**2. Methods of renal biopsy**

*Renal Diseases*

Renal biopsy may be associated with complications such as bleeding, pain, infections, injury to contiguous structures, and very rarely loss of a kidney or death of the patient. The safety and usefulness of renal biopsy in the diagnosis, monitoring and treatment of renal parenchymal diseases largely depends upon correct selection and adequate prepa-

ration of the patient, the skillfulness of the operator, and the technique used.

Over the years there has been a continuous refinement of renal biopsy techniques. It is mostly performed percutaneously using imaging guidance and more sophisticated soft-tissue needles (**Figure 1a**-**c**) of varying sizes. Other

*Soft tissue biopsy needles: (a) Tru-Cut, (b) semi-automated biopsy needle, and (c) automated biopsy needle.*

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**Figure 1.**

Iversen and Brun introduced percutaneous renal biopsy (PRB) of native kidneys in 1951, when they performed the procedure in a sitting patient using an aspiration needle after localizing the kidney with intravenous pyelography [3]. Although this innovation revolutionized the nephrology practice at the time, the tissue yield was inadequate in up 47% of the biopsies they performed over time [3]. Since then other percutaneous methods have been introduced and practiced with better tissue yields of up to 95–99% in some series [4–6]. Despite these encouraging figures, the tissue obtained is sometimes not diagnostically useful. This can be due to poor patient selection, wrong or poor technique, and inappropriate tissue handling, i.e., division of tissue for the different histopathologic examinations, and storage. The nephrologist should be adequately knowledgeable of indications, contraindications and complications of renal biopsy, and the several techniques available. This will significantly help to improve the usefulness of this procedure in terms of individual patient care and outcome.

Renal biopsy may be performed by one of the following approaches: percutaneous blind, blind after localisation with ultrasound scan, percutaneous real-time ultrasound guided, percutaneous CT guided, transjugular renal biopsy, laparoscopic renal biopsy, and open renal biopsy. The choice of technique among physicians often depends on skillfulness, availability of equipment and compelling indications in the patient. The techniques are briefly described below.
