Some people worry that kidney puncture may bring about kidney damage. In fact, the tissue taken by kidney biopsy is only one hundred thousandth of one side of the kidney, which basically will not cause kidney damage. At present, our hospital has safely performed more than 10,000 kidney biopsies and has accumulated rich experience. The PLA Kidney Research Institute of Nanjing General Hospital of Nanjing Military Region performed 2944 transplanted kidney biopsies between January 1994 and November 2008, and found that less serious complications such as simple carnal hematuria was 1.6%, and the incidence of small perirenal hematoma was 0.3%, which was relieved after symptomatic treatment. And all complications occurred within 4 hours postoperatively. The results of the study strongly confirm that both bedside, routine and periodic renal biopsies of the transplanted kidney, and repeat renal biopsies are safe for the vast majority of patients. Of course, clinicians still need to be careful in performing transplant kidney biopsies to try to avoid serious complications. Therefore, the following issues must be noted before and after the transplant kidney biopsy: 1. Contraindications to kidney biopsy Those with any of the following conditions should avoid kidney biopsy: ① patients cannot cooperate: patients are highly nervous, unable to control themselves and unable to cooperate with the instructions of the puncturing physician; ② uncontrolled hypertension: systolic blood pressure > 150 mmHg and diastolic blood pressure > 100 mmHg 2 days before puncture; ③ bleeding tendency: coagulation Four abnormalities; test tube method: clotting time >10 minutes; if abnormal, 2 retests are required to be normal; long-term anticoagulant medication, less than 5 days after stopping; platelets <100,000/ml; female patients are menstruating; ④ severe anemia; hemoglobin <8g/dl; severe leukocytopenia: peripheral blood leukocyte count <3000/mm3; less than 12 hours after heparin anticoagulation; ⑤ combined acute pyelonephritis. history of definite urinary tract infection; with perirenal abscess hematoma or hydronephrosis; dilated renal pelvis >25px; combined massive thoracoabdominal fluid, ultrasound detectable pleural or abdominal fluid; renal artery aneurysm; transplanted renal artery angioma; giant cyst: cyst with possible injury in the puncture path; transplanted renal neoplasm, polycystic kidney or with giant cyst; ⑥ end-stage transplanted renal failure; definite chronic transplanted renal function (6) end-stage transplanted kidney failure; defined chronic transplanted kidney function impairment, blood creatinine >5mg/dl for 3 months; transplanted kidney atrophy, transplanted kidney length <225px, unclear structure; (7) severe hepatic impairment; glutathione aminotransferase >100u/L, glutathione aminotransferase >100u/L; (8) severe cough, diarrhea, severe constipation. Biopsy should be performed after the above complications are effectively controlled. 2. Prepare for kidney biopsy Explain to the patient’s family the significance of transplant kidney biopsy, the safety of the operation and possible complications, and ensure that the patient cooperates with the physician. Practice breathing and breath-holding movements in the prone position before surgery. The most common complication of kidney biopsy is bleeding through the kidney. It is important to take a detailed medical history, paying special attention to the presence of bleeding disorders. Blood type, platelets, clotting time, prothrombin time, and especially clotting time and clot contraction time should be measured by test tube in order to have a more comprehensive and accurate understanding of the patient’s clotting mechanism. In patients with coagulation abnormalities, the cause should be further clarified, effective treatment measures should be taken, and only after the coagulation function is restored to normal should the transplanted kidney biopsy be performed. When the patient has poor recovery of renal function in the early stage after kidney transplantation, or with renal insufficiency, resulting in obvious azotemia, multiple times of heparin-free dialysis should be performed if necessary, so that azotemia can be controlled to some extent. And transplant kidney biopsy should be performed after 12 hours of heparin-free dialysis. In renal transplant patients with hypertension (especially in the early post-transplant period), the blood pressure must be controlled in the normal range before biopsy. 3. Accurate positioning and careful operation In principle, the lower pole of the transplanted kidney is preferred, followed by the upper pole as the puncture point. Donor kidney biopsy should be performed under the condition of kidney perfusion, and muscle tissue or gelatin sponge should be used to fill the eye of the puncture needle immediately after puncture to prevent bleeding after opening the blood flow. Postoperative transplant kidney biopsy is usually performed under ultrasound guidance to avoid accidental perforation of effusion and intestine; use biopsy needles of appropriate length and internal diameter, using 18G biopsy needles, about 98% of patients can obtain sufficient tissue specimens; as far as possible to avoid one-time penetration too deep, straight to the renal medulla easily cause hemorrhage. 4, effective compression to stop bleeding, to ensure the safety of kidney biopsy After renal puncture, local pressure with the palm of the hand for 15-30 minutes to achieve effective compression of the puncture site, if necessary, after palm pressure plus sandbag compression, or even local compression with elastic lap band to stop bleeding. On the day of surgery, it is necessary to eat and defecate in bed, because after puncture, it is necessary to lie absolutely flat for 4-6 hours, and under the condition of normal blood pressure and urine color, it is possible to turn slightly after 4 hours, and only after 12 hours, it is possible to get out of bed to urinate with the assistance of family members, and continue to rest in bed after urination. No strenuous activity is allowed for one week to avoid bleeding complications later. During this period, forceful defecation and lateral movement of the waist are strictly prohibited, and bed rest is the mainstay. In case of hemorrhagic complications, bed rest should be prolonged, pulse rate, blood pressure and urine color should be closely observed, patients should be encouraged to drink more water (do not drink more water if you have little urine), and hemostatic drugs should be applied after surgery if necessary. If you find carnal hematuria, there is no need to be nervous, the doctor will give timely treatment, you just need to lie absolutely still and avoid actions that increase abdominal pressure, such as coughing, straining to defecate, etc. If you have constipation, you should report to the nurse and take laxative measures.