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Kidney Biopsy

Kidney Biopsy Procedure Prep

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Ep 39 How to Take Better Biopsies with Dr. Thor Johnson
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Kidney Biopsy Pre-Procedure Prep


• Unexplained renal failure
• Nephrotic syndrome
• Isolated non nephrotic proteinuria
• Isolated glomerular hematuria
• Renal masses
• Renal transplant rejection
• Renal transplant dysfunction


• Severe uncontrollable Hypertension
• Uncooperative patient
• Uncorrectable coagulopathy

Pre-Procedure Evaluation

• Hold any blood thinners (See SIR anticoagulation guidelines for specific medications)
• Withhold solid foods except medications (do not hold BP meds) for 6 hours for moderate sedation.
• Informed consent
• Labs: Platelets, PT/PTT, INR, Cr, BUN.
• Choose imaging modality CT vs US (US is the most common and efficient for kidney biopsies)
• Review any prior imaging

Kidney Biopsy Podcasts

Listen to leading physicians discuss kidney biopsy on the BackTable VI Podcast. Get tips, tricks, and expert guidance from your peers and level up your practice.

Episode #39


Dr. Thor Johnson discusses his experience with the Argon BioPince biopsy needle for liver, renal and soft tissue biopsies, including tips and tricks for obtaining better biopsy samples with fewer passes. Recorded at SIR 2019 in ATX.

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Kidney Biopsy Procedure Steps


• Native kidneys are most easily biopsied with the patient in a prone position. Both focal and nonfocal biopsies may be performed with the patient in a prone position. Lesions along the lateral edge of the kidney may be difficult to access via an ipsilateral side–down approach.
• A supine position of the patient is chosen for non-focal ultrasound-guided biopsies of a transplanted kidney. Typically, a transplanted kidney is positioned in the right or left lower pelvis and the most direct access is via an anterior approach. A supine anterolateral approach may also be used in obese patients. A supine transhepatic approach is occasionally used to reach anterior renal lesions.

Imaging Guidance

• Ultrasound vs CT depending on body habitus, available equipment, and lesion vs non focal biopsy.


• Moderate Sedation most commonly used. General anesthesia if patient cannot hold still.


• IV access (18 g preferred)
• Position the patient as appropriate and localize the lower pole of the kidney by imaging
• Lower pole of the native kidney has the lowest risk of puncturing a vessel and causing a perinephric hematoma
• Determine kidney size and detect unexpected anatomical barriers like cysts that would indicate the use of the contralateral kidney
• Make a skin mark to identify where the biopsy will be indicated for the lower pole target
• Prep the site of the skin mark and anesthetize the subcutaneous tissues using 1% local Lidocaine
• Under imaging guidance, carefully place the tip of the 17 g coaxial needle into the lower pole cortex and verify positioning by imaging. Once in position, pass the 18 g biopsy needle through the coaxial needle to obtain samples.
• 3-4 core biopsy samples are recommended. Goal is to obtain renal cortex (or lesion) tissue, avoiding the central kidney.
• Follow up imaging with US or CT to confirm no immediate bleeding. If a small hematoma develops, watch for 15-20 minutes for growth. Keep Systolic BP <145 mmHg.

Kidney Biopsy Post-Procedure

Post-Operative Care

• Pressure over biopsy site for 1 hour. Patient can lay the flank over a rolled up towel.
• Close observation of vital signs and symptoms of hematoma for 3-6 hours is absolutely necessary.
• Vital signs should be monitored every 15 minutes for 2 hours, every 30 min for 2 hours, then every hour for 2 hours post procedure.
• If there is worsening pain over the flank, re-image with CT or ultrasound and check CBC.
• If bleeding rapidly, blood transfusion and transcatheter embolization may be necessary.

Potential Complications

• Perinephric and subcapsular hematoma
• Retroperitoneal hematoma
• Hematuria
• Arteriovenous fistula or Renal Artery pseudoaneurysm

Kidney Biopsy Demos

Watch video walkthroughs of kidney biopsy on the BackTable VI expanded content network.

Disclaimer: The Materials available on are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.



How to Take Better Biopsies with Dr. Thor Johnson on the BackTable VI Podcast)
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Dr. Thor Johnson on the BackTable VI Podcast

Dr. Thor Johnson

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