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We describe our experience with real-time ultrasound as a localization and guidance tool for percutaneous renal biopsy. Two hundred biopsies performed between June 1983 and January 1990 were reviewed retrospectively. Nephrology fellows performed 83.5% of the biopsies. The average age of the patients was 43 ± 17 years (range 6–80) and renal insufficiency (serum creatinine ≧ 1.3 mg, %) was present in approximately 60% of patients biopsied. Primary indications for biopsy were to evaluate proteinuria (46.5%) and renal manifestation of systemic lupus erythematosus (24%). Material for light microscopy, immunofluorescence, and electron microscopy was obtained in 99.5, 95.0 and 98.0% of cases, respectively. Adequate tissue for histologic diagnosis was obtained in 97.5% of patients. Primary diagnosis was glomerulonephritis in 77.9% of cases. Complications were assessed and separated by severity. Total complications were observed in 13.7% of patients with 8.1% of these being minor complications (not requiring blood transfusion) and 5.6% being major complications which required blood transfusions. Bleeding complications requiring massive blood transfusion and/or therapeutic radiologic intervention were seen in 1.5% of patients. We could find no significant difference with respect to age, serum creatinine, or coagulation parameters between patients with or without complications due to percutaneous renal biopsy. We conclude that real-time ultrasound is a safe, accurate method in localizing the kidney for percutaneous renal biopsy. However, patients must still be observed carefully post biopsy for potential complications.

The hepatitis C virus genome has been recently sequenced and cloned, allowing the identification of patients exposed to this virus, which is now felt to be the principal cause of "non-A, non-B" hepatitis. The hepatitis B virus has long been implicated in the pathogenesis of several glomerulopathies including membranoproliferative glomerulonephritis, mixed cryoglobulinemia, and membranous glomerulonephritis. Several authors have recently reported an association between hepatitis C virus infection and glomerular disease. The case of a patient with chronic hepatitis C virus infection who developed the nephrotic syndrome 3 months after liver transplantation is described. Serologic testing was significant for an elevated rheumatoid factor, circulating cryoglobulins, and a mildly depressed C4 level. Hepatitis C virus antibody and viral RNA (by polymerase chain reaction) were present in both the serum and cryoglobulin fraction. A renal biopsy demonstrated membranoproliferative glomerulonephritis. It is believed that persistent infection with the hepatitis C virus is responsible for an immune complex-mediated glomerulonephritis in this patient. Because hepatitis C has now been pathogenetically linked to several glomerulopathies, testing for this virus should be considered in the serologic work-up of the patient with glomerulonephritis.