In 1954 Kark and Muehrcke described a technique for percutaneous renal biopsy which involved the approximation of the kidney site by the transfer of bony landmarks to the patient's back from a preliminary intravenous pyelogram film and the insertion of the Franklin modification of the Vim-Silverman biopsy needle into the patient's flank to secure renal tissue.1 This method has enjoyed wide acceptance and presently represents the procedure of choice in most institutions.
Unfortunately, even in experienced hands, there is a failure rate of 10% to 20% with this method because of the "blind" approach.2,3 Furthermore, the complication rate is high and includes severe bleeding which may require transfusion or even nephrectomy2,3 and the formation of arteriovenous fistulae at the biopsy site.4 Consequently, there is a reluctance to biopsy the kidney via the percutaneous route, and, at the Massachusetts General Hospital, this method has been abandoned in favor of open surgical