This angiographic image of a kidney that appears to be smoking is unfortunately a post-biopsy hemorrhage.
In this arterial parenchymal phase you can clearly see contrast filling the biopsy route in the lower pole of the kidney and a ‘plume’ of contrast extravasating in the perirenal space.
Massive bleeding after kidney biopsy requiring an intervention occurs in less than 1%. [1]
Although unfortunate, in this case the bleeding could luckily be stopped by means of selective catherization and a couple of microcoils.
1: Am J Kidney Dis. 2012 Jul;60(1):62-73. doi: 10.1053/j.ajkd.2012.02.330. Epub 2012 Apr 24. Bleeding complications of native kidney biopsy: a systematic review and meta-analysis. Corapi KM1, Chen JL, Balk EM, Gordon CE.