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World J Nephrol. Jul 6, 2016; 5(4): 321-327
Published online Jul 6, 2016. doi: 10.5527/wjn.v5.i4.321
Renal biopsy: Still a landmark for the nephrologist
Luca Visconti, Valeria Cernaro, Carlo Alberto Ricciardi, Viviana Lacava, Vincenzo Pellicanò, Antonio Lacquaniti, Michele Buemi, Domenico Santoro
Luca Visconti, Valeria Cernaro, Carlo Alberto Ricciardi, Viviana Lacava, Vincenzo Pellicanò, Antonio Lacquaniti, Michele Buemi, Domenico Santoro, Unit of Nephrology and Dialysis, University of Messina, 98100 Messina, Italy
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Domenico Santoro, Professor, Unit of Nephrology and Dialysis, University of Messina, via Consolare Valeria n.1, 98100 Messina, Italy. santisi@hotmail.com
Telephone: +39-090-2212331 Fax: +39-090-2212331
Received: January 9, 2016
Peer-review started: January 13, 2016
First decision: March 1, 2016
Revised: March 14, 2016
Accepted: April 5, 2016
Article in press: April 6, 2016
Published online: July 6, 2016
Processing time: 171 Days and 13.6 Hours
Abstract

Renal biopsy was performed for the first time more than one century ago, but its clinical use was routinely introduced in the 1950s. It is still an essential tool for diagnosis and choice of treatment of several primary or secondary kidney diseases. Moreover, it may help to know the expected time of end stage renal disease. The indications are represented by nephritic and/or nephrotic syndrome and rapidly progressive acute renal failure of unknown origin. Nowadays, it is performed mainly by nephrologists and radiologists using a 14-18 gauges needle with automated spring-loaded biopsy device, under real-time ultrasound guidance. Bleeding is the major primary complication that in rare cases may lead to retroperitoneal haemorrhage and need for surgical intervention and/or death. For this reason, careful evaluation of risks and benefits must be taken into account, and all procedures to minimize the risk of complications must be observed. After biopsy, an observation time of 12-24 h is necessary, whilst a prolonged observation may be needed rarely. In some cases it could be safer to use different techniques to reduce the risk of complications, such as laparoscopic or transjugular renal biopsy in patients with coagulopathy or alternative approaches in obese patients. Despite progress in medicine over the years with the introduction of more advanced molecular biology techniques, renal biopsy is still an irreplaceable tool for nephrologists.

Keywords: Renal biopsy; Acute kidney injury; Bleeding; Haematuria; Hematoma; Chronic renal failure

Core tip: Percutaneous renal biopsy is an irreplaceable tool in the clinical practice of nephrologists to determine diagnosis, prognosis and treatment of several kidney diseases. This procedure is considered safe if it is performed in well-trained centers. Main indications are acute glomerulonephritis and nephrotic syndrome. Since bleeding is the major primary complication, careful evaluation of risks and benefits must be considered. The risk of complications in patients with coagulopathy may be reduced by using laparoscopic or transjugular renal biopsy or alternative approaches in obese patients. Despite progress in medicine over the years, renal biopsy is still an irreplaceable tool for nephrologists.