Renal biopsy is an invasive specialized test aimed at obtaining renal tissue for histologic diagnosis of a variety of kidney diseases. Common indications for renal biopsy in practice include adult nephrotic syndrome, steroid resistant or clinically atypical nephrotic syndrome in children, glomerulonephritis, acute kidney injury (AKI) of unknown aetiology, systemic diseases with renal involvement, and persistent proteinuria or haematuria with reduced renal function. Over the years there has been continuous refinement of renal biopsy techniques. It is now mostly performed percutaneously using imaging guidance and more sophisticated spring-loaded needles of varying sizes. Other non-percutaneous techniques such as transjugular, laparoscopic and open renal biopsy are also being performed especially in patients with contraindications to the percutaneous approach. Percutaneous ultrasound guided approach is standard care for biopsy of non-focal lesions. The CT-guided method can be used in obese patients and other patients who are unable to lay prone, patients with complex anatomy, and when the kidneys are not sufficiently visualised by ultrasound scan. The transjugular technique is most popular for combined liver and kidney biopsy. The major advantages of the laparoscopic and open biopsy techniques are the opportunity for direct visualization of the kidney and good intra-operative haemostasis.
Part of the book: Renal Diseases