Certificate of compliance


is in compliance with the HONcode

Logo certificat HONCode

Certificate validity: valid until Jul 2016

www.renalmed.co.uk Visit website

Logo certificat HONCode
HONcode identification number:


Date of initial review:

06 May 2015

Certificate validity:

valid until Jul 2016

Date of last visit:

08 Oct 2015
See the HONcode seal on the site

Content identified by the HONcode team

The content below is a sample of the content identified at a specific date by the HONcode team that justifies the respect of the eight ethical principles.

RenalMed is a website written and maintained by a group of senior nephrology (UK and non-UK based) health professionals.
The Editorial Team

(06 May 2015) - Link

The information provided in this website is only a guideline. It should not be used as a basis for the diagnosis or treatment of any medical condition. Your patient may be different. The information relating to case details in 'Lesson of the Month' will have been changed from the original cases we encountered to protect the patient's anonymity

(06 May 2015) - Link

Privacy Policy
We do not capture, collect or store any personal information about individuals who access this website, except where you voluntarily choose to give us your personal details via e-mail. In this latter case, the personal information you give us is used exclusively by us to provide you with current and future information about our website. We do not pass any of your personal data to outside organisations and/or individuals, except with your express consent. Personal information from email correspondence will only be viewed by the editorial team www.renalmed.co.uk/about-us
You have a right to know about the personal information we hold about you. You also have a right to have your data corrected or deleted. Please address all your requests and/or queries about our data protection to:

We respect the law(s) on confidentiality applicable to this website (UK) and we will never pass on these data to any third party, unless required by law. Our website does not collect any cookies.
Data Protection Notice
Any personal information collected from this website will be used in accordance with the Data Protection Act 1998. We have taken appropriate measures to keep users' personal information secure. Any disclosures of information will be made only with your permission. We may use your name and e-mail address to contact you with information about the RenalMed.
We currently use Google Analytics to analyze the audience from our website to help improve our content. No personal information is collected from Google Analytics and for more information on the privacy policyconcerning Google Analytics, please visit www.google.com/analytics/learn/privacy.html

(07 Jul 2015) - Link

The data displayed correspond to only one of the selected samples.


