Diagnostic studies before laparoscopy: Kidney disease was recognized when Wendy was being evaluated prior to anesthesia for dentistry. The blood urea nitrogen and creatinine were increased to 175 mg/dl (normal less than 30) and 5.0 mg/dl (normal less than 1.5) respectively. Urine was dilute at 1.014 and contained high amounts of protein (3+). The urine protein/creatinine ratio was 13.64, versus a normal of 0 to 0.3).
Endoscopic procedure: Laparoscopic biopsy. Laparoscopic kidney biopsy. Kidney disease was found to be glomerular due to amyloidosis. This is a poor prognosis.
Benefits of using endoscopy: Determination of the cause of renal disease characterized by protein loss through the kidneys requires biopsy of the kidneys. Laparoscopy requires two 5-mm trocar holes and a small hole for the 14-gauge biopsy needle. We have compared the quality of the biopsy needles samples obtained by laparoscopy versus ultrasonography (See slides). The 14 gauge needle biopsies obtained twice as many glomeruli and only contained kidney tissue in contrast to those obtained by ultrasonography. Biopsies obtained by 18 gauge needles were nearly worthless and were usually fractured and crushed.
