Medical Kidney Diseases

Abstract

Medical kidney biopsy and interpretation is a highly subspecialized area of pathology in which the pathologist interacts with nephrologists and radiologists in taking small needle core biopsies and use sophisticated interpretation of the needle cores along with clinical signs and symptoms to make diagnoses of medical glomerular and tubular-interstitial renal diseases. The examination and final diagnoses require complex interpretations with the use of light microscopy, immunohistochemistry, and electron microscopic studies. The processing of minute tissue fragments with precise localization of glomeruli and other basic anatomic structures requires a great deal of technical skills. The correct interpretation of these minute biopsies requires highly trained renal pathologists with knowledge of renal medicine as well as renal pathology. The renal pathologist correlates the clinical data with information from histopathology, immunohistochemistry, and electron microscopy in order to obtain the most accurate diagnosis for treating the patient. The basic stains used for light microscopy include hematoxylin and eosin, periodic acid Schiff (PAS) reaction, methenamine silver, and trichrome [1]. Other stains such as von Kossa, toluidine blue, and Congo Red whenever amyloid is suspected as well as other histochemical stains are used by the renal pathologist to arrive at the correct diagnosis [2, 3]. Examples of well characterized renal glomerular diseases include minimal change disease and acute (post-streptococcal) glomerulonephritis which affects mainly pediatric patients. Additional glomerular diseases that are more common in adults include membranoproliferative disease and diabetic nephropathy.