(06 May 2015) - Link

Last updated: Lesson of the Month - May 2015
on 24 Apr 2015

(06 May 2015) - Link

Renal Biopsy
Lisa Crowley, Kieron Donovan, Peter Topham - Review Date Jan 2016 (Senior Editor Pete Topham)
Since its introduction to clinical medicine in the 1950s, percutaneous renal biopsy has become a routine investigation in the evaluation of patients with kidney dysfunction. It provides a tissue diagnosis in more than 95% of cases, and is a relatively safe procedure with a life-threatening complication rate of less than 0.1%. However, the decision to proceed to biopsy should not be taken lightly and must be made by a consultant. It is important that trainees discuss the need for a biopsy with a consultant before booking it.
Aim of Renal Biopsy
Patients with renal disease often present with a syndrome' such as nephrotic syndrome, AKI, or CKD. In themselves, these are not diagnoses'. They are merely patterns of kidney disease that can have many causes.To aid the management of such patients, the histological analysis of a renal biopsy sample should therefore aim to:
identify a specific diagnosis
reflect the level of disease activity
provide information to allow informed decisions about treatment.
Is the Biopsy Necessary?
This is a vital question to ask oneself at all stages of the process; as it is always a judgement of the balance of risk vs useful information. A renal biopsy is not without risk therefore before undertaking a biopsy, think carefully about whether the biopsy result is likely to alter management. Given the complexity of renal pathology, a discussion between the pathologist and the nephrologist is required, in order for the result to interpreted correctly within the clinical context.
The information gained subsequently affects management in approximately 30-40% of cases, and 85% of patients with nephrotic syndrome and unexplained AKI (Richards 1994, Stratta 2007). Nonetheless, at times, the role of renal biopsy has been debated (Madaio 1990, Adu 1996).
Most nephrologists would agree that renal biopsy is more likely to change management in symptomatic kidney disease (proteinuria, nephrotic syndrome), unexplained AKI or sudden changes in eGFR in CKD. It can also be useful for prognostic purposes, as well as helping to direct or change treatment.
In nephrotic syndrome and AKI, the biopsy may make the difference between giving immunosuppression or not, withdrawal of drugs or not etc. The role of renal biopsy in determining the quantity and intensity of treatment is widely but not universally accepted, particularly in lupus nephritis.
There are four common indications for renal biopsy:
Significant proteinuria/nephrotic syndrome (>1g/L, or PCR > 100mg/mmol) with two normal sized, non-obstructed, kidneys and no obvious cause (usually considering the diagnosis of a glomerulo- or interstitial nephritis)
Acute Kidney Injury (AKI) with two normal sized, non-obstructed, kidneys and no obvious cause
Chronic Kidney Disease (CKD) with two normal sized, non-obstructed, kidneys and no obvious cause
Renal transplant dysfunction
Other, less common (and more controversial) indications. Many of these patients may have normal renal function:
Non-visible haematuria
Renal dysfunction in systemic disease (eg diabetes, myeloma, amyloidosis, SLE)
Familial renal disease (where diagnosis in this patient, benefits them and their family)
Biopsies are absolutely contraindicated in the following situation:
Uncontrolled bleeding diathesis
Biopsies are relatively contraindicated when:
Uncontrolled hypertension (>160/95)
Uncooperative patient
Patient unable to consent
Solitary kidney. This is a 'big decision' and should be carefully made by a consultant and the patient
Obstructed kidneys
Small kidneys (less than 10 cm; less than 9 cm in a small patient)
Anatomical abnormalities (eg vascular lesion)
Renal neoplasm, multiple cysts, abscess or pyelonephritis
Note: when considering a diagnosis of amyloid, it may be advisable to biopsy other less vascular tissues (fat, rectum) first, since this may establish the diagnosis and avoid the inherent risk of the renal biopsy. Patients with amyloid (particularly those with blood vessel deposition) may be more likely to bleed. This view has been challenged by Fish in 2010.
Diabetes and Renal Biopsy
If the clinical presentation is consistent with diabetic nephropathy (ie signficant proteinuria [often nephrotic range], CKD3b-4, diabetes of over 10 years duration, normal soluble immunology, presence of other microvascular complications [eg retinopathy and neuropathy]), renal biopsy is not necessary and it can be assumed that the patient has diabetic nephropathy.
If however the presentation is atypical (haematuria, haematoproteinuria, diabetes of less than 5 years duration, abnormal soluble immunology, no microvascular complications, rapid fall in GFR), renal biopsy should then be considered. Patients with diabetes may develop a glomerulonephritis or another form of intrinsic renal disease. A higher than average risk of glomerulonephritis has been described in patients with diabetes (Soni, 2006) although this has not been universally seen (Waldherr, 1992).
Age, Race and Renal Biopsy
Moutzouris (2009) has published a series of biopsies in the elderly (> 80 years) suggesting this is still a useful technique with results that affect management in a significant number of patients.
There are racial differences between biopsy appearances. For example, Hoy (2012) has described a wide range of atypical findings in Australian aborginal people.
This talk by Vishal Golay (on 28.10.10) is a very good, especially regarding the practicalities of renal biopsy.

(06 May 2015) - Link

You can contact Renal Med by:

You can also use the form below to contact us:
Your name:
Your email address:
Enter the above code:

(06 May 2015) - Link

It is non-profit making and has benefited from an educational grant from the Association of Renal Industries (ARI).

(06 May 2015) - Link

Our website does not host any form of advertisement.

The content of this certificate has been collected by the HON Foundation and may not be used without HON's express consent.

responsive devices

The HONcode's significance

The Health On the Net (HON) certificate guarantees that this website complies with the eight principles of the HON Foundation's Code of Conduct at the date indicated above. The persons responsible for the site commit to maintaining its compliance with the HONcode principles for the duration of the site's certification.

However, despite the complaint system that has been put in place and the periodic review and automatic monitoring of certified sites to ensure maximum compliance with the HONcode ethical principles, it is impossible to eliminate all risks of incoherence that may appear.

Under no circumstances shall the HON Foundation and/or its partner(s) be held liable for any damages resulting from the use or the inability to use HONcode-certified websites. Similarly, the HON Foundation and/or its partner(s) shall not be held liable for the content of such certified websites or any other website accessible via a hypertext link or through third-party information.

Those responsible for the certified website are responsible for the content of the website unless otherwise provided by law.

More information about the HONcode?
responsive devices

Health website editors

Do you have your own website?

Request HONcode certification!

HONcode certification request

Health information you can trust!

Search HONcode-certified websites:


Download the free HONcode toolbar
barre d'outils HONcode

The HONcode toolbar is easy to download and add to your Web browser. It connects in real time to the HON server to verify the certification status of health and medical websites. It does not collect any personal information and contains no spyware or other hidden functions.


Video about the HONcode

YouTube channel

Providing you with trustworthy health information

YouTube channel