Handbook of Renal Biopsy Pathology

Aim and Acknowledgements
Contents
1: Introduction
	1.1	 Aim of the Book
	1.2	 Introduction to Renal Disease from a Pathologist’s Point of View
	1.3	 The Value of a Renal Biopsy
	1.4	 Summary: Introduction
	Further Reading
2: General Points About Renal Biopsy Specimens
	2.1	 Introduction to General Points
	2.2	 Common Things are Common and Diseases Present in Characteristic Ways
	2.3	 Things to Remember About the General Rules
	2.4	 Importance of the Request Form to the Pathologist
	2.5	 Indications for Renal Biopsy
	2.6	 Complications of a Renal Biopsy
	2.7	 Summary: General Points About Renal Biopsy Specimens
3: Technical Handling of Renal Biopsy Specimens
	3.1	 Types of Renal Biopsy Specimen
	3.2	 Fixation and Processing of Specimens
	3.3	 Arrangements for Electron Microscopy of Specimens
	3.4	 Sectioning of Specimens
	3.5	 Staining of Specimens
	3.6	 Immunohistologic Study of Specimens
	3.7	 Summary: Technical Handling of Renal Biopsy Specimens
	Further Reading
4: How to Look at a Renal Biopsy Specimen: Preliminary Study
	4.1	 Immediate Study of Initial Sections
	4.2	 Actions After Immediate Study of Initial Sections
	4.3	 Summary: How to Look at a Renal Biopsy Specimen: Preliminary Study
5: How to Look at a Renal Biopsy Specimen: Initial Study of the Kidney
	5.1	 Introduction to Initial Study of the Kidney
	5.2	 Initial Study of Tubules
	5.3	 Assessment of Atrophy
	5.4	 A Note on Hypertension and the Kidney
	5.5	 Initial Study of Glomeruli: Glomerular Size
	5.6	 Initial Study of Glomeruli: Distribution of Glomerular Abnormalities
	5.7	 Initial Study of Interstitial Tissues
	5.8	 Initial Study of Blood Vessels
	5.9	 Summary: How to Look at a Renal Biopsy Specimen: Initial Study of the Kidney
	Further Reading
6: Indication for Biopsy: Nephrotic Syndrome
	6.1	 Introduction to the Nephrotic Syndrome
	6.2	 Detection and Measurement of Proteinuria
	6.3	 Value of a Renal Biopsy in the Nephrotic Syndrome
	6.4	 Approach to the Diagnosis in the Nephrotic Syndrome
	6.5	 Initial Inspection of a Renal Biopsy Specimen in the Nephrotic Syndrome
	6.6	 Do Glomeruli Look Normal? Is the Diagnosis Minimal Change Nephropathy?
	6.7	 Diagnosis of Minimal Change Nephropathy
	6.8	 Differential Diagnosis of Minimal Change Nephropathy
	6.9	 Are Glomeruli Abnormal? Is There Membranous Nephropathy?
	6.10	 Diagnosis of Membranous Nephropathy
	6.11	 Differential Diagnosis of Membranous Nephropathy
	6.12	 Are Glomeruli Abnormal? Is There a Segmental Sclerosing Disorder?
	6.13	 Segmental Abnormalities at the Tubular Opening
	6.14	 Segmental Abnormalities Not Only at the Tubular Opening
	6.15	 Human Immunodeficiency Viral Infection and Its Effects in the Kidney
	6.16	 Diagnosis of Collapsing Glomerulopathy
	6.17	 Other Findings in the Kidney in Human Immunodeficiency Viral Infection
	6.18	 Is the Pathologist Told That the Person Biopsied Has Diabetes Mellitus? Is There Evidence of Diabetic Glomerulopathy?
	6.19	 Value of a Renal Biopsy in Diabetes Mellitus
	6.20	 Diagnosis of Diabetic Glomerulopathy
	6.21	 Differential Diagnosis of Diabetic Glomerulopathy
	6.22	 Is the Pathologist Told That the Person Biopsied Has Systemic Lupus Erythematosus? Is There a Possibility of Lupus Nephritis?
	6.23	 Value of a Renal Biopsy in Systemic Lupus Erythematosus
	6.24	 Diagnosis of Lupus Nephritis
	6.25	 Classification of Lupus Nephritis
	6.26	 International Society of Nephrology/Renal Pathology Society 2003 Classification of Lupus Nephritis with 2018 Revisions
	6.27	 Are Glomeruli Abnormal? Is There Amyloid?
	6.28	 Diagnosis of Amyloid
	6.29	 Principles of Polarizing Microscopy
	6.30	 Determination of the Type of Amyloid
	6.31	 Differential Diagnosis of Amyloid
	6.32	 Have Minimal Change Nephropathy, Membranous Nephropathy, Segmental Sclerosing Disorders, Diabetic Glomerulopathy, Lupus Nephritis, Amyloid, and Conditions That Could Be Confused with Them Been Excluded?
