Care Of Kidney Transplant Recipients Research Articles

Prevention and management of infectious and tropical diseases in kidney transplant recipients residing in European outermost and overseas territories.

The European Union encompasses 30 outermost and overseas countries and territories (OCTs). Despite a recent increasing activity of renal transplantation in these territories, many patients still undergo transplantation in continental Europe, with follow-up care coordinated between health professionals from both their transplant center and their home region. Each territory has its unique infectious epidemiology which must be known to ensure appropriate care for kidney transplant recipients (KTRs). This paper proposes a pragmatic approach to optimize pre-transplant check-up and to provide an overview of the specific epidemiological features of each region. It offers practical algorithms to help practitioners in managing infected KTR living in these territories. This work advocates for increased collaborative research among European OCTs.

362.4: Pilot study of clinical use of peripheral blood gene expression profile in the care of kidney transplant recipients between 2- and 5-years post-transplant.

362.4: Pilot study of clinical use of peripheral blood gene expression profile in the care of kidney transplant recipients between 2- and 5-years post-transplant.

Challenges in posttransplantation care for kidney transplant recipients: A qualitative study highlighting gaps in psychological, social and exercise support.

Kidney transplantation offers meaningful health improvements compared to dialysis, yet the quality of life and life expectancy of kidney transplant recipients still lag behind those of their healthy peers. Physical inactivity and poor physical fitness are prevalent among kidney transplant recipients, affecting overall life participation. To explore challenges hindering life participation for kidney transplant recipients and reveal facilitators and barriers to integrating rehabilitation into their daily lives. An explorative study using a qualitative method. Fourteen purposively selected kidney transplant recipients. Semistructured, individual interviews were conducted posttransplantation. The following topics were covered: living with chronic kidney disease, pretransplantation challenges, posttransplantation recovery, engagement in various activities, including physical activity, and the need for supervised exercise rehabilitation programmes. Interviews were recorded and transcribed verbatim, and an inductive thematic analysis approach was used. Data saturation occurred after analysing 12 interviews, revealing two main themes: the impact on life participation and the impact on physical and mental functioning. Participants expressed the need for comprehensive posttransplant care, including mental health support, family education and guidance on returning to work. Structured support in managing physical fitness, tailored to individual preferences, was also recognised as important. The study underscores the necessity for a biopsychosocial approach to posttransplant care that addresses the multifaceted challenges faced by kidney transplant recipients. A multidisciplinary approach, tailored support, education and individualised exercise programmes are crucial for enhancing their overall well-being and integrating rehabilitation into their daily lives, considering both physical and psychosocial aspects.

Optimising Diabetes Care for Kidney Transplant Recipients

Diabetes is the leading cause of end-stage kidney disease (ESKD) worldwide.

Transplant nephropathology: Wherefrom, wherein, and whereto.

Renal pathology is a relatively recent entry in nephrology. While diseases of the kidney are old, their study began in the 19th century with the report of Richard Bright of the lesions of end-stage kidney disease. Its easy diagnosis from albuminuria soon elevated Bright's nephritis into a leading cause of death. The transformative events in the care of these cases were renal replacement therapy that converted a fatal into a chronic disease, and kidney biopsy that allowed study of the course and pathogenesis of kidney disease. Apart from its fundamental contributions to clinical nephrology, biopsy of renal allografts became an integral component of the evaluation and care of kidney transplant recipients. The Banff transplant pathology conferences launched in 1991 led to developing the classification of allograft pathology into an essential element in the evaluation, treatment, and care of allograft recipients with spirit of discovery. That success came at the cost of increasing complexity leading to the recent realization that it may need the refinement of its consensus-based system into a more evidence-based system with graded statements that are easily accessible to the other disciplines involved in the care of transplanted patients. Collaboration with other medical disciplines, allowing public comment on meeting reports, and incorporation of generative artificial intelligence (AI) are important elements of a successful future. The increased pace of innovation brought about by AI will likely allow us to solve the organ shortage soon and require new classifications for xenotransplantation pathology, tissue engineering pathology, and bioartificial organ pathology.

