**2.1 Percutaneous blind**

This technique is now obsolete in advanced countries, but still being practiced in some centres in low and low-middle income countries. The patient is placed in the prone position with a pillow or towel under the abdomen; the lower pole of the kidney to be biopsied is localised using the anatomic landmark (the tip of the twelfth rib posteriorly). Thereafter the skin is prepped, draped, and local anaesthetic is used to infiltrate the skin down to the kidneys. Either the manual (Tru-Cut) or spring-loaded biopsy needle is inserted through a nick made on the anaesthetized skin, and advanced towards the renal capsule while patient breaths gently. When the needle just pierces the renal capsule (signified by a give and swinging of the biopsy needle with respiratory excursions), the patient is instructed to hold the breath, and the biopsy cut is taken. Patient is observed usually for at least 6–8 hours, but may require longer admission depending on the presence of complications. This technique can be cumbersome and potentially associated with complications; tissue yield is often not optimal and several passes may be required to obtain adequate tissue.
