Society of Diabetic Nephropathy Prevention Journal of Nephropathology 2251-8363 14 4 2025 10 01 Kidney biopsy; challenges with peri-procedural management e17222 e17222 10.34172/jnp.2022.17222 EN Lawrence Nguyen https://orcid.org/0000-0002-7634-4008 Sami Souccar https://orcid.org/0000-0003-4535-7516 Jonathan E. Zuckerman Joline L. T. Chen https://orcid.org/0000-0003-2617-3463 James Katrivesis https://orcid.org/0000-0002-4891-4595 Nadine Abi-Jaoudeh Lisa X Lee https://orcid.org/0000-0002-0664-2253 Uttam Reddy https://orcid.org/0000-0002-4540-6296 Afshan Baraghoush https://orcid.org/0000-0001-7211-2974 Debra E. Morrison https://orcid.org/0000-0002-5257-4159 Xiaodong Li https://orcid.org/0000-0002-2558-2583 Beverly Wang https://orcid.org/0000-0002-8656-7360 Wei Ling Lau https://orcid.org/0000-0002-3118-1073 Journal Article 10.34172/jnp.2022.17222 2021 04 18 2021 06 27 Native kidney biopsies are high-risk for bleeding complications due to the vascularity of the kidney and the inability to compress the biopsy site within a deep retroperitoneal location. Recommended parameters to minimize bleeding risk include a platelet count above 100 x 109/L, hemoglobin above 10 g/dL, systolic blood pressure <140 mm Hg, and minimizing the number of biopsy cores. In this paper we present patient cases to discuss management of other factors pertinent to kidney biopsy planning including interruption of anticoagulation, treatment of anxiety which can elevate blood pressure, and use of Doppler. Undiagnosed chronic kidney disease can affect triaging of tissue to light, immunofluorescence and electron microscopy, as sclerosed glomeruli are difficult to visualize in fresh cores. It is recommended to have a back-up retrieval protocol in place to obtain immunofluorescence and electron microscopy results, in the event that only limited kidney tissue was acquired for light histology. A collaborative effort between nephrology, interventional radiology and pathology is essential to optimize the diagnostic yield while minimizing bleeding risk with kidney biopsies. Of paramount importance is physician judgment of whether there is an acceptable balance of benefits/risks to proceed with a kidney biopsy.