Original Article

Safety and Efficacy of Percutaneous Renal Biopsy by Physicians-in-Training in an Academic Teaching Setting

Authors: Tibor Fülöp, MD, Bereket Alemu, MD, Neville R. Dossabhoy, MD, Justin H. Bain, DO, David E. Pruett, MD, Anita Szombathelyi, PhD, Albert W. Dreisbach, MD, Mihály Tapolyai, MD


Objectives: The safety and efficacy of percutaneous renal biopsy (PKB) are relatively little studied in a training setting. We sought to review our recent experience with bedside PKB in our training program.

Methods: We performed a retrospective cohort review of our consecutive 2.5-year renal biopsy experience (May 2007–November 2009) at the University of Mississippi Nephrology Fellowship. All of the biopsies were performed exclusively by renal fellows using real-time ultrasound (US) visualization within the framework of a structured US-PKB training course.

Results: A total of 64 patients underwent PKB during the index period; 50 (78.1%) of these procedures were performed on native kidneys. Participant age was 39.8 ± 13.7 years, blood pressures measured 140.1/85.3 ± 21.5/14.9 mm Hg, serum creatinine was 3.05 ± 3.15 mg/dL, and median random urine protein:creatinine ratio was 2.38 (25%–75% interquartile range 0.49–7.32). The biopsied kidneys measured 11.8 (±1.6) cm. We recovered 18.8 ± 11.5 glomeruli per procedure; two biopsies were unsuccessful. Focal glomerular sclerosis and lupus nephritis (22% and 25%, respectively) predominated among the specimens. Only three specimens returned with no diagnostic changes. There was a close correlation between preceding history and recovered diagnoses of diabetic changes and lupus nephritis ( r 0.605 and 0.842; P < 0.0001 for both). Initial hemoglobin of 10.8 ± 1.8 g/dL dropped to 10.2 (1.9) g/dL after the procedure ( P < 0.0001). Five (7.8%) patients needed transfusion; one patient experienced persistent urine leakage; however, none of the patients needed surgical or radiological intervention or died.

Conclusions: In the setting of a well-structured training environment, US-guided PKB is a reasonably safe and valuable component of renal fellowship training.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Weigert AL, Schafer AI. Uremic bleeding: pathogenesis and therapy. Am J Med Sci 1998;316:94-104.
2. Shidham GB, Siddiqi N, Beres JA, et al. Clinical risk factors associated with bleeding after native kidney biopsy. Nephrology (Carlton) 2005;10:305-310.
3. Whittier WL, Korbet SM. Renal biopsy: update. Curr Opin Nephrol Hypertens 2004;13:661-665.
4. Whittier WL. Complications of the percutaneous kidney biopsy. Adv Chronic Kidney Dis 2012;19:179-187.
5. Maya ID, Maddela P, Barker J, et al. Percutaneous renal biopsy: comparison of blind and real-time ultrasound-guided technique. Semin Dial 2007;20:355-358.
6. Cozens NJA, Murchison JT, Allan PL, et al. Conventional 15 G needle technique for renal biopsy compared with ultrasound-guided spring-loaded 18 G needle biopsy. Br J Radiol 1992;65:594-597.
7. Hergesell O, Felten H, Andrassy K, et al. Safety of ultrasound-guided percutaneous renal biopsy-retrospective analysis of 1090 consecutive cases. Nephrol Dial Transplant 1998;13:975-977.
8. Kovalik EC, Schwab SJ, Gunnells JC, et al. No change in complication rate using spring-loaded gun compared to traditional percutaneous renal allograft biopsy techniques. Clin Nephrol 1996;45:383-385.
9. Honma M, Toyoda M, Umezono T, et al. An investigation of 2,093 renal biopsies performed at Tokai University Hospital between 1976 and 2000. Clin Nephrol 2008;69:18-23.
10. Fuiano G, Mazza G, Comi N, et al. Current indications for renal biopsy: a questionnaire-based survey. Am J Kidney Dis 2000;35:448-457.
11. Burstein DM, Schwartz MM, Korbet SM. Percutaneous renal biopsy with the use of real-time ultrasound. Am J Nephrol 1991;11:195-200.
12. Maya ID, Allon M. Percutaneous renal biopsy: outpatient observation without hospitalization is safe. Semin Dial 2009;22:458-461.
13. Clark EG, Schachter ME, Palumbo A, et al. Temporary hemodialysis catheter placement by nephrology fellows: implications for nephrology training. Am J Kidney Dis 2013;62:474-480.
14. Korbet SM. Nephrology and the percutaneous renal biopsy: a procedure in jeopardy of being lost along the way. Clin J Am Soc Nephrol 2012;7:1545-1547.
15. Islam N, Fulop T, Zsom L, et al. Do platelet function analyzer-100 testing results correlate with bleeding events after percutaneous renal biopsy? Clin Nephrol 2010;73:229-237.
16. Corapi KM, Chen JL, Balk EM, et al. Bleeding complications of native kidney biopsy: a systematic review and meta-analysis. Am J Kidney Dis 2012;60:62-73.
17. Tøndel C, Vikse BE, Bostad L, et al. Safety and complications of percutaneous kidney biopsies in 715 children and 8573 adults in Norway 1988-2010. Clin J Am Soc Nephrol 2012;7:1591-1597.
18. Manno C, Strippoli GF, Arnesano L, et al. Predictors of bleeding complications in percutaneous ultrasound-guided renal biopsy. Kidney Int 2004;66:1570-1577.
19. Bataille S, Jourde N, Daniel L, et al. Comparative safety and efficiency of five percutaneous kidney biopsy approaches of native kidneys: a multicenter study. Am J Nephrol 2012;35:387-393.
20. Margaryan A, Perazella M, Mahnensmith R, et al. Experience with outpatient computed tomographic-guided renal biopsy. Clin Nephrol 2010;74:440-445.
21. Peters B, Andersson Y, Stegmayr B, et al. A study of clinical complications and risk factors in 1001 native and transplant kidney biopsies in Sweden. Acta Radiol 2013. [Epub ahead of print]
22. Tang S, Li JH, Lui SL, et al. Free-hand, ultrasound-guided percutaneous renal biopsy: experience from a single operator. Eur J Radiol 2002;41:65-69.
23. Augusto JF, Lassalle V, Fillatre P, et al. Safety and diagnostic yield of renal biopsy in the intensive care unit. Intensive Care Med 2012;38:1826-1833.
24. Whittier WL, Korbet SM. Timing of complications in percutaneous renal biopsy. J Am Soc Nephrol 2004;15:142-147.
25. Lin WC, Yang Y, Wen YK, et al. Outpatient versus inpatient renal biopsy: a retrospective study. Clin Nephrol 2006;66:17-24.
26. Tavares MB, Chagas de Almeida Mda C, Martins RT, et al. Cute tubular necrosis and renal failure in patients with glomerular disease. Ren Fail 2012;34:1252-1257.
27. Stiles KP, Hill C, LeBrun CJ, et al. The impact of bleeding times on major complication rates after percutaneous real-time ultrasound-guided renal biopsies. J Nephrol 2001;14:275-279.
28. Waldo B, Korbet SM, Freimanis MG, et al. The value of post-biopsy ultrasound in predicting complications after percutaneous renal biopsy of native kidneys. Nephrol Dial Transplant 2009;24:2433-2439.