The Role of Protocol Allograft Biopsies in Postrenal Transplantation: A Systematic Review and Meta-analysis

Introduction: Kidney transplantation is the preferred treatment for end-stage kidney disease, offering improved outcomes compared to dialysis. However, factors such as immunological rejection, drug toxicity, and infections limit its success. Incorporating protocol biopsies (PBs) into standard care for kidney transplant recipients varies widely. This study aims to review the literature on the practice, histopathological findings, and benefits of performing PB on allograft function. Materials and Methods: A systematic review was conducted using PubMed, ScienceDirect, and other databases from 2000 to 2023. Studies describing findings of PBs within 2 years posttransplant were included. Data extraction covered study design, immunosuppression, biopsy timing, incidence of subclinical rejection (SCR), clinical rejection, and allograft function measures. Statistical analysis was performed using R and RevMan software. Results: Among 25 studies (3384 patients) included, 8 were randomized controlled studies. Protocol biopsy timing varied, with the highest number performed at 1 year (44.84%). The pooled incidence of SCR was 13%, with heterogeneity across estimates. Subgroup analysis did not reveal significant differences in SCR rates between high- and low-immunologic risk patients. Patients who underwent PBs had lower clinical rejection rates (12.64% vs. 20.17%) and better allograft function. Incidence of calcineurin inhibitor toxicity ranged from 1.2% to 63.4%, and BK virus nephropathy ranged from 0% to 5.9% in included studies. Conclusion: Performing PB at 6 months, 1 year, and 2 years posttransplant can reveal SCR and potentially improve long-term graft outcomes. Treatment of SCR may reduce clinical rejection episodes. However, further research, particularly comparing PB with noninvasive methods, is needed to better understand their efficacy and complications in the modern transplant landscape.

Implementing a self-reported immunosuppression adherence questionnaire to screen for non-adherence in routine care of kidney transplant recipients.

Self-reported measures of immunosuppression adherence have been largely examined in research settings. In this single center study of 610 kidney transplant recipients, we examined if a voluntary, non-anonymous self-report measure could identify non-adherence in a routine clinic setting and how patients perceived such a measure. Non-adherence was measured using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS) and patient perception was elicited using a customized questionnaire. Non-responders to the survey (15%) were younger, more likely to be black, and less likely to have had a pre-emptive transplant. Among complete responders (n=485), 38% reported non-adherence with non-adherent patients being younger (54y vs. 60y; p=.01), less likely to have been on dialysis pre-transplant (59%vs. 68%; p=.04), further out from transplant (37vs. 22 months; p<.001) and had more rejections in the preceding year (8%vs. 3%; p=.02). Self-reported non-adherence was associated with higher calcineurin inhibitor intra-patient variability (27.4%vs. 24.5%; p=.02), but not with donor-specific antibody detection (27.8%vs. 21.2%, p=.15). Of patients providing feedback (n=500), the majority of patients felt comfortable reporting adherence (92%), that the survey was relevant to their visit (71%), and that the survey did not interfere with their clinic visit (88%). In summary, a self-reported questionnaire during clinic visits identified immunosuppression non-adherence in a significant proportion of patients and was well received by patients. Integrating self-report measures into routine post-transplant care may enable early identification of non-adherence.

Nurse-led clinical activity in kidney transplantation care in Spain: A cross-sectional observational study.

To explore the presence of specialist outpatient nursing activity in care for kidney transplant recipients in Spain and to determine the level of competence development of this activity according to the Advanced Practice Nurse model. Descriptive, cross-sectional study. All outpatient nurses specialising in renal transplantation in the 39 transplant hospitals in Spain were included. To fulfil the study objectives, an ad hoc questionnaire and the 'Advanced Practice Nurse Role Definition Instrument (IDREPA)'were administered to assess the nurses' level of competence development. Of the facilities included in the study, 25 (64.1%) had posttransplant nursing activity, 13 (33.3%) had pretransplant nursing activityand 11 (28.2%) had nursing activity involving kidney donor candidates. Twenty-seven specialist nurse's offices were identified. The results of the IDREPA reflect the presence of advanced practice in the domains of 'expert care planning' and 'comprehensive care'. Three (11.1%) nurses met all criteria for advanced nursing practice. The results on specialised outpatient nursing activity at the 39 transplantation facilities in Spain indicate a low presence of this type of activity, with an even lower presence of advanced practice nurses. Management teams should consider investing in the quality of care provided by advanced nurse practice to ensure that suitable treatment is provided and better clinical outcomes are obtained.

Low selenium intake is associated with risk of all-cause mortality in kidney transplant recipients.

