Interventional Ultrasound: Renal Biopsy

  • Carlo Manno
  • Anna Maria Di Palma
  • Elisabetta Manno
  • Michele Rossini
  • Loreto GesualdoEmail author


The study of renal biopsy by light microscopy, immunofluorescence and electron microscopy allowscorrect diagnosis andtherapy of acute and chronic renal diseases. The most important indications in clinical practice are numerous, as elevated serum creatinine, hematuria, nephritic or nephrotic syndrome and systemic diseases with renal dysfunction. The absolute contraindications are generally represented by uncontrolled bleeding diathesis, severe arterial hypertension, multiple renal cysts, renal mass, acute pyelonephritis, end-stage kidney disease with small kidneys. In the classic procedure of percutaneous renal biopsy the patient is in prone position, while in patients obese or with respiratory problems has been successfully used the supine anterolateral position. The technique has significantly improved by the introduction of automated-gun biopsy devices and real-time ultrasound guidance which allows visualization of the biopsy needle and its path during the procedure. The bleeding complications include silent hematoma detected only by post-biopsy imaging, macroscopic hematuria, large hematoma and blood loss requiring erythrocyte transfusion, arteriovenous fistula, pagekidney and, rarely, the need for emergent angiographic intervention or nephrectomy. The main finding of the literature is that a renal biopsy should be regarded as a safe and successful procedure, and the overall rate of major complications is very low if general contraindications are respected. The declining trend in the performance of renal biopsy by practicing nephrologists should be alarming, while the importance should be emphasized because the information provided by this procedure directly affects the care of nephropathic patients.


Lupus Nephritis Renal Biopsy Glomerular Basement Membrane Kidney Biopsy Acute Pyelonephritis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video 12.1

Prone position in percutaneous renal biopsy (M4V 28728 kb)

Video 12.2

Supine anterolateral position (SALP) in percutaneous renal biopsy (MP4 133391 kb)


  1. 1.
    García Nieto V, Luis Yanes MI, Ruiz Pons M (2009) Celebrating fifty years of percutaneous renal biopsies in Spain. Nefrologia 29:71–76PubMedGoogle Scholar
  2. 2.
    Iversen P, Brun C (1951) Aspiration biopsy of the kidney. Am J Med 11:324–330CrossRefPubMedGoogle Scholar
  3. 3.
    Kark RM, Muehrcke RC (1954) Biopsy of kidney in prone position. Lancet 266:1047–1049Google Scholar
  4. 4.
    Whittier WL, Korbet SM (2004) Timing of complications in percutaneous renal biopsy. J Am Soc Nephrol 15:142–147CrossRefPubMedGoogle Scholar
  5. 5.
    Manno C, Strippoli GFM, Arnesano L et al (2004) Predictors of bleeding complications in percutaneous ultrasound-guided renal biopsy. Kidney Int 66:1570–1577CrossRefPubMedGoogle Scholar
  6. 6.
    Islam N, Fulop T, Zsom L et al (2010) Do platelet function analyzer-100 testing results correlate with bleeding events after percutaneous renal biopsy? Clin Nephrol 73:229–237CrossRefPubMedGoogle Scholar
  7. 7.
    Culkin DJ, Exaire EJ, Green D et al (2014) Anticoagulation and antiplatelet therapy in urological practice: ICUD/AUA review paper. J Urol 192:1–9CrossRefGoogle Scholar
  8. 8.
    Waldo B, Korbet SM, Freimanis MG, Lewis EJ (2009) The value of post-biopsy ultrasound in predicting complications after percutaneous renal biopsy of native kidneys. Nephrol Dial Transplant 24:2433–2439CrossRefPubMedGoogle Scholar
  9. 9.
    Gesualdo L, Cormio L, Stallone G et al (2008) Percutaneous ultrasound-guided renal biopsy in supine antero-lateral position. Nephrol Dial Transplant 23:971–976CrossRefPubMedGoogle Scholar
  10. 10.
    Ishikawa E, Nomura S, Hamaguchi T et al (2009) Ultrasonography as a predictor of overt bleeding after renal biopsy. Clin Exp Nephrol 13:325–331CrossRefPubMedGoogle Scholar
  11. 11.
    Dopson SJ, Jayakumar S, Velez JC (2009) Page kidney as a rare cause of hypertension: case report and review of the literature. Am J Kidney Dis 54:334–339CrossRefPubMedGoogle Scholar
  12. 12.
    Corapi KM, Chen JL, Balk EM, Gordon CE (2012) Bleeding complications of native kidney biopsy: a systematic review and meta-analysis. Am J Kidney Dis 60:62–73CrossRefPubMedGoogle Scholar
  13. 13.
    Manno C, Bonifati C, Torres DD, Campobasso N, Schena FP (2011) Desmopressin acetate in percutaneous ultrasound-guided kidney biopsy. A randomized controlled trial. Am J Kidney Dis 57:850–855CrossRefPubMedGoogle Scholar
  14. 14.
    Corvin HL, Schwartz MM, Lewis EJ (1988) The importance of sample size in the interpretation of the renal biopsy. Am J Nephrol 8:85–89CrossRefGoogle Scholar
  15. 15.
    Sethi S, Haas M, Markowitz GS et al (2015) Mayo clinic/renal pathology society consensus report on pathologic classification, diagnosis, and reporting of GN. J Am Soc Nephrol 27:1278–1287.Google Scholar
  16. 16.
    Segarra-Medrano A, Carnicer-Cáceres C, Arbós-Via MA et al (2012) Biological markers of nephrotic syndrome: a few steps forward in the long way. Nefrologia 32:558–572PubMedGoogle Scholar
  17. 17.
    Tøndel C, Vikse BE, Bostad L, Svarstad E (2012) Safety and complications of percutaneous kidney biopsies in 715 children and 8573 adults in Norway 1988–2010. Clin J Am Soc Nephrol 7:1591–1597CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Carlo Manno
    • 1
  • Anna Maria Di Palma
    • 1
  • Elisabetta Manno
    • 1
  • Michele Rossini
    • 1
  • Loreto Gesualdo
    • 1
    Email author
  1. 1.Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ TransplantationUniversity of BariBariItaly

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