	6.33	 Differentiation Between Acute Post Infective Glomerulonephritis and Subendothelial Membranoproliferative Glomerulonephritis
	6.34	 Subendothelial Membranoproliferative Glomerulonephritis
	6.35	 C3 Glomerulopathy
	6.36	 Other Findings in the Nephrotic Syndrome
	6.37	 Summary: Nephrotic Syndrome
	Further Reading: Nephrotic Syndrome
7: Indication for Biopsy: Acute Kidney Injury
	7.1	 Introduction to Acute Kidney Injury
	7.2	 Causes of Acute Kidney Injury
	7.3	 Value of a Renal Biopsy in Acute Kidney Injury
	7.4	 A General Rule
	7.5	 Acute Abnormalities in Tubules
	7.6	 Approach to the Diagnosis in Acute Kidney Injury
		7.6.1	 Is There Necrosis in the Kidney?
	7.7	 Is There the Expected Number of Tubules in the Kidney?
	7.8	 Are There Clues to the Cause of Acute Tubular Damage?
	7.9	 Common Findings in Renal Biopsy Specimens in Acute Kidney Injury
	7.10	 Is There Evidence of Renal Vasculitis?
	7.11	 Diagnosis of Vasculitic Glomerulonephritis
	7.12	 Clinical Conditions with Renal Vasculitis
	7.13	 If There Is Renal Vasculitis, Are There Clues to Recognizable Conditions?
	7.14	 Conditions that Can Be Differentiated from Pauci Immune Vasculitic Glomerulonephritis: 1 Henoch Schönlein Nephritis (IgA Vasculitis)
	7.15	 Conditions that Can Be Differentiated from Pauci Immune Vasculitic Glomerulonephritis: 2 Lupus Nephritis
	7.16	 Conditions that Can Be Differentiated from Pauci Immune Vasculitic Glomerulonephritis: 3 Goodpasture’s Disease (Anti Glomerular Basement Membrane Disease)
	7.17	 Conditions that Can Be Differentiated from Pauci Immune Vasculitic Glomerulonephritis: 4 Cryoglobulinemic Glomerulonephritis
	7.18	 Are glomeruli Abnormal but There Is No Evidence of Vasculitis?
	7.19	 Diagnosis of Acute Post Infective Glomerulonephritis
	7.20	 Diagnosis of Subendothelial Membranoproliferative Glomerulonephritis
	7.21	 Impression of Glomerulonephritis Given by Ischemic Glomeruli
	7.22	 Has a Glomerular Disorder been Excluded in Acute Kidney Injury?
	7.23	 Has a Glomerular Disorder been Excluded? Is There a Clue in Interstitial Tissues to the Cause of Acute Kidney Injury?
	7.24	 Diagnosis of Acute Interstitial Nephritis
	7.25	 Causes and Associations of Acute Interstitial Nephritis
	7.26	 Has a Glomerular Disorder been Excluded? Is There a Clue in Tubules to the Cause of Acute Kidney Injury?
	7.27	 Findings in Tubules: Light Chain Cast Nephropathy (Myeloma Kidney)
	7.28	 Findings in Tubules: Myoglobinuria or Crystals
	7.29	 Has a Glomerular Disorder been Excluded? Is There a Clue in Blood Vessels to the Cause of Acute Kidney Injury?
	7.30	 Changes in Blood Vessels: Vasculitis or Embolism
	7.31	 Acute Renal Ischemia
	7.32	 Diagnosis of Thrombotic Microangiopathy
	7.33	 Disorders Associated with Thrombotic Microangiopathy
	7.34	 Summary: Acute Kidney Injury
	Further Reading
8: Indication for Biopsy: Chronic Renal Failure
	8.1	 Introduction to Chronic Renal Failure
	8.2	 Assessment of Chronic Renal Failure
	8.3	 Stages of Chronic Kidney Disease
	8.4	 Causes of Chronic Renal Failure
	8.5	 Value of a Renal Biopsy in Chronic Renal Failure
	8.6	 Findings in Renal Biopsy Specimens in Chronic Renal Failure
	8.7	 Assessment of Renal Biopsy Specimens in Chronic Renal Failure
	8.8	 Is There a Glomerular Disorder?
	8.9	 Differentiation of Types of Segmental Sclerosing Glomerular Disorders
	8.10	 Differential Diagnosis of Overload Changes in Glomeruli
	8.11	 Is There Evidence of a Glomerular Disorder Other than IgA Nephropathy, Diabetic Glomerulopathy, or a Segmental Sclerosing Condition?