Deficiency of the essential trace element selenium is common in kidney transplant recipients (KTR), potentially hampering antioxidant and anti-inflammatory defence. Whether this impacts the long-term outcomes of KTR remains unknown. We investigated the association of urinary selenium excretion, a biomarker of selenium intake, with all-cause mortality; and its dietary determinants. In this cohort study, outpatient KTR with a functioning graft for longer than 1 year were recruited (2008-11). Baseline 24-h urinary selenium excretion was measured by mass spectrometry. Diet was assessed by a 177-item food frequency questionnaire, and protein intake was calculated by the Maroni equation. Multivariable linear and Cox regression analyses were performed. In 693 KTR (43% men, 52±12 years), baseline urinary selenium excretion was 18.8 (interquartile range 15.1-23.4) μg/24-h. During a median follow-up of 8 years, 229 (33%) KTR died. KTR in the first tertile of urinary selenium excretion, compared with those in the third, had over a 2-fold risk of all-cause mortality [hazard ratio 2.36 (95% confidence interval 1.70-3.28); P<.001], independent of multiple potential confounders including time since transplantation and plasma albumin concentration. The most important dietary determinant of urinary selenium excretion was protein intake (Standardized β 0.49, P<.001). Relatively low selenium intake is associated with a higher risk of all-cause mortality in KTR. Dietary protein intake is its most important determinant. Further research is required to evaluate the potential benefit of accounting for selenium intake in the care of KTR, particularly among those with low protein intake.

Clinical Utility of the OmniGraf Biomarker Panel in the Care of Kidney Transplant Recipients (CLARITY): Protocol for a Prospective, Multisite Observational Study

Death with a functioning allograft has become the leading category of graft loss in kidney transplant recipients at all time points. Previous analyses have demonstrated that causes of death in kidney transplant recipients are predominated by comorbidities strongly associated with immunosuppressant medications. Adverse drug events (ADEs) have been strongly associated with nonadherence, health care utilization, and graft loss; clinicians face a difficult decision on whether making immunosuppressant adjustments in the face of ADEs will improve symptomology or simply increase the risk of acute rejection. Clinicians also face a treatment quandary in 50% of kidney transplant recipients with stage 3 or worse chronic kidney disease at 1 year post transplantation, as progressive decline in renal function has been strongly associated with inferior allograft survival. The primary objective of the CLinical Utility of the omnigrAf biomarkeR Panel In The Care of kidneY Transplant Recipients (CLARITY) trial is to evaluate change in renal function over time in kidney transplant recipients who are undergoing OmniGraf monitoring in conjunction with monitoring of their medication-related symptom burden (MRSB). A secondary objective of this study is to identify the impact of OmniGraf use in conjunction with patient-reported MRSB as part of clinical care on patients' self-efficacy and quality of life. CLARITY is a 3-year prospective, multisite, observational study of 2000 participants with a matched control, measuring the impact of real-time patients' MRSB and the OmniGraf biomarker panel on change in renal function over time. Secondary outcome measures include the Patient-Reported Outcomes Measurement Information System (PROMIS) Self-Efficacy for Managing Chronic Conditions-Managing Medications and Treatment-Short Form 4a; the PROMIS-29 Profile (version 2.1); the PROMIS Depression Scale, hospitalizations-subcategorized for hospitalizations owing to infections; treated rejections, MRSB, and proportion of participants with overall graft survival at year 3 post transplantation; graft loss or death during the 3-year study follow-up period; and change in provider satisfaction. The primary outcome measure of the study will be a comparison of the slope change in estimated glomerular filtration rate from baseline to the end of follow-up between study participants and a matched control group. Secondary outcome measures include changes over time in PROMIS Self-Efficacy for Managing Chronic Conditions-Managing Medications and Treatment-Short Form 4a, the PROMIS-29 Profile (version 2.1), and PROMIS Depression Scale in the study group, as well as a comparison of hospitalizations and causes, rejections, and graft and patient survival compared between participants and a matched cohort. The anticipated first enrollment in the study is October 2022 with data analysis and publication expected in October 2027. Through this report, we describe the study design, methods, and outcome measures that will be utilized in the ongoing CLARITY trial. ClinicalTrials.gov NCT05482100; https://clinicaltrials.gov/ct2/show/NCT05482100. PRR1-10.2196/41020.

