Percutaneous Kidney Biopsy: Indications, Technique, and Peri-Procedural Management—A Narrative Review

Percutaneous kidney biopsy (PKB) is an essential tool in the nephrologist’s armamentarium that plays a major role in establishing the diagnosis, monitoring response to interventions and providing prognostication. Over the last few decades, the technique of PKB has evolved from a blind procedure with a high complication rate to an image-guided procedure with substantially reduced but still clinically relevant complication rates, with major bleeding reported in approximately 1–6% of biopsies in contemporary series. With appropriate pre-procedure planning, patient selection, and experienced operators, PKB generally has a low rate of major complications and a high diagnostic yield, while clinicians must remain vigilant for bleeding and other adverse events. In this narrative review, we summarize current indications, contraindications, technical considerations, and complication mitigation strategies for PKB, integrating contemporary guideline recommendations and key observational studies to support bedside decision-making. Further, we review details pertaining to peri-procedure protocols. Special populations that require PKB such as morbid obesity, pregnancy, elderly, single kidney and anatomic abnormalities are discussed as well. Alternative approaches to performing PKB, when PKB is infeasible or challenging, are briefly covered in this review.