Protective hands gently cradle a healthy kidney, symbolizing hope and care in kidney transplantation.

Kidney Biopsies: Are They Always Necessary Before Transplant?

Mira Elwood in Health & Wellness November 2025 • 4 min read.

"Uncover the surprising truth about zero-hour biopsies and their impact on kidney transplant success. Learn why these routine procedures might not be as crucial as you think."

The world of kidney transplantation is a complex landscape, filled with meticulous procedures designed to ensure the best possible outcomes for recipients. Among these procedures, the zero-hour biopsy—a tissue sample taken from the donor kidney immediately before transplantation—has been a common practice. The goal? To identify any existing abnormalities in the kidney that could affect its long-term health and function in the recipient.

Glomerulonephritis, a condition characterized by inflammation and damage to the kidney's filtering units (glomeruli), is one such concern. It can potentially be transmitted from the donor kidney to the recipient, leading to complications post-transplant. Studies have explored the role of pre-transplant donor biopsies in detecting and managing transmitted glomerulonephritis, but the overall clinical significance of these findings remains a topic of debate.

Now, a new study is challenging the necessity of routine zero-hour biopsies. Researchers are retrospectively examining zero-hour renal allograft biopsies to investigate the prevalence and clinical significance of transmitted glomerular lesions. Their findings could potentially reshape pre-transplant evaluation procedures, making the process safer and more efficient for both donors and recipients.

Zero-Hour Biopsies: What the Research Reveals

Protective hands gently cradle a healthy kidney, symbolizing hope and care in kidney transplantation.

Researchers in Korea retrospectively reviewed 229 zero-hour renal allograft biopsies performed between 2006 and 2010. These biopsies were examined to identify any glomerular lesions—abnormalities affecting the glomeruli, the kidney's filtering units. The study aimed to determine the prevalence of these lesions and whether they had any impact on the recipient's health after transplantation.

Out of the 117 cases where immunofluorescence microscopy was used, immune complex-associated glomerular lesions were detected in eight cases (6.8%). Among these, seven cases were diagnosed as immunoglobulin A (IgA) nephropathy, a common kidney disease. Interestingly, none of these cases showed significant urinary abnormalities during the average follow-up period of 21.9 months. The remaining case was diagnosed as C1q nephropathy, which initially presented with significant proteinuria (protein in the urine) and hematuria (blood in the urine) one month after transplantation.

The study also revealed other glomerular abnormalities, including:

Focal segmental glomerular sclerosis (scarring of the glomeruli) in five cases.
Focal endocapillary leukocyte infiltration (immune cell accumulation) in three cases.
Glomerular fibrin thrombi (blood clots) in three cases.

However, in all these cases, urinary abnormalities were absent during the follow-up period.

These findings suggest that many of the transmitted glomerular lesions detected in zero-hour biopsies may not have a significant clinical impact. This raises the question: Are these routine biopsies always necessary? Could resources be better allocated to other aspects of the transplant process?

Rethinking the Need for Routine Biopsies

The study's authors concluded that most transmitted glomerular lesions were clinically irrelevant, suggesting that a renal biopsy may be unnecessary as part of a pre-transplant donor evaluation. This could potentially streamline the transplant process, reduce costs, and minimize the burden on both donors and recipients. While zero-hour biopsies may still be valuable in certain high-risk cases, these findings support a more selective approach to their use. Further research is needed to refine the criteria for biopsy selection and optimize the overall transplant process.

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This article is based on research published under:

DOI-LINK: 10.4285/jkstn.2012.26.3.174, Alternate LINK

Title: Most Transmitted Glomerular Lesions In A Zero-Hour Biopsy Of Allograft Kidney Have No Clinical Significance

Journal: The Journal of the Korean Society for Transplantation

Publisher: The Korean Society for Transplantation

Authors: Beom Jin Lim, Dong Jin Joo, Yu Seun Kim, Hyeon Joo Jeong

Published: 2012-01-01

Everything You Need To Know

What exactly is a zero-hour biopsy in the context of kidney transplantation, and what is its purpose?

A zero-hour biopsy is a procedure where a tissue sample is taken from a donor kidney immediately before transplantation. The primary purpose is to identify any pre-existing abnormalities, such as glomerulonephritis, that could potentially affect the kidney's long-term health and function in the recipient after the transplant. These biopsies aim to detect conditions that might complicate the transplant outcome.

What did the researchers discover in their study of zero-hour renal allograft biopsies?

The Korean study retrospectively reviewed 229 zero-hour renal allograft biopsies performed between 2006 and 2010. The researchers found that while glomerular lesions were present in some biopsies, many of these lesions, including cases of immunoglobulin A (IgA) nephropathy, did not result in significant urinary abnormalities or impact the recipient's health during the follow-up period. This suggests that many transmitted glomerular lesions detected in zero-hour biopsies may not have a significant clinical impact.

What types of glomerular lesions were identified in the zero-hour biopsies, and how did these lesions manifest?

The study revealed several types of glomerular lesions in the zero-hour biopsies. These included immune complex-associated glomerular lesions, with seven cases diagnosed as immunoglobulin A (IgA) nephropathy and one as C1q nephropathy. Other abnormalities included focal segmental glomerular sclerosis, focal endocapillary leukocyte infiltration, and glomerular fibrin thrombi. However, most of these lesions did not result in significant urinary abnormalities during the follow-up period, questioning the clinical relevance of routinely screening for these conditions.

What are the implications of this research on the necessity of routine zero-hour biopsies before kidney transplantation?

The findings suggest that routine zero-hour biopsies might not always be necessary. Because many transmitted glomerular lesions do not significantly impact transplant outcomes, resources could potentially be better allocated to other aspects of the transplant process. A more selective approach to using zero-hour biopsies, focusing on high-risk cases, could streamline the transplant process, reduce costs, and minimize the burden on both donors and recipients. However, further research is needed to refine the criteria for biopsy selection and optimize the overall transplant process.

Are zero-hour biopsies completely unnecessary, or are there specific situations where they are still considered valuable?

While the study suggests that many transmitted glomerular lesions detected in zero-hour biopsies may not have a significant clinical impact, zero-hour biopsies might still be valuable in certain high-risk cases. Factors such as the donor's medical history, the presence of specific risk factors for kidney disease, or other clinical indications might warrant a zero-hour biopsy to provide additional information and guide treatment decisions. Determining the specific criteria for biopsy selection requires further research.