The Kidney Biopsy Paradox

I have found it surprising in practice that I usually want a kidney biopsy more often than conventional providers for patients with kidney disease without an obvious cause. Here I will talk about why, particularly about how incredibly helpful this can be in determining optimal naturopathic, and sometimes conventional, treatment. 

Kidney diseases do not usually give us sufficiently distinctive signs or symptoms to tell us what is causing them. Sometimes, it is obvious, such as in someone who has long-untreated diabetes mellitus or high blood pressure (if they are well treated, these conditions don't or minimally hurt the kidneys, by the way). But even in some patients like this, they have kidney disease that seems too extreme to be explained just by these conditions, or treating the diabetes or blood pressure doesn't seem to help their kidneys. At least 10% of everyone with kidney disease has an autoimmune condition, and usually we can only diagnose this with a biopsy.

In all cases, if we don't know the disease(s) damaging the kidneys, the treatment we choose could easily be wrong. This is one of the worst outcomes, as it wastes time, potentially letting the kidney disease get worse due to using the wrong treatments (besides wasting the patient's money!).

Here is a good example. A consulted with a 54-year-old man who had high blood pressure for about three years. He took a medication at first, but stopped due to side effects and unfortunately didn't implement any other treatment (and wasn't really offered any choices by his conventional provider). Unfortunately, he then collapsed one day in church, and it was found his blood pressure was through the roof. In the emergency room, it was found he was in serious kidney failure, and it was assumed he had chronic high blood pressure causing kidney damage. He ultimately had to be put on six different medications at the same time to control his blood pressure. He still felt terrible from the kidney failure, but now also had new side effects from all the drugs.

Right way this did not sound right to me. Usually it takes more than 10 years for chronically high blood pressure to hurt the kidneys. He only had a problem for three years. And when it was first diagnosed, it just wasn't that bad. While he should have continued treating the high blood pressure, it seemed highly unlikely the problem was coming from hypertension. It is critical to remember the kidneys are the primary controllers of blood pressure, and that high blood pressure is in fact a common symptom of kidney disease, and not always the cause of it.

So I suggested he get a kidney biopsy. At first he and his wife were skeptical, but they quickly realized this was the only way to figure out what was really going on. His convention provider at first resisted, but the patient ultimately was able to convince him, and get a kidney biopsy. It turned out he has a disease called IgA nephropathy that was attacking his kidneys. This was the cuase of the high blood pressure. Now that I had the correct diagnosis, I could recommend the most effective herbs and diet for him, and we were able to move him out of stage 5 kidney failure back up to stage 4. This is critical as it stops all discussion of implementing dialysis. We were able to get him off half his blood pressure medicines within a few months while keeping his blood pressure under control. He has done much better. Unfortunately, he hasn't been able to improve much beyond this, as so much damage was done to his kidneys. If he had gotten a diagnosis sooner, things could have turned out better, but this was still a better result than dialysis or transplant!

Conventional providers are often hesitant to do biopsies because they don't have that many specific treatments for individual kidney diseases, or at least they think so. But more and more drug options are even becoming available (for example, for IgA nephropathy, several new drugs have been approved to treat this condition in the last 10 years). And of course they don't really know anything about natural medicine approaches. But these can be very different depending on the diagnosis, which often only a biopsy can tell us.

Another crucial point is that there are naturopathic treatments to reverse scar tissue in the kidneys. This is considered largely impossible in conventional medicine, so determining the degree and severity of kidney scarring is often overlooked. But I have found it helpful in guiding treatment as well as getting a diagnosis. I hate to put people through an invasive procedure, but the rewards have always been so high it has been worth it in every case.

Not everyone needs a biopsy. Often if there is a clear cause, usually when someone has a clear history of long un- or poorly-treated diabetes or hypertension, and now had kidney disease, we can initiate treatment on this basis. If we see good results, there is no need for a biopsy. If there isn't improvement, I will start to push for one so we can figure out if we're missing something else. Most often though, it is patients without a clear cause for their kidney disease who will almost always profit from a biopsy.

If you have questions, don't hesitate to schedule and I can talk through whether a kidney biopsy makes sense from my perspective, and help support you through the process of getting one if that is what you decide to do. It really is a minimally traumatic procedure with modern ultrasound-guided procedures. In 30 years, I've only had one patient develop bleeding afterward, and that stopped without treatment in just a couple of hours! Given how safe it almost always is, and how much we can learn from the process, I have found myself in the paradoxical position of being the naturopathic doctor pushing for more of these than conventional nephrologists.