MO590: A Home-Based Exercise and Physical Activity Intervention After Kidney Transplantation: Impact of Exercise Intensity. The Phoenix-Kidney Study Protocol

Abstract BACKGROUND AND AIMS Advances in the field of kidney transplantation have led to improved postoperative survival rates, but age-standardized mortality nonetheless remains 2- to 7-fold higher in kidney transplant recipients—with cardiovascular disease representing the leading cause of death in recipients with a functioning graft. Poor physical fitness, not completely recovering after transplantation, adds to the heightened cardiovascular risk of hypertension, diabetes, dyslipidemia and obesity. So does the post-transplant continuation of gut microbial dysbiosis, which recently emerged as a modulator of muscular, metabolic and cardiovascular health. Exercise-based rehabilitation and physical activity interventions may prove pivotal in the care of kidney transplant recipients to address aforementioned outcomes. METHOD At 3 months post-transplant, a probability sample of 147 adult kidney transplant recipients from two independent Belgian transplant centers will be randomly allocated to either 6 months of home-based moderate-intensity training (MIT, n = 49), concurrent moderate- and high-intensity training (MHIT, n = 49) or usual care (CON, n = 49) (Figure1). High-intensity training sessions in MHIT are based on the Scandinavian model (four blocks of 4 min at high intensity interspersed by 3 min of active recovery), performed twice a week, and of equivalent energy expenditure as moderate-intensity training (Figure2). MIT and MHIT will perform similar muscle strengthening exercises, twice a week. The training intervention will be followed by an individualized activity intervention aiming for long-term physical activity maintenance in MIT and MHIT; using motivational interviewing techniques, co-creation of an action plan adapted to the patients’ preferences, goal-setting, gradually decreasing follow-up prompts over time and self-monitoring of physical activity behavior. Study participants will be followed-up till 2 years after transplantation. We hypothesize that the study intervention will improve our primary outcome cardiorespiratory fitness, assessed as peak oxygen uptake, at 9 months post-transplant. Secondary outcomes include muscle fitness, motor fitness, body composition, cardiovascular health, gut microbiome characteristics, health-related quality of life, safety, cost-effectiveness and implementation outcomes (Figure1). The role of training intensity and the role of baseline gut microbiome characteristics as predictor of individuals’ training response will be explored. RESULTS Results from this two-phased RCT will provide novel insights in the safety, implementation potential, cost-effectiveness and effectiveness of a home-based exercise program and physical activity intervention in de novo kidney transplant recipients to improve physical fitness, cardiovascular health, gut microbiome characteristics and health-related quality of life. CONCLUSION PHOENIX-kidney represents the first adequately powered multicenter RCT evaluating basic, clinical and health-economic outcome parameters in response to an exercise training and physical activity intervention in kidney transplant recipients.

Delayed Graft Function Under the Microscope: Surveillance Biopsies in Kidney Transplantation.

Delayed graft function (DGF) is a common complication of kidney transplantation and frequently leads to the necessity of surveillance biopsies. The purpose of this study is to describe the histological findings in surveillance biopsies of deceased donor kidney transplant recipients and evaluate the risk factors for graft outcomes. This is a monocentric, retrospective study including kidney transplant recipients that underwent a graft biopsy during the DGF period between January 2006 and July 2019. 356 biopsies were performed in 335 deceased donor transplant recipients. Biopsies were analyzed according to the Banff classification. The main histological findings were: acute tubular necrosis in 150 biopsies (42.1%), acute rejection in 96 biopsies (26.9%), and borderline findings in 91 biopsies (25.5%). In the multivariate analysis, recipient age (p = 0.028) and DGF duration (p = 0.005) were associated with rejection, antibody-induction with anti-thymocyte globulin (ATG) was protective (p = 0.001). The occurrence of rejection was associated with lower death-censored graft survival (log-rank; p = 0.009). Surveillance biopsies of kidney grafts experiencing DGF remain an essential tool for the care of kidney transplant recipients. The recipient's age and duration of DGF are independent risk factors for acute rejection, while antibody-induction therapy with ATG is associated with protection from its occurrence.

Inpatient Kidney Palliative Care for Kidney Transplant Recipients With Failing Allografts

Kidney transplantation provides longer survival and better quality of life than dialysis for patients with end-stage kidney disease. However, complications and allograft failure are common.1 The clinical course of patients with allograft failure tends to be complex and variable.2,3 Navigating the experience of allograft failure—including decisions regarding dialysis, retransplantation, or conservative management—can therefore be emotionally challenging for both patients and providers.

