Abstract
Taking a kidney biopsy is not a trivial procedure. The sample is almost invariably smaller than the pathologist would like. Investigation usually requires division into even smaller samples to permit the application of specialist techniques. In some cases the biopsy is taken not for diagnosis, but to assess the extent of tissue damage. The clinical need is sometimes extremely urgent. These features all underline the crucial importance of collaboration between pathologist and nephrologist if maximum benefit is to be obtained from such very small samples. Consequently, in deciding what to do with a renal biopsy, flexibility and thought are required rather than a single prescribed list of procedures. This article, written after extensive international consultation, represents an attempt to define current best practice in the laboratory handling of renal biopsy specimens, while not neglecting the need to tailor processing to the individual needs of each case.J Clin Pathol
Key Words: renal biopsy • immunofluorescence • immunohistochemistry • electron microscopy
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Figure 1 Fresh renal cortical biopsy, taken with an 18 gauge needle, under a dissection microscope. Glomeruli marked by arrows, on the surface (white arrow) and within the biopsy (black arrows).
Selected References
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- Das A. K., Pickett T. M., Tungekar M. F. Glomerular basement membrane thickness - a comparison of two methods of measurement in patients with unexplained haematuria. Nephrol Dial Transplant. 1996 Jul;11(7):1256–1260. [PubMed] [Google Scholar]
- Furness P. N., Boyd S. Electron microscopy and immunocytochemistry in the assessment of renal biopsy specimens: actual and optimal practice. J Clin Pathol. 1996 Mar;49(3):233–237. doi: 10.1136/jcp.49.3.233. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hoffmann E. O. High-resolution light microscopy for interpretation of renal biopsies. Pediatr Nephrol. 1995 Dec;9(6):763–769. doi: 10.1007/BF00868738. [DOI] [PubMed] [Google Scholar]
- Howie A. J., Gregory J., Thompson R. A., Adkins M. A., Niblett A. J. Technical improvements in the immunoperoxidase study of renal biopsy specimens. J Clin Pathol. 1990 Mar;43(3):257–259. doi: 10.1136/jcp.43.3.257. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Matyas J. R., Rattner J. B., Benediktsson H. Enhanced glomerular retrieval for renal biopsies. Am J Kidney Dis. 1996 Jun;27(6):834–843. doi: 10.1016/s0272-6386(96)90521-1. [DOI] [PubMed] [Google Scholar]
- Monga G., Mazzucco G., Novara R., Reale L. Intertubular capillary changes in kidney allografts: an ultrastructural study in patients with transplant glomerulopathy. Ultrastruct Pathol. 1990 May-Jun;14(3):201–209. doi: 10.3109/01913129009076124. [DOI] [PubMed] [Google Scholar]
- Oberholzer M., Torhorst J., Perret E., Mihatsch M. J. Minimum sample size of kidney biopsies for semiquantitative and quantitative evaluation. Nephron. 1983;34(3):192–195. doi: 10.1159/000183008. [DOI] [PubMed] [Google Scholar]
- REYNOLDS E. S. The use of lead citrate at high pH as an electron-opaque stain in electron microscopy. J Cell Biol. 1963 Apr;17:208–212. doi: 10.1083/jcb.17.1.208. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Racusen L. C., Solez K., Colvin R. B., Bonsib S. M., Castro M. C., Cavallo T., Croker B. P., Demetris A. J., Drachenberg C. B., Fogo A. B. The Banff 97 working classification of renal allograft pathology. Kidney Int. 1999 Feb;55(2):713–723. doi: 10.1046/j.1523-1755.1999.00299.x. [DOI] [PubMed] [Google Scholar]
- Solez K., Axelsen R. A., Benediktsson H., Burdick J. F., Cohen A. H., Colvin R. B., Croker B. P., Droz D., Dunnill M. S., Halloran P. F. International standardization of criteria for the histologic diagnosis of renal allograft rejection: the Banff working classification of kidney transplant pathology. Kidney Int. 1993 Aug;44(2):411–422. doi: 10.1038/ki.1993.259. [DOI] [PubMed] [Google Scholar]
- Thomas C. M., Howat A. J. Assessment of renal biopsy specimens. J Clin Pathol. 1996 Jul;49(7):614–615. doi: 10.1136/jcp.49.7.614-c. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Woodrow D. F., Shore I., Moss J., Gower P., Phillips M. Immunoelectron microscopic studies of immune complex deposits and basement membrane components in IgA nephropathy. J Pathol. 1989 Jan;157(1):47–57. doi: 10.1002/path.1711570107. [DOI] [PubMed] [Google Scholar]

