Should we biopsy kidneys of patients post-liver transplant?

Thirty days after orthotropic liver transplantation, a 52-year-old Hispanic male developed full-blown nephrotic syndrome. Although the patient was posttransplantation, he underwent a kidney biopsy under real-time ultrasound guidance. The pathological specimen revealed membranous nephropathy. A change in the immunosuppressive regimen resulted in a rapid decrease in urinary protein excretion, leading to resolution of the nephrotic syndrome. We report this case to illustrate the precautions that need to be taken when liver transplant patients require a kidney biopsy.