Reporting and Interpreting Renal Biopsies – A Review Article

Abstract

Medical renal biopsy is an important tool in patient care in nephrology department. Systematic reporting of a renal biopsy eases the communication between the pathologist and the clinician, thereby improving patient care. H & E (Hematoxylin and eosin) sections alone cannot help to arrive at a diagnosis, immunofluorescence (IF), special stains and EM (electron microscopy) play  important roles too. To arrive at an accurate diagnosis, an expert renal pathologist, who has a thorough knowledge of renal pathology as well as renal medicine is required to correlate tissue with clinical data. Although a lot of review articles regarding renal biopsies have been published, review of literature covering all aspects of renal biopsy are a few especially from India. In children the common cause of nephrotic syndrome is minimal change disease, which can only be confirmed with EM (diffuse effacement of foot processes). While the commonest cause of nephrotic syndrome in adults is membranous nephropathy which needs a combination of H & E (Thickened capillary loops), Silver stains (Spikes), IF (Fine granular staining of IgG & C3 in capillary walls) and EM (Subepithelial deposits). In terms of nephritic syndrome, the most common cause in children is post-streptococcal glomerulonephritis, which is diagnosed with H & E (Hypercellularity), IF (Coarse granular staining of IgG & C3 in capillary walls) and EM (Large subepithelial deposit). In adults, one of the most common causes of nephritic syndrome is rapidly progressive glomerulonephritis, which shows characteristic crescents in both H & E and special stains.