Percutaneous renal biopsy. An improved method using television monitoring and high-dose infusion pyelography

In 1954 Kark and Muehrcke described a technique for percutaneous renal biopsy which involved the approximation of the kidney site by the transfer of bony landmarks to the patient's back from a preliminary intravenous pyelogram film and the insertion of the Franklin modification of the Vim-Silverman biopsy needle into the patient's flank to secure renal tissue.¹This method has enjoyed wide acceptance and presently represents the procedure of choice in most institutions. Unfortunately, even in experienced hands, there is a failure rate of 10% to 20% with this method because of the "blind" approach.²,³Furthermore, the complication rate is high and includes severe bleeding which may require transfusion or even nephrectomy²,³and the formation of arteriovenous fistulae at the biopsy site.⁴Consequently, there is a reluctance to biopsy the kidney via the percutaneous route, and, at the Massachusetts General Hospital, this method has been abandoned in favor of open surgical