Emerging biomarkers in kidney transplantation and challenge of clinical implementation.

Despite improvement in short-term outcomes after kidney transplantation, long-term outcomes remain suboptimal. Conventional biomarkers are limited in their ability to reliably identify early immunologic and nonimmunologic injury. Novel biomarkers are needed for noninvasive diagnosis of subclinical injury, prediction of response to treatment, and personalization of the care of kidney transplant recipients. Recent biotechnological advances have led to the discovery of promising molecular biomarker candidates. However, translating potential biomarkers from bench to clinic is challenging, and many potential biomarkers are abandoned prior to clinical implementation. Despite these challenges, several promising urine, blood, and tissue novel molecular biomarkers have emerged and are approaching incorporation into clinical practice. This article highlights the challenges in adopting biomarker-driven posttransplant management and reviews several promising emerging novel biomarkers that are approaching clinical implementation.

Clinical Correlates and Outcomes of Dual Basiliximab and Antithymocyte Globulin Induction in Kidney Transplant Recipients: A National Study.

We used national transplant registry data to study clinical correlates and outcomes of single versus dual induction therapy in adult kidney-only transplant recipients in the United States (2005-2018). The risk of death and graft loss at 1 and 5 y, according to induction therapy type, was assessed using multivariate Cox regression analysis (adjusted hazard ratio with 95% upper and lower confidence limits [LCLaHRUCL]). Of the 157 351 recipients included in the study, 67% were treated with ATG alone, 29% were treated with IL2rAb alone, and 5% were treated with both. Compared with IL2rAb alone, the strongest correlates of dual induction included Black race, calculated panel reactive antibody ≥80%, prednisone-sparing maintenance immunosuppression, more recent transplant eras, longer cold ischemia time, and delayed graft function. Compared with ATG alone, dual induction was associated with an increased 5-y risk of death (aHR 1.071.151.23; P < 0.0001), death-censored graft failure (aHR 1.051.131.22; P < 0.05), and all-cause graft failure (aHR 1.061.121.18; P < 0.0001). Further research is needed to develop risk-prediction tools to further inform optimal, individualized induction protocols for kidney transplant recipients.

Construction of an index system for evaluating the effectiveness of transitional care in kidney transplant recipients

BackgroundPrevious studies showed that transitional care reduces the complication rate and readmission rate and improves the quality of life in kidney transplant receipts, nevertheless, in fact there are no standard evaluation indexes and debatable scientific of existing indexes in kidney transplant recipients. Therefore, the aim of this study was to construct an evaluation index system to assess the effects of transitional care in kidney transplant recipients.MethodsBased on Omaha system, an initial evaluation index system about the effects of transitional care in kidney transplant recipients was drafted by the literature review and semi-structured interview. Two rounds of correspondence were conducted in 19 experts and the analytic hierarchy process (AHP) was used to calculate the weights of all indexes.ResultsFive first-level indexes, sixteen second-level indexes, and forty-eight third-level indexes were selected in the initial evaluation index system. The authority coefficient of two-round expert consultations was 0.90 and coordination coefficients of indexes ranged from 0.24 to 0.34.ConclusionThe established evaluation index system for the effectiveness of transitional care for kidney transplant recipients was scientific and reliable. Furthermore, it would be a potential method to evaluate effects of transitional care in kidney transplant recipients after further examination.

Implementing a pharmacist-led transition of care model for posttransplant hyperglycemia.

DisclaimerIn an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.PurposeThe implementation of a pharmacist-managed transition of care program for kidney transplant recipients with posttransplant hyperglycemia (PTHG) is described.MethodsIn September 2015, a collaborative practice agreement between pharmacists and transplant providers at an academic medical center for management of PTHG was developed. The goal of the pharmacist-run service was to reduce hospitalizations by providing care to patients in the acute phase of hyperglycemia while they transitioned back to their primary care provider or endocrinologist. For continuous quality improvement, preimplementation data were collected from August 2014 to August 2015 and compared to postimplementation data collected from August 2017 to August 2018. The primary endpoint was hospitalizations due to hyperglycemia within 90 days post transplantation. Secondary endpoints included emergency department (ED) visits due to hypoglycemia and the number of interventions performed, number of encounters completed, and number of ED visits or admissions for hypoglycemia. A Fisher’s exact test was used to compare categorical data, and a Student t test was used to compare continuous data. A P value of <0.05 was considered to be statistically significant.ResultsForty-three patients in the preimplementation group were compared to 35 patients in the postimplementation group. There was a significant reduction in hospitalizations due to hyperglycemia in the postimplementation versus the preimplementation group (9 vs 1, P < 0.05); there was a reduction in ED visits due to hyperglycemia (5 vs 0, P = 0.06). There were no ED visits or hospitalizations due to hypoglycemia in either group. Clinical transplant pharmacists performed an average of 8.3 (SD, 4.4) encounters per patient per 90 days.ConclusionA collaborative practice agreement was created and successfully implemented. A pharmacist-managed PTHG program could be incorporated into the standard care of kidney transplant recipients to help minimize rehospitalizations due to hyperglycemia.

