Technique

Preparation:

• obtain patient's informed consent
• check full blood count, urea and electrolytes, creatinine, liver function tests, clotting profile
• group and save serum for later blood crossmatching
• intravenous access for infusion
• assess size and symmetry of kidneys by ultrasound
• other specialist investigations as required, for example, anti-glomerular basement membrane antibodies
• pre-medication as appropriate
• blood pressure should be less than 90 mm Hg diastolic
• give desamino-D-arginine vasopression if creatinine level exceeds 400 micromoles per litre so as to minimise risk of bleeding
• notify histopathologist of the time of biopsy

Obtaining the tissue sample:

• ultrasound or CT guidance
• tissue usually taken from lateral border of lower pole
• modern needles tend to be of the Tru-cut type
• patient under local anaesthetic

After care:

• keep patient in hospital for 24 hours - bed rest for the first 12 hours
• monitor pulse, blood pressure, urine output - every 15 minutes, then half-hourly, hourly as appropriate to clinical status
• observe for complications