**5. Conclusion**

*Renal Diseases*

immediately after it is obtained.

provided there are no major complications.

discharged as early as 4 hours post procedure.

the disadvantages.

anatomically complex kidneys). Some comparative studies have reported that automated needles provide superior yield and lower major complication rates than older, hand-driven (Tru-Cut) systems [17, 18]. A 14- or 16-gauge needle provides larger cores and the tissue yields are comparable however, the 14-gauge needle is reportedly associated with more bleeding complications [19, 20]. The 18-gauge needle on the other hand is smaller and some studies report a lower tissue yield [19, 20]. A study by Kriegshauser et al. found that operator experience, taking multiple specimens, and using the cortical tangential approach significantly improved the pathologic material obtained during native renal biopsies [21]. It also helps to have a light microscope available during renal biopsy procedure, to visualize biopsy core

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 [8]. This procedure has been associated with 100% success in some reports [22]. Biopsy of focal lesions is more successful with CT-guidance using either core biopsy or aspiration needle, although some authors have reported increased diagnostic yield when a combination of both needles are used [9]. Unlike the ultrasound-guided technique, it is not performed real-time and patients are exposed to some radiation. Most patients will usually require conscious sedation but can be discharged a few hours after the procedure

Contraindications to PRB such as uncontrolled severe hypertension, morbid obesity, uncontrolled bleeding diathesis, solitary kidney, small kidneys, complex kidney anatomy (e.g. high location, horse-shoe kidney), and renal impairment; are often reasons for selection of alternative techniques. Additionally, failed percutaneous biopsy, poor visualization on imaging, cystic kidney with rapidly progressing GN, and high location of the kidneys are some indications for a laparoscopic or open biopsy [13]. The major advantages of the laparoscopic and open biopsy techniques are the opportunity for direct visualization of the kidney and good intra-operative haemostatic control of the biopsy site [13]. The tissue yield is often abundant and diagnostically useful, however the risks of general surgery/anaesthesia, need for special surgical skill, overnight admissions and high costs are some of

The transjugular technique is most popular for combined liver and kidney biopsy, and in patients with certain contraindications to PRB (bleeding, inability to lie prone due to obesity, ascites or respiratory difficulty) in whom pathological diagnosis might alter clinical management. Diagnostic yield is comparable with PRB, but differs slightly depending on the approach used, 73–95% diagnostic yield has been reported for the aspiration needle approach [23–26] compared with 89–96.5% for the core biopsy needle [27, 28]. Although judged to be a safe and efficient procedure, there is the risk of contrast induced nephropathy and capsular perforation, which might require coil embolisation. Major complications are seen in 1–18% of cases when using the aspiration needle [23–26], compared to 2.7–27% with the core biopsy technique [27, 28]. Rathod et al. in India reported capsular perforation in five out of nine patients who had TRJRB using the core biopsy approach, although none had major event requiring intervention (blood transfusion or embolisation) [11]. Contrast nephropathy is a concern given that a significant proportion of patients undergoing this procedure have baseline renal impairment, but only 15–30 ml of contrast is used. There is usually no need for overnight stay as patient can be

Finally, regardless of the renal biopsy method selected, the nephrologist must ensure adequate pre- and post-care of the patient and obtain informed consent. Biopsy protocols should ideally exist in every centre carrying out renal biopsies,

**20**

Renal biopsy can be an indispensable tool in the diagnosis, monitoring, treatment, and prognosis, of patients with non-focal or focal renal parenchymal disease or systemic diseases with renal manifestation. The diagnostic usefulness significantly depends upon the operator's ability to select and prepare the patient based on in depth knowledge of the indications, contraindications and complications. The operator's skill, choice of technique and instruments are key factors that will determine the safety and efficacy of the procedure.
