Whether high blood creatinine needs kidney puncture mainly depends on the cause of elevated creatinine. If the creatinine is elevated due to chronic renal failure, there is no need to do renal puncture; if the creatinine is elevated due to atypical glomerulonephritis, acute progressive nephritis syndrome, primary nephrotic syndrome, acute kidney injury, secondary glomerular disease, transplantation of kidneys and other diseases, there is a need to do renal puncture to further clarify the diagnosis. 1. Atypical glomerulonephritis: when there is a sharp deterioration of renal function, resulting in elevated creatinine and clinically similar to acute progressive nephritis, renal puncture biopsy should be performed as early as possible to clarify the diagnosis and timely treatment. 2. Acute-progressive nephritis syndrome: this syndrome has various etiologies, progresses rapidly, and creatinine elevation may occur, which requires renal puncture examination to clarify pathological diagnosis and early treatment. 3. Primary nephrotic syndrome: middle-aged and old-aged nephrotic syndrome, or nephrotic syndrome combined with hematuria, hypertension, renal impairment, can lead to creatinine elevation, and can be further treated by renal puncture examination. 4. Acute kidney injury: all kinds of acute kidney injury can lead to elevated creatinine, if the cause is unknown clinically, as long as there is no contraindication, should be performed early renal puncture biopsy. 5. Secondary glomerular diseases: various secondary glomerular diseases may lead to elevated creatinine, which need to be treated promptly after renal puncture biopsy to clarify the diagnosis and pathologic type. 6. Transplanted kidney: when the transplanted kidney function is obviously reduced and creatinine is elevated, and the cause is unknown, transplanted kidney aspiration biopsy is feasible. High creatinine may also have other reasons, it is recommended that patients go to regular hospitals in a timely manner, improve the examination to clarify the cause of the disease, and follow the doctor’s instructions for standardized treatment.