Renal biopsy for the diagnosis of parenchymal renal diseases, has long been established as the diagnostic modality of choice. Traditionally this is performed from the lower pole of the native kidney using image guidance and a spring loaded biopsy device that obtainsa core of renal tissue for histopathological analysis. A cranial angulation is us ually applied to the path of the biopsy needle. The diagnostic accuracy of the sample is based on the number of glomerulii present in the sample. Over shooting the renal cortex and sampling the renal medulla not only increases the risk of complications (vascular injury) but also reduces the diagnostic yield due to the absence of glomerulii in the tissue. We describe a technique where using an image guided caudally angulated needle which precludes medullary sampling, improving both safety and diagnostic yield of the renal biopsy.

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