Complications and Techniques in Renal Biopsy

The renal biopsy remains the cornerstone for the diagnosis of renal parenchymal disorders. Contemporary practice predominantly employs percutaneous approaches under ultrasound guidance to obtain cortical tissue for histopathological analysis. Despite its diagnostic yield, the procedure carries risks of bleeding complications such as perinephric haematoma, gross haematuria and, less commonly, arteriovenous fistula formation. Refinements in needle gauge selection, real-time imaging and post-procedural monitoring have reduced major bleeding rates to below 2 per cent in experienced centres. In patients with coagulopathy or comorbidities that heighten bleeding risk, alternative access via a transjugular route has been explored to limit extravasation. Operator expertise, choice of needle passes and on-site adequacy assessment further influence specimen quality and complication rates. Advances in Doppler ultrasound assessment facilitate early detection of vascular injuries, while standardised protocols for bed rest duration, haemodynamic observation and haemoglobin monitoring underpin current safety guidelines. Together, these developments have broadened the applicability of renal biopsy worldwide, ensuring robust tissue yield for light microscopy, immunofluorescence and electron microscopy analyses, and underpinning personalised management of glomerular, tubular and transplant pathologies.

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Complications and Techniques in Renal Biopsy publication trend

The graph below shows the total number of articles in complications and techniques in renal biopsy across all publications each year (not limited to Nature Index journals).

Technical terms

Percutaneous renal biopsy: Minimally invasive procedure to obtain renal tissue via a needle inserted through the skin using imaging guidance.

Doppler ultrasound: Imaging modality that measures and visualises blood flow within vessels to detect vascular complications.

Arteriovenous fistula: An abnormal connection between an artery and vein that may form following renal biopsy and can present with turbulent blood flow.

Haematoma: Localised collection of blood in the perinephric space resulting from vessel injury during biopsy.

Allograft: Transplanted kidney from a donor, for which biopsy may be indicated to assess rejection or dysfunction.

References

1. Safety and tissue yield for percutaneous native kidney biopsy according to practitioner and ultrasound technique. BMC Nephrology (2014).
2. Frequency, Timing, and Prediction of Major Bleeding Complications From Percutaneous Renal Biopsy. Canadian Journal of Kidney Health and Disease (2020).
3. A nationwide survey on clinical practice patterns and bleeding complications of percutaneous native kidney biopsy in Japan. Clinical and Experimental Nephrology (2020).
4. Factors that can minimize bleeding complications after renal biopsy. International Urology and Nephrology (2014).
5. Arteriovenous fistulae after renal biopsy: diagnosis and outcomes using Doppler ultrasound assessment. BMC Nephrology (2017).
6. Percutaneous Native Renal Biopsy Adequacy: A Successful Interdepartmental Quality Improvement Activity. Canadian Journal of Kidney Health and Disease (2015).
7. Safety and adequacy of percutaneous kidney biopsy performed by nephrology trainees. BMC Nephrology (2018).
8. Transjugular renal biopsy in high-risk patients: an American case series. BMC Nephrology (2002).