area selected for biopsy, which will briefly sting and then go numb. Most people will feel a pushing sensation, but the biopsy is not usually painful. A special needle is used to remove a small piece of kidney tissue. Occasionally it is necessary to take more than one sample.
• Once the radiologist has taken the sample, the needle will be removed, and the radiologist will apply a dressing.

• You will be taken back to the day case area so that the nursing staff may monitor you closely.
• If you are in pain tell the nursing staff so you can be given appropriate painkillers.
• You will be required to stay flat for one hour and then sit up for a further two hours. Then walk around for half an hour.
• You will be able to eat and drink as normal.
• If everything is satisfactory, you will be free to go home. Please arrange for someone to collect you on discharge rather than drive yourself. n Have someone stay with you overnight.
• You should rest for the remainder of that day and the following day, avoiding any strenuous activities for 36 hours.
• Keep a regular check on the biopsy site. The dressing can be removed after 24 hours.
• If you have any discomfort, take your usual pain relief as prescribed. But, if the pain is severe please contact the Imaging department using the number on your appointment letter.
• Some people pass blood in their urine after a biopsy. This will usually settle on its own within a few days. If you continue to pass blood for more than 1 week or if you pass a lot of blood, then contact the Imaging department to ask for assessment and advice. If you become unwell out of working hours, then attend A&E.

The results of the biopsy will be sent to the consultant who referred you, who in turn will either contact you or write to your GP with the results. 

If you experience any symptoms you are concerned about, please contact the Imaging department directly on the number on your appointment letter or contact your GP or the emergency department. 

Finally, we hope this information is helpful. If you have any questions either before or after the procedure the staff in the Imaging department will be happy to answer them.

North Bristol NHS Trust (2022) “Ultrasound Guided Liver Biopsy” 

North Bristol NHS Trust (2022) “Kidney Biopsy Information for Patients” 

Halimi, J., Gatault, P., Louguet, H., Barbet, C., Bisson, A., Sautenet, B., Herbert, J., Buchler, M., Grammatico-Guillon, L. & Fauchier, L. Clinical Journal of the American Society of Nephrology (2020) “Major Bleeding and Risk of Death after Percutaneous Native Kidney Biopsies”

A coronary angiogram (sometimes called ‘cardiac catheterisation’) is an X-ray study which takes pictures of the blood flowing through the coronary arteries which supply the heart with blood. It can highlight narrowings or blockages in these arteries caused by fatty calcified deposits – coronary artery disease. 

The angiogram gives a detailed assessment of the arteries to give doctors extra information to help them decide on the appropriate treatment. If you have a narrowing coronary (heart) artery, that can be treated with ‘balloon coronary angioplasty and stent’ (PCI). This can be done in the same procedure or sometimes separately at a later date.  

Coronary angioplasty, often called PCI (Percutaneous Coronary Intervention), is a procedure where a balloon is used to open a blockage in a coronary artery. It is very similar to an angiogram procedure and is performed in the same room, under the same conditions, and the recovery is similar. The main difference is that an angiogram only collects information (pictures), whereas an angioplasty performs a treatment (inserting a stent). 

An angioplasty/PCI takes approximately 1-2 hours to perform. The length of time will vary from person to person depending on the complexity of the coronary artery disease. A balloon is used to stretch the artery and a stent (wire mesh tube) is then put in the narrowed artery and acts as internal scaffolding, keeping the artery open.

Generally it is a very safe procedure. Potential complications are uncommon but include: 

Damage to the blood vessels in the leg or arm. Bleeding or haematoma (a lump/bruise under the skin) around the puncture site.

• A small risk of stroke.
• A small risk of heart attack.
• A small risk of emergency cardiac surgery. 
• A small risk of death.
• Very rarely an allergic reaction to the injected substance.
• X-ray is used in this procedure but with modern equipment the risk from the X-ray is very low.

You will be invited to attend pre-assessment clinic/ telephone consultation, where we will explain the procedure to you and collect information. If you need an interpreter, please let us know as soon as possible. An ECG will be performed and you might be asked for a blood sample. 

You will need someone to take you to and from the procedure and who will stay with you at home overnight. If this is not possible, let us know in advance and we will arrange an overnight bed. They will not be able to stay with you on the day of the procedure.  

Please let us know if you might be pregnant. Also, let us know of any allergies, and bring a list of your current medication. 

• If you take diuretics (water tablets), do not take them on the morning of your procedure as you may find it inconvenient.
• If you are taking metformin (glucophage), ideally it should be stopped 48 hours prior and not re-started until 48 hours after your procedure. 
• If you take warfarin, stop taking it 4 days prior to the procedure. 
• If you take any other anticoagulant (blood thinner, e.g. rivabaxan, dabigatran, apixaban, edoxaban) stop taking it 2 days prior to the procedure.

