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A standardized biopsy protocol is flipping the script on who can safely undergo kidney biopsies. A large prospective study of nearly 2,000 biopsies found severe complications in less than 1% of high-risk patients using the ROCKY protocol. The findings suggest that being "high-risk" shouldn't automatically rule out this critical diagnostic procedure.
Kidney biopsies have long been withheld from patients deemed "high-risk" — those with advanced age, obesity, renal impairment, or who are on blood thinners. But a major new study is challenging that caution. Researchers from the University of Turin used the ROCKY (Renal-biopsy Optimized Care and Knowledge Yielding safety) protocol across nearly 2,000 native kidney biopsies and found that serious complications were remarkably rare, even in the most vulnerable patients.
The study, presented at Kidney Week 2026, followed 1,096 high-risk biopsies and found a severe complication rate of just 0.8%. Crucially, there was no significant difference in complication rates between inpatients and outpatients, opening the door for broader outpatient biopsy programs that could reduce unnecessary hospitalizations.
Key Takeaways:
Why it matters: Many patients who stand to benefit most from a kidney biopsy are the very ones being turned away due to perceived risk. This study suggests that with the right protocol and an experienced team, far more patients can safely access this vital diagnostic tool — potentially preventing missed or delayed diagnoses.