POS-735 NSAID PRESCRIPTIONS IN KIDNEY TRANSPLANT RECIPIENTS

After kidney transplantation, optimization of graft function and avoidance of nephrotoxic medications is essential. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for pain management but are potentially nephrotoxic. The 2009 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for the Care of Kidney Transplant Recipients recommends that NSAIDs be avoided in kidney transplant recipients. Currently, it is unclear whether physicians are adhering to this guideline recommendation.

Patient and graft outcome among Filipinos with post-kidney transplant malignancy

Background: Improvements in the care of kidney transplant recipients (KTRs) resulted to longer life expectancy and increased survival rate. However, studies showed an increase in the incidence of post-kidney transplant malignancy (PTM) affecting the survival and quality of life of the said patients. Methods: This is a retrospective cross-sectional study among 91 patients in a tertiary referral center. The primary endpoints were patient and graft survival at 12 and 24 months after diagnosis and/or treatment of malignancy. Kaplan-Meier analysis was applied to estimate probabilities of survival. Results: The overall incidence of patients developing malignancy after kidney transplant was 1.4% with patient median age at 57 years on diagnosis. The median period from kidney transplant to malignancy diagnosis was at 7.39±5.94 years. The most com mon primary sites of malignancy seen were colorectal, breast, and renal malignancies. The overall graft survival probability of PTM patients was 98.6% and 93.6% at 12 and 24 months, while the overall patient survival probability of PTM patients was 75.5%, 63.3%, and 48.8% at 12, 24, and 64 months, respectively. Conclusions: The incidence of PTM in our study was lower compared with other countries. The overall patient survival rate, how ever, was much lower than those who did not develop PTM. Moreover, our study showed lower patient survival rate compared with other countries. Routine screening for cancers among our KTRs following our local guidelines should be adhered to. The type of cancer among Filipino KTRs were also different from what were reported in other publications. Further studies that will look into risk factors to developing malignancy after KT among Filipinos and the role of type and dose of immunosuppressant is recommended.

Kidney Biopsy

The introduction of renal biopsies has transformed practice in nephrology, particularly with regard to glomerular disease and the care of kidney transplant recipients. A biopsy can provide information about the diagnosis and prognosis of kidney disease while most importantly often leading to changes in therapy that can be life saving. Four groups of patients benefit most from renal biopsy: those with nephrotic syndrome, those with acute nephritic syndromes with rapid deterioration of renal function, those with unexplained acute kidney injury and renal transplant recipients. Non-nephrotic range proteinuria and/or hematuria or unexplained chronic kidney disease represent indications in selected cases. The evaluation of patients prior to undergoing a kidney biopsy requires a careful assessment that includes a detailed history to confirm the relative benefit of a biopsy in making an accurate diagnosis compared with individual’s risk of bleeding. The use of real-time ultrasound or CT-guidance with gun-mounted biopsy needles is paramount for the successful performance of the biopsy and reduction of risks. renal biopsies are mostly done as an inpatient but can be performed on an outpatient basis in selected cases. A renal biopsy has a bleeding risk of up to 5% and is considered a “high bleeding risk procedure”. For patients receiving -antithrombotic therapy, the approach to periprocedural use of antithrombotic agents needs to be individualized. Because it is a high-risk procedure, all efforts must be undertaken to minimize the risk including a careful assessment of the patient's specific situation, and only experienced operators at institutions that can care for post-biopsy complications should perform the procedure. This review contains 7 tables, 7 figures and 83 references Key words: kidney biopsy, native kidney, transplant kidney, indications, preparation, performing biopsy, ultrasound guidance, transjugular, CT-guided, complications