It is now very common to have combined ‘angiogram and angioplasty (PCI)’ and it is very important that you take dual anti-platelet medication leading up to, and on, the morning of the procedure. This is usually a combination of aspirin and clopidogrel, or aspirin and ticagrelor. This will be discussed in pre-assessment, and prescribed if necessary. These medications are vital for the procedure to go ahead as they prevent blood clotting in the stent.

• Have nothing to eat after 6:30am if your procedure is in the morning.
• Have nothing to eat after 10:30 am if your procedure is in the afternoon.  
• You can drink water up until the procedure. 
• Bring all your usual medication in with you on the day of the procedure.
• Your wedding ring can be taped to your finger but please leave other valuables at home. Please remove all nail varnish.
• Bring a newspaper or a book with you so that you will have something to do when the procedure is over.
• Bring slippers and a dressing gown, but as few other possessions as possible. 
• Take/stop taking medication as instructed. You should take your usual regular medication unless instructed otherwise.

You will arrive at the Imaging Department (Gate 19) and be accompanied into our day case area. A cardiologist will explain the procedure to you, and the benefits and potential risks. You will have an opportunity to ask questions. If you choose to go ahead with the procedure you will need to sign a consent form, which may be done during your pre-assessment visit. Please let us know of any allergies too. From there, you will be asked to change into a hospital gown and paper pants and a nurse will go through the procedure checklist and place a small plastic tube called a cannula, in a vein in your forearm to allow medications to be given if necessary during the procedure.

You will be taken to the Cardiac Catheterisation Laboratory (Cath Lab). You will be asked to lie down flat on the X-ray table with a pillow for the procedure. There will be a small team of nurses, doctors, cardiac physiologists and radiographers with you throughout. 

If you are feeling anxious, you will be offered sedation but will stay awake. The nurse will then cover you with a drape and clean the area at the top of your leg or wrist with antiseptic solution. Then the doctor will inject local anaesthetic into your wrist (if radial) or the area at the top of your leg (if femoral) which will briefly sting and then go numb. 

After this, you may just feel a pushing sensation when a small plastic tube (sheath) is inserted into your femoral or radial artery. A catheter is passed though the sheath and up inside the artery to the heart. Once the catheter reaches your coronary (heart) arteries, contrast liquid is injected into the bloodstream and X-ray images are taken.

The X-ray machine will move around you, but will not touch you. It is important that you stay still throughout to take the clearest pictures possible. Once the doctor has acquired enough images, the X-ray machine will be removed. 

If the doctor used the wrist artery (radial), a pressure device called a TR band will be placed on your wrist and inflated. This will be deflated gradually until it can be removed. Alternatively, if the doctor used the leg artery (femoral), a seal may be used to plug the artery or pressure will be applied either with a pressure device or manual pressure. 

You will be taken back to recovery/day case area initially, so that nursing staff can monitor your observations and the wound site very closely. Relax as much as you can and tell the nurse straight away if you experience any discomfort, notice any swelling or bleeding at the wound site, numbness in the leg/arm, or you feel unwell. You will be able to eat and drink as normal. Please make sure you drink plenty of fluids after this procedure which will help pass the contrast liquid out in the urine. 

Recovery time after an angiogram is usually around 3 hours, but can sometimes be longer. 

Recovery time after an angiogram is usually around 3 hours, but can sometimes be longer. If you have an angioplasty (PCI), your recovery time will be longer (about 6 hours) or you may require an overnight stay in hospital. This will be discussed in your pre-assessment appointment. 

If the doctor used the wrist radial artery:

• The band around your wrist will be slowly deflated over 2-3 hours and then removed. This will be longer, usually 3-5 hours, for an angioplasty/PCI. 
• The band will then be removed and replaced with a small dressing. 
• Try not to move your wrist much while your artery is healing.

• If the doctor used the leg femoral artery:

• If a pressure device or manual pressure was used to stop the bleeding you will need to stay flat for 1 hour and bed rest for a total of 3 hours. 
• If you have had a seal you can sit up straight away if there is no bleeding, and move around after 2 hours. This may be longer if bleeding occurs. require an overnight stay in hospital. This will be discussed in your pre-assessment appointment. 

Before you are discharged, the doctor will discuss the results with you. If you have coronary artery disease that requires further treatment, the doctor will explain the options and there may be a meeting. This may be cardiac surgery (coronary artery bypass grafts – CABG), coronary angioplasty/PCI or drug therapy. You will then be given a discharge letter. 

Do not do any heavy lifting or strenuous exercise, like weight lifting or cycling, for 4-5 days. Do not drive 48 hours after an angiogram and 1 week after an angioplasty/PCI (DVLA advice). Drink lots of water (2L) in the following 24 hours. If you were sedated, don’t sign any legal documentation for 48 hours.

Radial (wrist) puncture: 

• Rest the arm for 2-3 days.
• Avoid flexing/ bending the wrist, lifting and putting weight through the arm. 
• Avoid bathing and washing up for 48 hours after. You may shower the following day, but avoid scrubbing the wound. If wet, replace the dressing with a plaster.

