# Renal Procedures: Purpose, Preparation, and Follow-Up

Choose the procedure by the question it can answer, then name the complication you will actively look for.

![Infographic: Renal Procedures: Purpose, Preparation, and Follow-Up](https://urinenephrology.org/visual-reference/images/student-renal-procedures.png?v=20261003c)

## When kidney tissue can change care

Unexplained AKI with active sediment, significant unexplained proteinuria, suspected systemic renal disease, or graft dysfunction may justify biopsy. Ask which diagnosis would change treatment before exposing the patient to bleeding risk.

## Prepare for a kidney biopsy

Review blood pressure, blood count, coagulation, imaging, and antithrombotic medicines. Correct modifiable bleeding risks and agree on medication interruption with the responsible team; thrombotic risk and procedure policy determine timing.

## Recognize post-biopsy bleeding

Increasing flank pain, visible hematuria, hypotension, tachycardia, or falling hemoglobin requires prompt assessment. Observation instructions must specify whom to contact and when to return; an initially uncomplicated biopsy does not exclude delayed bleeding.

## Choose dialysis access for the life plan

A fistula needs usable vessels and time to mature; a graft may become usable sooner; a catheter provides immediate access but has substantial infection risk. Match the choice to anticipated treatment, anatomy, prognosis, and patient preference.

## Examine the access before use

Look for redness, drainage, swelling, skin breakdown, or aneurysmal change; feel the thrill and assess hand perfusion. An absent thrill, painful cold hand, or uncontrolled bleeding requires urgent access-team assessment.

## A successful procedure still needs follow-up

After biopsy, confirm specimen adequacy and who will discuss pathology. After access creation, reassess maturation and usable flow. After a PD catheter, check healing, drainage, and training before unsupervised exchanges.

## Source lessons

- [chapter 21 procedures](https://urinenephrology.org/nephrology-textbook/chapters/chapter-21-procedures.html)
- [renal pathology biopsy student handout](https://urinenephrology.org/student-resources/advanced/renal-pathology-biopsy-student-handout.html)
- [dialysis access complications student handout](https://urinenephrology.org/student-resources/dialysis/dialysis-access-complications-student-handout.html)
- [vascular access selection student handout](https://urinenephrology.org/student-resources/dialysis/vascular-access-selection-student-handout.html)
- [kidney biopsy student handout](https://urinenephrology.org/student-resources/procedures/kidney-biopsy-student-handout.html)

Read alongside the full lessons; the findings and decisions shown here require the stated clinical context.