Transitioning From Blind to Real‐Time Ultrasound‐Guided Kidney Biopsy in Children: Diagnostic Yield and Bleeding Outcomes in a Vietnamese Tertiary Referral Hospital, a Retrospective Cohort Study

Background Kidney biopsy is the gold standard for diagnosing renal parenchymal diseases, guiding treatment and assessing prognosis. Real‐time ultrasound‐guided biopsy is widely regarded as the preferred technique. However, the implementation may be affected by equipment availability, trained personnel and workflow constraints in resource‐limited settings worldwide. Objective This study compared the safety and effectiveness of real‐time ultrasound‐guided and blind kidney biopsy techniques in a paediatric tertiary referral hospital in Vietnam and examined the practical implications of transitioning to real‐time ultrasound guidance. Methods A retrospective cohort study was conducted at the Nephro‐Endocrinology Department, City Children’s Hospital, Ho Chi Minh City, Vietnam, from May 2018 to April 2025. All native kidney biopsies performed during the study period were included. A standardised questionnaire was used to extract data from medical records, including demographics, biopsy techniques, glomerular yield, samples containing ≥ 10 and ≥ 25 glomeruli, and inadequate yield and complications, including macroscopic haematuria and major complications. Results Among 221 participants (median age: 11 [IQR 7–13] years), 173 underwent real‐time ultrasound‐guided biopsy and 48 used the blind technique. The ultrasound‐guided group had a significantly higher median glomerular count ( p = 0.01) and greater proportion of samples with ≥ 10 ( p < 0.001) and ≥ 25 glomeruli ( p = 0.04). There were no significant differences in inadequate sample rates ( p = 0.06), macroscopic haematuria ( p = 0.63) or major complications ( p = 0.60). Lower eGFR was independently associated with post‐biopsy bleeding events, mainly macroscopic haematuria (AOR = 0.809 per 10 mL/min/1.73 m 2 increase, 95% CI 0.671–0.975, p = 0.03). Conclusion In this Vietnamese paediatric tertiary referral setting, real‐time ultrasound‐guided biopsy provided superior tissue adequacy compared with the blind technique, without a detectable increase in macroscopic haematuria or major complications. Lower estimated glomerular filtration rate was associated with post‐biopsy bleeding events in this cohort, mostly macroscopic haematuria rather than major bleeding.