Aims: Acute kidney injury is common in patients on the intensive care unit. Although causation is most often multifactorial, on occasion acute kidney injury may be associated with multisystem disease. In such cases early identifcation and treatment may signifcantly affect outcome. We describe the use of transjugular renal biopsy in a critically ill patient for which the results directly affected the patient's subsequent management. Method: The practical aspects of the technique employed for transjugular renal biopsy are described. A clinical case is briefy described where percutaneous or open renal biopsy were contraindicated and transjugular biopsy was performed resulting in a change of treatment. Conclusions: Transjugular renal biopsy is a relatively safe technique in the critically ill patient and should be considered where the cause of acute kidney injury is unclear; using the technique may yield useful information that directly infuences treatment. © 2011, Nederlandse Vereniging voor Intensive Care. All Rights Reserved.