Ultrasound-guided approaches to renal biopsy

Percutaneous renal biopsy is a cornerstone procedure in modern nephrology, resulting from a technical and clinical evolution that began in the 1950s. The introduction of real-time ultrasound guidance in the 1980s revolutionized the safety, accuracy, and reproducibility of the procedure, transforming it into a highly standardized diagnostic technique. Major international and national guidelines define renal biopsy as a high-impact diagnostic test that should be performed only after a careful risk-benefit assessment in the evaluation of glomerular, tubulointerstitial, and vascular kidney diseases. Ultrasound-guided biopsy, in its various technical approaches, together with post-procedural clinical and imaging monitoring, is essential for ensuring adequate tissue sampling and the early detection of complications, thereby consolidating percutaneous renal biopsy as the diagnostic gold standard in contemporary nephrology.