Kidney nontumor
Primary glomerular diseases
Biopsy - general

Author: Nikhil Sangle, M.D. (see Authors page)

Revised: 12 September 2017, last major update April 2012

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Kidney biopsy [title] "loattrfree full text"[sb]

Cite this page: Sangle, N. Biopsy - general. PathologyOutlines.com website. http://pathologyoutlines.com/topic/kidneybiopsy.html. Accessed October 24th, 2017.
Definition / general
  • Helps establish diagnosis and determine prognostic factors for renal disorders and transplant recipients
  • Needle core or open biopsies are relatively safe and only rarely cause morbidity or mortality; outpatient complication rate is 8% (Clin Nephrol 2011;76:464)
  • Also important for appropriate management of elderly and very elderly patients with kidney disease (Adv Chronic Kidney Dis 2012;19:61)
  • Percutaneous ultrasound guided renal biopsy is safe, reliable and effective in children; most common indication is steroid resistant, steroid dependent or frequent relapsing idiopathic nephrotic syndrome (Hippokratia 2011;15:258)
  • Pathology should correlate complete clinical and laboratory information (using a clinical form is recommended) with light microscopy, immunofluorescence and electron microscopy; cannot diagnose certain diseases without immunofluorescence or EM (Mod Pathol 2004;17:1555)
  • Must carefully evaluate glomeruli, tubules, interstitium and vessels
Diagrams / tables

Images hosted on other servers:

Diagram about
dividing up core tissue
if no dissecting
microscope is present

Procedure
  • Specimen must be handled gently
  • Don’t: use forceps, pull or stretch tissue, place tissue on dry gauze or water soaked gauze, freeze entire sample or place on ice cold saline
  • Do: transport with tissue culture medium on saline moistened gauze; cut with fresh scalpel
  • Dissecting microscope helps assess adequacy of glomeruli; place sample on glass slide with saline
  • Two cores recommended
  • Core #1: take samples 0.5 to 1.0 mm thick from each end with razor / scalpel and put in glutaraldehyde for EM; place remainder in saline, then fixative for light microscopy
  • