- Preparation
- Sterile technique: skin cleaned with chlorhexidine, sterile drapes applied
- Infiltrate local anaesthetic (e.g. lignocaine) down to the renal capsule
- Needle insertion and biopsy
- Small skin nick made
- Under real-time ultrasound guidance, insert biopsy needle (usually 16G automated spring-loaded) toward lower pole cortex
- Ensure patient holds breath during firing
- Fire needle to obtain core biopsy
- Usually 2–3 cores obtained for adequate histology
- Post-procedure care
- Apply pressure to site, sterile dressing placed
- Patient remains supine and monitored for 4–6 hours (or longer if risk factors)
- Observe vitals, flank pain, haematuria, and signs of bleeding
- Repeat FBC or ultrasound if concern for haematoma
- Complications to watch for
- Macroscopic haematuria (common but usually self-limiting)
- Perirenal haematoma
- AV fistula
- Rare: bleeding requiring transfusion or intervention