	8.12	 Is There No Evidence of a Glomerular Disorder?
	8.13	 Is There Evidence of Chronic Ischemic Damage?
	8.14	 Is There Evidence of a Disorder of Urinary Drainage?
	8.15	 Is There Evidence of a Medullary Disorder?
	8.16	 Is There Evidence of a Cystic Disorder in the Cortex?
	8.17	 Is There Evidence of a Tubular Disorder?
	8.18	 Is There Evidence of an Interstitial Nephritis?
	8.19	 Summary: Chronic Renal Failure
	Further Reading
9: Indication for Biopsy: Hematuria
	9.1	 Introduction to Hematuria
	9.2	 Detection of Hematuria
	9.3	 Investigation of Hematuria
	9.4	 Value of a Renal Biopsy in Hematuria
	9.5	 Common Findings in Hematuria
	9.6	 Approach to the Study of Renal Biopsy Specimens in Hematuria
	9.7	 Initial Assessment of Orthodox Light Microscopic Sections
	9.8	 Assessment of Immunohistologic Sections: Is There IgA Nephropathy?
	9.9	 Diagnosis of IgA Nephropathy
	9.10	 Henoch Schönlein Nephritis (IgA Vasculitis)
	9.11	 If IgA Nephropathy Has Been Excluded, Is There an Abnormality on Electron Microscopy?
	9.12	 Diagnosis of Thin Glomerular Basement Membrane Disease
	9.13	 Diagnosis of Hereditary Nephropathy of Alport Type
	9.14	 Other Findings in Hematuria
	9.15	 Summary: Hematuria
	Further Reading
10: Indication for Biopsy: Proteinuria
	10.1	 Introduction to Proteinuria
	10.2	 Types of Proteinuria
	10.3	 Value of a Renal Biopsy in Proteinuria
	10.4	 Findings in Proteinuria
	10.5	 Approach to Study of Renal Biopsy Specimens in Proteinuria
	10.6	 Is There a Segmental Glomerular Disorder?
	10.7	 Does the Request form give Information About a Systemic Disorder?
	10.8	 Does the Specimen Appear Normal or Nearly Normal on Light Microscopy?
	10.9	 The Unsatisfactory Nature of the Terms Mesangial Proliferative Glomerulonephritis, and Focal or Segmental Proliferative Glomerulonephritis
	10.10	 Summary: Proteinuria
	Further Reading
11: Indication for Biopsy: Renal Allograft
	11.1	 Introduction to Renal Allograft Biopsy Specimens
	11.2	 Reasons for Biopsy of an Allograft Other Than Dysfunction
	11.3	 Value of Biopsy of a Renal Allograft
	11.4	 Technical Handling of Renal Allograft Biopsy Specimens
	11.5	 Approach to the Diagnosis in Renal Allograft Biopsy Specimens
	11.6	 Is There Evidence of Acute Rejection?
	11.7	 Antibody Mediated Rejection
	11.8	 Conventional Acute Rejection
	11.9	 Diagnosis of Acute Cellular Rejection
	11.10	 Diagnosis of Significant Acute Cellular Rejection
	11.11	 Diagnosis of Acute Vascular Rejection
	11.12	 Summary of Acute Rejection
	11.13	 Is There Any Other Acute Abnormality Instead of Acute Rejection, or in Addition to it?
	11.14	 Is There Evidence of Chronic Rejection?
	11.15	 Differential Diagnosis of Late Damage in a Renal Allograft
	11.16	 Is There a Glomerular Disorder?
	11.17	 Is There Evidence of a Neoplastic Disorder, or Any Other Disorder?
	11.18	 Summary: Renal Allografts
	Further Reading
12: Other Indications for Biopsy of Kidneys
	12.1	 Introduction
	12.2	 Investigation of the Kidney in Systemic Disease
	12.3	 Investigation of Metabolic or Other Familial Disorders, and Disorders of Tubular Function
	12.4	 Assessment of Effects of Treatment on the Kidney
	12.5	 Investigation of a Renal Mass
	12.6	 Chance Finding of a Neoplasm in a Renal Biopsy Specimen
	12.7	 Summary: Other Indications for Biopsy of Kidneys
	Further Reading
Index