The role of percutaneous renal biopsy in clinical nephrology

Percutaneous renal biopsy provides the cornerstone for our understanding of the diseases of the kidney. Recent advances in biopsy techniques, such as the use of real-time ultrasonography and the biopsy gun, have made this procedure easier, increased the yield of diagnostically adequate tissue, and may result in a lower complication rate as well. Despite these improvements, the role of biopsy in the treatment of individual patients remains controversial. Even in diseases such as nephrotic syndrome and systemic lupus erythematosus, where biopsy findings have been used to categorize outcome events, it is unclear whether the biopsy provides more accurate information than can be obtained from less invasive procedures or from empiric therapy. Renal biopsy, however, does remain the best method for evaluation of renal dysfunction in renal allograft recipients. The role of fine-needle aspiration cytology in the management of transplant rejection remains to be established.