Rebecca has a Renal Biopsy
“Rebecca, what’s the matter? You’ve hardly said a word since we left hospital.”
“I can’t hear you. Speak up” said Mum.
“Oh nothing” replied Rebecca grumpily. “I’m just fed up with hospitals.”
“I know that,” said Mum “But you’re also fed up with not being well and being unable to do all the things you like to do when you are feeling well.”
“Oh, Mum, I just don’t want any more tests and this one, the renal biopsy or whatever, sounds horrid.”
“You’ve had quite a few tests and some of them have not been very comfortable, have they? But you have always managed to handle them fairly well.”
“That’s because they always tell me what’s going to happen and what I can do to help.”
“And this is no different. We can go through all the instructions together and work out ways in which you can make it as easy as possible for yourself. “
“I know but I just wish I didn’t have to have this done.”
“We all wish that Rebecca, but at least we know that they would not ask you to have a biopsy unless it was really necessary. You heard what the doctor said, we need more information about your kidney and they can only get that by taking a tiny sample of it and sending that to the lab for examination.”
“But that sounds painful, how do they do it?”
Mum picked up the papers which the doctor had given them and said “There’s only one way to find out! The first thing is that the biopsy is only a day case procedure which means we will go to the hospital in the morning and we should be home by tea time.”
“But I thought it was a small operation.” said Rebecca with surprise.
“I thought so too but the Consultant explained that it is now possible to do the procedure on the ward which means that it is quicker for you and you don’t have to stay in hospital overnight. It also means that you don’t have to have a general anaesthetic.”
“Oh no. I want to be put to sleep! I’m frightened.”
“Remember we talked before about general anaesthetics. Sometimes they are needed, and then you will have one, but it is not good to have too many anaesthetics so when a procedure can be done without one it is better and you recover quicker. That doesn’t mean that you will feel much pain. You will be given some medicine to help you with that.
Let’s go over exactly what will happen on the day ......It will be the same rules as for an anaesthetic – no food for 6 hours before hand. Once you are on the ward, you will have the usual measures taken, height, weight, blood pressure, temperature. You will also have to give them a urine sample to test.
Then they will but a cannula in. If you want Emla before this you can have it but you will then have to wait an hour before it is working. Once the cannula is in place, the doctor will see you and may have to take some blood. The blood has to be tested before they can do the biopsy so there will be another wait. Then you will have some Emla cream put on your back above the place where your kidneys are.”
“Then you will be taken to the treatment room.”
“Will you or Dad be with me?” said Rebecca anxiously.
“Not all the time, because it is like a small operation and we wouldn’t be present for that. We will come into the treatment room at first and then we will be close by on the ward. We’ll be there as soon as you come out. You will be feeling fairly groggy because of the medicine. The nurse who is going to look after you on the day will be with you. As well as the doctor and nurse there will be other people in the room to look after the biopsy and take it to the laboratory where it is studied under the microscope.”
“I suppose that will be alright. What happens when I’m in the treatment room?”
“First of all they will wipe off the EMLA cream. Then they will put some cold jelly on your back.”
“Like the stuff they used when I had an ultrasound?” asked Rebecca.
“Exactly the same,” said Mum “because they are going to use an ultrasound to get a picture of where your kidneys are before they carry out the test. Then they will mark the spot on your back where they are going to carry out the test. When they have done that they will give you a small injection to ‘ freeze’ the area under the mark and down to your kidney so that you will not feel pain.”
“I still feel it though. When they ‘freeze’ your gums at the dentist you can still feel it” Rebecca chimed in.
“You can still feel that something is happening to you, but can you feel pain?” asked her Mum.
“If I’m frightened it seems to hurt. Tony’s frightened of the dentist and he always thinks it hurts, but I’m not frightened there so it doesn’t hurt then. With me it just aches a bit when the anaesthetic wears off because my jaw has had to stay open for so long.”
“That’s a good point, Rebecca. Your brother has not realised that yet. When you’re frightened, things seem to hurt but if you know what is going to happen, that it needs to be done and that you trust the people who are doing it, you can manage to get through the situation without too much pain.”
“I try to pretend that I’m somewhere else when I’m at the dentist and that seems to help.”
“That’s a really good idea, Rebecca and you can use it to help you through the renal biopsy too. It will help a lot as well if you are able to lie very still while they are doing the biopsy. If you can pretend you are somewhere else when you need to lie very still that would be ideal.”
“Maybe I could pretend I was watching some wild animals and if I moved it would scare them off.”
“Great idea” said Mum who was clearly impressed.
“But wouldn’t it be easier for them to give me a general anaesthetic and then I would be sure to be still?”
“Nice try Rebecca, but we’ve gone through that. It is better if you can manage without going to sleep and you will recover much quicker. Also it can help the Doctor who is carrying out the biopsy because he or she may ask you to take a deep breath from time to time.”
“Why do they do that?”
“It helps them place the needle exactly where they want it.”
“Do they use a needle for the biopsy?”
“Yes. It’s a special kind of needle but basically that’s what it is. When they are happy that your skin is frozen, they will tell you that they are going to make a little cut and then put the special needle in. You will feel the needle go in but, just like at the dentist, it shouldn’t hurt and you may not be aware of it because of the sleepy medicine. They may have to try two or three times before they have the little samples which they need so that is when it would help to imagine you are watching the animals and you have to lie very still.”
“Will I be able to go home straight away?”
“No you will have to lie down for a while – about 6 hours – and the nurses will check your pulse and blood pressure from time to time to see that you are O.K. Also we will have to wait until you have been to the toilet for a wee because sometimes after a renal biopsy there can be a bit of blood in the wee and we have to make sure that this is not a problem before we go home.”
“Will it hurt afterwards?” asked Rebecca quickly.
“It may be a bit tender for a day or so which means you may have to rest.” replied Mum.
“You mean no school?” Rebecca looked interested.
“You will probably be able to go back to school, because you will have the weekend to recover, but you will have to be careful – no rough play in the playground.
“O.K.” agreed Rebecca.
“Do you think you will be able to cope with the biopsy the day after tomorrow?”
“I think so, but can we go over what I have to do again tomorrow?”
“Of course we can.” said Mum. “Things become much more possible when you have talked them through and made a plan, don’t they?”
“I suppose so” mumbled Rebecca.
Later that evening Rebecca described the test and what she was going to do with her Dad. He liked her idea about lying still and watching the animals. He even suggested that she could imagine that when she felt something on her back, she could imagine it was a spiky branch of a tree. Rebecca liked that idea and when she had her biopsy at the hospital she tried it out and it worked well. She was very proud of herself because she managed to do what the doctor and nurse asked and still keep her imagination on her animal watching. This helped her to stay very still even when she felt things touching her back.
The doctor and nurse were full of praise because she had done so well and they gave her a certificate to prove it.
“I’m going to show this to Tony” she said later to her mother “He’d never get one of these from the dentist would he?”
“No he would not. Perhaps when you are feeling kind you could teach him your trick with your imagination.”
Rebecca was glad of the rest in hospital before going home but was happy when at last she was ready to go. She couldn’t wait to tell her Dad how well she had coped.
Content compiled by members of the Children’s Renal & Urology Unit, QMC Campus, Nottingham University Hospitals.
The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.