Renal Biopsy Training RPA/Concord
Native Kidney
Theory
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Basic anatomy of the kidney + important surrounding structures
o Location
o Cortex/Medulla/Pelvis/Vessels
o Surrounding Structures – Rib/Muscle/Bowel
o Transplant kidneys
Basic understanding of Ultrasound + probe
o Orientation/Limitations
o Selection of appropriate probe/handling the probe
o Basic functions – Depth/Freeze/Measure/Colour
Basic understanding of tissue requirements
o Native kidney: cortex>medulla
o 2x 16G cores
o 25-30 gloms for FSGS v MCD
Complications
o Bleeding/Macrohaematuria/A-V Fistula/Failure to get adequate sample/Injury to
other organs/ vasovagal
o Rare but serious: need for transfusion/embolisation/nephrectomy/death
Contra-indications/For prior discussion
o Single Kidney/Small Kidneys/Thin Cortex/Multiple cysts/Obstruction
o Location under Ribs or below pelvic brim
o Hypertensive pt – BP >170 Sys or >100 Dia. Ideal <140/90.
o On antiplatelet or anticoagulation
o Bleeding diathesis incl recent plasma exchange
o Uraemia and dialysis/desmopressin
o Only right kidney suitable
o Active UTI
Check List
o Indication/Consent/Medications/Blood Pressure/Bloods/Imaging/Previous biopsies
o Sedation/premed guidelines
Post-biopsy care
o Routine monitoring/care
o Contra-indications to discharge
o Discharge instructions
Practical
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Positioning the patient
Identify suitable site for bx
o Native - Lower pole - preference for left
o Identify kidney + relevant structures e.g. ribs/vessels/bowel
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o Measure distance – understand underestimate
Observation of biopsy x2
Infiltrate anaesthetic superficially – x 1-2
o Identify needle with USS
Infiltrate anaesthetic down to capsule x2-3 or until competent
o Identify needle tip + anaesthetic in tissue planes
o Locate kidney with LP needle with Pt holding breath
o (Demonstrate LP needle swinging – optional)
Perform biopsy with supervisor assisting/gowned x 2-3 or until competent
Perform biopsy under observation x5 or until competent
Perform biopsy unsupervised
If no renal tissue has been sampled after 3 passes then the operator should call the treating
physician for discussion
All biopsies and complications to be recorded in the unit database. Importance of QA/review.
Trainees are encouraged to record biopsies and complications in their own logbook.
Transplant
Theory
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Basic anatomy of the graft + surrounding structures
o Cortex/Medulla/Pelvis/Vessels/Ureter
o Possibility of fibrous capsule in older grafts
o Surrounding Structures – Bowel/Iliac vessels/Bladder
Basic understanding of Ultrasound + probe
o Orientation/Limitations
o Select appropriate probe/handling the probe
o Basic functions – Depth/Freeze/Measure/Colour
Basic understanding of tissue requirements
o Cortex not medulla (some medulla desirable if looking for BK)
o 1-2x 18G cores
o Tissue requirements differ depending on tests required LM,IF, EM
o Usually > 7 gloms
Complications
o Bleeding/Macrohaematuria/A-V Fistula/Failure to get adequate sample/Biopsy of
other organs
o Rare but serious: need for transfusion/embolisation/nephrectomy/death
Contra-indications/For prior discussion
o Overlaying bowel gas or fluid collection
o Hypertensive pt – BP >170 or >100. Ideal <140/90.
o On antiplatelet and anticoagulation
o Bleeding diathesis incl recent plasma exchange
o Uraemia and dialysis/desmopressin
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o Obstruction
o Active UTI
Check List
o Indication/Consent/Medications/Blood Pressure/Bloods/Imaging/Previous biopsies
o Sedation/pre-med guidelines
Post-biopsy care
o Routine monitoring/care
o Contra-indications to discharge
o Discharge instructions
Practical
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



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Positioning the patient
Identify suitable site for bx
o Most superficial pole
 Superior preferable to lower pole
o Identify graft + relevant structures - Bowel/Iliac vessels/Bladder/Fluid collections
o Measure distance – understand underestimate
Observation x2
Infiltrate anaesthetic– x2-3 or until competent
o Identify needle with USS
o Infiltrate anaesthetic down to capsule
o Identify needle tip at capsule
Perform biopsy with supervisor assisting/gowned x 2-3 or until competent
Perform biopsy under observation x5 or until competent
Perform biopsy unsupervised
If no renal tissue has been sampled after 3 passes then the operator should call the treating
physician
All biopsies and complications to be recorded in the unit database. Importance of QA/review.
Trainees are encouraged to record biopsies and complications in their own logbook.
New trainees
Second or third year trainees new to the hospital should present their logbook for review and be
supervised at least 1-2 times to ensure they are competent. If the trainee has not performed renal
transplant biopsies then they should go through training outlined above and be will be certified
when competent.