My Kidney Biopsy

Today, we’re going to get real on my blog.  As in, pictures of needles and scars and my exposed abs.  Possibly NSFW (not suitable for work) if that’s where you are.  So if you think you will be squeamish or uncomfortable, you may want to stop reading now.

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My biopsy story…

Three weeks ago I went in for an all-day (9-hour) appointment at UCSF (how I’ve missed you!) for a kidney biopsy.  It’s standard for transplant centers to perform this procedure several months after surgery.

What’s a biopsy?  A kidney biopsy involves taking a tiny piece of the kidney for analysis.

Which kidney did they biopsy and why?  The newly transplanted one of course! (Remember they kept the old ones in.  They don’t cause harm; they simply don’t function anymore).  Doctors want to make sure new kidney is working well, although sometimes I wish they could biopsy the old ones too to determine exactly what went wrong with them.  Tissue from the new kidney is analyzed to determine if there is any rejection (or other issues) that would not have been picked up on the regular lab tests.

How do they extract kidney tissue?  There are two ways:

• “Percutaneous biopsy” – A needle is placed through the skin and guided to the right place in the kidney, usually with the help of ultrasound.
• “Open biopsy” – The kidney sample is taken directly from the kidney during surgery.

Doctors used the Percutaneous method to get to my kidney.

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Here is a photo log of my day…

After I am admitted at UCSF, I am sent upstairs where I am ushered to my bed.  Here I will prep and later return to rest for several hours after biopsy.  By the way, I run into Dr. Gluck in the halls here.   Remember him?  He’s Dr. Awesome Nephrologist, my UCSF kidney doctor before I switched to Kaiser insurance at the beginning of the year.  I’m SO happy to see him and still wish I could see him for my regular kidney checkups.  (I come to UCSF only for all transplant-related issues since Kaiser outsources this surgery.)

By my bed are supplies waiting for blood and urine collection.

I change into my gown.  My nurse reviews my health info.

By the way, where are my happy yellow Daffy Duck socks like the ones I got on Transplant Day?  These are boring beige-brown.

My socks on Transplant Day back in May

The nurse puts in the IV.  This is always, always the worst part for me!  I absolutely hate it!  She went in the first time near the elbow, and it hurt so much she decided to start over elsewhere.  She’s very gentle but I’m incredibly relieved when it’s done.  Now I’m good.

 

The nurse draws blood pre-biopsy.  UCSF will be testing for the BK virus among other things.  Most of us have the BK virus which remains quiet (latent) and harmless but will sometimes cause illness in immuno-suppressed patients like me.

I put in my lunch order for later.  My nurse tells me to get something I can eat lying down.

Before I am wheeled into the biopsy, I make sure to empty my bladder.  After the procedure, I will not be able to get up for hours even to use the restroom.

My nurse gives me Ativan to help me stay calm.   I tell her I’m not anxious, and the biopsy later isn’t supposed to hurt anyway, right?  But she says the doctors would like patients to take it though we can refuse it if we want.  We need to stay calm and still during the procedure.  It’s a low dose, and it could help me sleep so I take it anyway.

Apparently it’s a busy day even though you wouldn’t know it; it’s so quiet around here.  After maybe a 45-minute wait,  it’s time to go!

Here I am in the ultrasound/biopsy room.  Feeling ready.

First step: Get an image of the kidney.

See all my battle scars (from Transplant in 2016 and Dialysis Catheter Surgery in 2015).  Once you’re done figuring out what they all are, you’ll notice they’re performing an ultrasound.  They’re looking at the kidney to make sure everything is normal.

I ask for a printout.  Congratulations to me.  I have a new beanie baby.

They determine the best place to insert the needle, then mark the spot.

They sterilize the area with iodine.  By the way, I’m the one taking all these photos.  They’re happy to let me shoot for my blog.  At this point, they tell me to keep my hands away from the sterilized area.  So I’m lying on my back, slightly propped up, arms and hands retracted like a T-rex’s, iPhone in hand shooting away indiscriminately.

Now for some local anesthesia.

Ooooowww.  I won’t deny that that hurt too!  It’s lidocaine like at the dentist’s office.  They inject me a few times.  They get it all numb so I don’t have to worry … about … this…..

WHOA!!!!!!!!!

My doctor was happy to hold up the biopsy needle for my photo so we can all have our OMG!! moment.

And there it goes. With the aid of ultrasound imaging, the radiologist guides the nephrologist to the best spot in the kidney for tissue extraction. It’s a good thing the kidney itself has no nerve endings.  When I hear the click, I know the deed is done.  Extraction completed.  Mission accomplished.  It didn’t hurt at all.

If you’re brave enough (and no one in my family was), you can view the video.

Afterwards my doctor applies pressure to the area for several minutes to prevent bleeding, which is the biggest risk after biopsy.  After she’s done, she places a weight (sandbag wrapped in a towel) on top of the area for continual pressure.  It will be my friend for the next several hours as I lay on my back.  I’m allowed to be propped up at a 45° angle at most.

 

applying pressure by hand…

and sandbag weight

Here is the prize for all that hard work.

A piece of the bean!  (Actually two samples; they went in twice.)

They wheel me back to my room (or curtained off space).  My nurse tethers me to pulse/oxygen and bp monitors that automatically check my vitals every 15 minutes.  Now I rest.   I’m a happy camper.  I get to lie here and do nothing except eat and message my friends for the next four hours. (I had sent Marty off to take advantage of being in San Francisco all day:  visit his uncle,  grab a bite at Poki Time…)

 

After four hours, they take another blood draw.   All good; no indication of any bleeding.  I’m discharged with instructions: Go easy for a few days; no heavy lifting.

So what did you think?  Not so bad, right?  If you were able to handle all that, you’ll be ready for a reward: a bonus photo of …….

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… Queen Nephrotiti herself! (That’s my new kidney)

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But only if you’re up for it.

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Ready?

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Are you sure?

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Okay!

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And now…

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her majesty

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the Queen!

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Yep!  That’s the actual kidney from my donor (Wonder Woman) right before it was transplanted into me!  I gave my nurses a disposable camera on Transplant Day to take some photos in the OR.  Queen Nephrotiti is bigger than I thought.  I don’t see how that fit inside of me next to my hip bone.  I don’t even feel it anymore.  But so glad it’s there!

Thank you Superman and Wonder Woman!

 

If you’re new to my blog, Superman is the friend who donated a kidney on my behalf to the kidney transplant chain.  Wonder Woman is the donor in the chain whose actual kidney was transplanted into me.   You can read more about how the kidney exchange works in this previous blog post.

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Two and a half weeks later…..

I went to my followup appointment this past Thursday.  Final results from the biopsy show everything is normal.  No change in treatment or medication.   If everything continues to be normal from here on out, I may never need to come back to UCSF (until my next transplant in maybe 15 years).  I’m actually sad as I leave, and I take one last photo.

Goodbye UCSF!  I miss you already!

I am eternally grateful for your amazing, amazing care!

Dedicated to true heroes.