Purpose of review: The renal biopsy is an invaluable tool in the diagnosis, prognosis, and management of patients with kidney disease. As the success of the procedure is defined not only by the ability to obtain adequate tissue but also by the safety profile, significant advances which define risk factors and determine the optimal timing of observation after the percutaneous native renal biopsy merit discussion. Alternative methods of obtaining tissue, such as transvenous renal biopsies, have also been described, especially in patients with contraindications to the percutaneous method.
Recent findings: The percutaneous renal biopsy has been established as a safe and effective method of obtaining renal parenchyma. Complications, although rare, may occur and the majority of these are related to bleeding. The optimal timing of observation after the biopsy should be determined by when most complications occur, and, as over 33% of complications occur after 8 h, an observation period of at least 24 h is recommended. In patients with contraindications to the percutaneous approach, such as failure of adequate radiologic visualization or a bleeding diathesis, alternative methods of obtaining tissue have been attempted. These include open, laparascopic, transurethral, or transvenous renal biopsy.
Summary: Without contraindications, the percutaneous renal biopsy remains the standard method of acquiring renal tissue. At least 24 h of observation is recommended after the percutaneous native kidney biopsy for the development of potential complications. When a contraindication to the procedure exists, other methods of renal biopsy by experienced physicians may be attempted.