Purpose Renal biopsies are commonly performed for renal failure, renal transplants, or small renal masses. Whilst there is evidence for the safety of renal biopsies as a whole, the patient and disease characteristics of these groups are quite heterogenous. This study aimed to compare the safety profile of targeted renal biopsies for small renal masses to non-targeted, non-transplant renal biopsies, which constitute the majority of biopsies performed. Methodology A single centre retrospective study of patients who underwent renal biopsies from January 2019 to December 2023 was performed. Basic demographics, complications, and 30 day mortality were recorded. Relevant ethics approval was obtained. Results The small renal mass group (n=104) were older (average 65 years vs 55 years old) and more likely to be male (70% vs 61%) than the renal impairment group (n=426). Of the targeted renal biopsies, 7 were non-diagnostic (7%) and 4 resulted in complications (4%). Three patients had perinephric haematomas, and one patient had haematuria, which were all Clavien Dindo 1 complications. There were no deaths at 30 days. In comparison, for the renal impairment group, 49 (11%) developed complications. The most common complication was haematoma (n=27, 6.3%), followed by bleeding necessitating transfusion (n=11, 2.6%) and haematuria (n=8, 1.9%). The majority of these were Clavien Dindo 1 complications (n=34), 11 were Clavien Dindo 2, and 3 were Clavien Dindo 3. There were 7 deaths within 30 days, all unrelated to the biopsy. Conclusion Patients undergoing renal biopsy for small renal masses represent a different cohort to those undergoing biopsies for renal impairment. Nonetheless, the complication rates for both groups remain reassuringly low.