■ Renal biopsy remains indispensable in the diagnosis of medical renal disease manifesting as proteinuria, hematuria, or renal failure.

■ Indications for direct-vision renal biopsy include patients with bleeding diatheses, those on chronic anticoagulation medications, morbidly obese patients, patients with failed prior attempts at percutaneous biopsy, uncooperative patients, patients with a solitary kidney, patients with uncontrolled hypertension, and those patients with anomalous anatomy.

■ Open biopsy and laparoscopic biopsy are the two methods that allow direct vision both during biopsy and during subsequent achievement of hemostasis, which is important in patients who may be at high risk of bleeding. Laparoscopy has the advantage of being less invasive and less morbid than open biopsy.

■ Laparoscopic renal biopsy is generally well tolerated. The majority of patients return home within 24 hours, with most of the remaining patients being discharged within 48 hours.

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