Background

Kidney biopsy first described in the early 1950s by Iverson and Brun and Alwall. An adequate tissue diagnosis was achieved in <40% with patient in sitting position by use of suction needle and IV urography for guidance.
In 1954, Kark and Muehrcke described a modified technique using the Franklin-modified Vim-Silverman needle, with the patient in a prone position and an exploring needle used to localise the kdiney before insertion of the biopsy needle. It has a tissue diagnosis of 96%.

Indications

Nephrotic syndrome
AKI if ruled out obstruction, ischemia/reduced perfusion, ATN.
Systemic disease with kidney dysfunction, e.g small vessel vasculitis, anti-glomerular basement membrane disease and SLE, diabetes with atypical features (proteinuria-associated with glomerular hematuria, absence of retinopathy or neuropathy (in patients with type 1 diabetes), onset of proteinuria less than 5 years from the documented onset of diabetes, uncharacteristically rapid change in kidney function or kidney disease of acute onset, or immunologic abnormalities.
Non-nephrotic proteinuria or proteinuria if >1g/24h
Isolated microscopic hematuria once ruled out structural lesions (stones, urothelial malignancy); IgA nephropathy and thin basement membrane nephropathy is most common.
Unexplained CKD
Familial kidney disease
Kidney transplant dysfunction if ruled out obstruction, sepsis, renal artery stenosis, toxic calcineurin inhibitor levels