Femoral (groin) puncture: 

• Avoid bending from the hip for 2-3 days or anything that strains stomach muscles. 
• Avoid straining when going to the toilet. 
• Apply light pressure over the puncture site, when coughing, sneezing, or laughing. 
• Avoid bathing for 48 hours post procedure. You may shower the following day, but avoid scrubbing the wound, and pat dry thoroughly. 

Complications are rare but can happen, particularly in the first 24 hours, so make sure you have a responsible adult with you. If the wound starts to bleed or swell suddenly, apply firm pressure to the puncture site for 10-20 minutes. If the wound is in the groin, lie flat while pressure is applied for you. If the bleeding stops, seek medical advice. If you are unable to stop the bleeding, call 999 immediately. 

A bruise around the site is common but should fade after 2-3 weeks. If it becomes swollen, or you develop persistent pain/ tenderness, contact your GP. If you get any chest discomfort after discharge that does not resolve 5-10 minutes after using your GTN spray, call 999.

To reduce the amount of phosphate additives you eat:

• Eat freshly cooked, unprocessed food more often.
• Check ingredient labels and limit foods with phosphate additives.
• Swap to brands without phosphate additives.

When the kidneys are not working properly, the level of phosphate in the blood often rises too high. The normal range for blood phosphate is between 0.8mmol/l and 1.5mmol/l. 

High levels of phosphate can cause:

• Hardening of blood vessels.
• Damage to your heart.
• Weak bones.
• Aching joints.
• Itchy skin.

If a food contains phosphate additives, you will see the name or E number on the ingredient label. Additives with “phos” in their name contain phosphate. You may be able to swap to a different brand without phosphate additives. 

Check ingredient labels and try to avoid these additives:

To help you avoid phosphate additives, here are some examples of food labels. They show how phosphate additives are listed on the packaging.

Sausages

Cake

If food contains phosphate additives try checking similar options to find one without. 

By choosing fresh, unprocessed foods where possible, you can reduce the phosphate additives you are eating. This will help to you lower your blood phosphate levels. 

Here are some suggestions for swaps:

It can be difficult to find processed meat without phosphate additives. Your dietitian can guide you on processed meats without additives available where you normally shop. 

Eating less red and processed meat is recommended for us all as they are linked with causing bowel cancer. They are also high in fat and salt. For healthier, lower phosphate options, see the NHS websites on the next page.

Many people want to eat food that is more environmentally friendly. These are good ideas for the planet and for you too:

• Limit red and processed meats. Try some plant food sources of protein such as beans, lentils, soya mince, Quorn, and tofu instead.
• Moderate the amount of dairy foods you eat and consider a plant-based milk.
• Eat less processed food that is high in fat, sugar, and salt.

For guidance on healthy amounts of meat to help reduce your risk of bowel cancer:

Meat in your diet - NHS (www.nhs.uk)

Information on kidney disease and food written by the kidney dietitians at North Bristol NHS Trust:

Nutrition & Dietetics Patient Information (Kidney Disease) | North Bristol NHS Trust (nbt.nhs.uk)

Recipes to enable you to cook delicious kidney friendly meals from scratch:

Recipe Index | Kidney Care UK

Practical advice to help you reduce your weekly food shopping bill while maintaining a nutritious and kidney friendly diet:

Shop for a kidney friendly diet on a budget | Kidney Care UK

Research can be defined as the attempt to derive generalisable or transferable new knowledge to answer or refine relevant questions with scientifically sound methods. This excludes: audit; needs assessments; quality improvement and other local service evaluations. It also excludes routine banking of biological samples or data, except where this activity is integral to a self-contained research project designed to test a clear hypothesis.

If you are in any doubt, please contact the Research Development & Grants team – we can support your project or signpost you to a more appropriate team, if required. 

Yes. There are lots of opportunities to get involved in research, including developing a project or grant application of your own, as part of your role. The R&D Department have funding available to cover your time to work in research. This would be discussed on a case-by-case basis with your department, so please get in touch with the Research Development & Grants team who can support you with conversations with your line manager and clinical division.

Research ideas and grant applications are welcome from everyone, no matter how much (or little) prior experience you have. The Research Development & Grants team can provide additional support to those that need it, especially if you are new to research.

Please email the Research Development & Grants team: ResearchGrants@nbt.nhs.uk

The Research Development and Grants team can support you from early stages of developing a research idea. We can help to find suitable funding opportunities, calculate costs for an established proposal, and navigate systems for submitting your grant application, and much more.

Any time! From just having a brief idea for a research project, to needing final costings on a grant application. You can speak to the Research Development & Grants team at any stage of your research development. The sooner you contact us the better though, and the team will provide tailored support.

This is dependent on your project. But the Research Development and Grants team can support you with every aspect of your costing. The sooner you get in touch with us (i.e. as soon as you begin writing your grant application) the more support we can offer.