Ultrasound-guided percutaneous renal / adrenal biopsy

Percutaneous biopsy of renal or adrenal tissue is a minimally invasive procedure performed under ultrasound guidance (or, in selected cases, CT guidance) to obtain tissue samples for diagnostic purposes. It is considered the “gold standard” for morphological diagnosis of kidney diseases and for the evaluation of focal renal and adrenal lesions.

Anatomical areas involved

• Renal parenchyma (cortical layer) – the primary sampling site in glomerular diseases; contains glomeruli, tubules, and vessels.
• Renal medulla – assessed to ensure safe needle trajectory; biopsy is performed only under strict indications.
• Adrenal gland – an endocrine gland located above the upper pole of the kidney; biopsy is performed only for clearly defined focal lesions.
• Retroperitoneal space – provides safe access to the kidney and adrenal gland.

The Role 

• Determining the etiology of renal diseases (glomerulonephritis, nephrotic syndrome, interstitial nephropathies).
• Assessing disease activity and severity to guide appropriate treatment.
• Diagnosing focal renal and adrenal lesions (benign, malignant, infiltrative).
• Identifying the cause of persistent proteinuria or hematuria.
• Diagnostic evaluation of transplanted kidney function (in specialized centers).

Indications

• Chronic kidney disease of unknown etiology.
• Nephrotic or nephritic syndrome.
• Persistent proteinuria/hematuria of unclear origin.
• Suspected focal renal lesions (tumors, infiltrative changes).
• Adrenal focal lesions requiring morphological verification.
• Suspected acute kidney injury or exacerbation of chronic kidney disease.
• Monitoring of renal transplant status (in specialized centers).

Contraindications

Absolute:

• Severe coagulation disorders.
• Uncontrolled arterial hypertension.
• Active infection at the puncture site.

Relative:

• Single functioning kidney (individual decision).
• Atypical vascular anatomy or lack of a safe ultrasound window.
• Multiple cysts in the planned access area.

Procedure 

The procedure is performed under sterile conditions. The patient is positioned laterally or prone depending on the access site. After local anesthesia, a safe entry point is identified under ultrasound guidance.

A specialized biopsy needle (tru-cut) or coaxial system is used. Typically, 1–3 tissue cores are obtained and sent for histological and immunohistochemical analysis. After the procedure, the patient is monitored to exclude complications (hematoma, pain, gross hematuria).

Procedure duration: 20–30 minutes.
The procedure is minimally traumatic, well tolerated, and safe when performed correctly.

Percutaneous renal/adrenal biopsy is a highly informative, safe, and indispensable method for accurate morphological diagnosis, enabling appropriate treatment planning and prognosis assessment.