Indications for percutaneous needle biopsy include

1. Unexplained acute renal failure or chronic renal insufficiency;

2. Acute nephritic syndromes;

3. Unexplained proteinuria and hematuria;

4. Previously identified and treated lesions to plan future therapy;

5. Systemic diseases associated with kidney dysfunction, such as systemic lupus erythematosus (SLE), Goodpasture's syndrome, and Wegener's granulomatosis, to confirm the extent of renal involvement and to guide management;

6. Suspected transplant rejection, to differentiate it from other causes of acute renal failure; and

7. To guide treatment.

Relative contraindications include a solitary or ectopic kidney (exception: transplant allografts), horseshoe kidney, uncorrected bleeding disorder, severe uncontrolled hypertension, renal infection, renal neoplasm, hydronephrosis, end-stage renal disease (ESRD), congenital anomalies, multiple cysts, or uncooperative patient.

References:

1. Reisman L, Dikman S, Churg J, Kupfer S. Renal biopsy: why and when. Mt Sinai J Med. 1996 May-Sep;63(3-4):178-90. [Medline]

2. Fuiano G, Mazza G, Comi N, Caglioti A, De Nicola L, Iodice C, Andreucci M, Andreucci VE. Current indications for renal biopsy: a questionnaire-based survey. Am J Kidney Dis. 2000 Mar;35(3):448-57. [Medline]