Renal Biopsy Technique
- Author: Lanna Cheuck, DO; Chief Editor: Edward David Kim, MD, FACS more...
A renal biopsy is typically performed percutaneously through the patient’s back.
The patient is placed in the prone position, and the biopsy is typically taken from the lower pole of the kidney if there are no specific locations of interest. In order to localize this portion of the kidney, the biopsy is typically performed under ultrasound guidance.
The biopsy needle is guided using ultrasound to ensure visualization of the needle as it pierces the kidney parenchyma. The size of the needle varies based on physician preference. Needle sizes may vary from 14-18 gauge. Care is taken not to enter the collecting system (as it would result in hematuria) or to go near the renal hilum (to prevent injury to the vessels). An illustration of ultrasound-guided percutaneous renal biopsy is depicted below.
A study by Kriegshauser et al found that operator experience, taking more than 1 specimen, and the use of the cortical tangential approach significantly improved the pathologic material obtained during native renal biopsies.
In other cases, renal biopsy can be performed with CT guidance (see image below) done in order to localize the needle in a very specific portion of the kidney which can only be visualized on a CT scan.
If no imaging is used to guide the biopsy, the patient may be asked to take several deep breaths to ensure proper needle placement before taking the biopsy.
In some cases a urologist may obtain a piece of renal tissue to determine whether it is benign or malignant tissue and to determine if the margins are negative. For instance, a urologist performing a partial nephrectomy may take a renal biopsy at the surgical bed to ensure that no tumor is left behind before continuing with the renorrhaphy. This can be approached in the same manner as the partial nephrectomy—robotic, purely laparoscopic, or the traditional open approach.
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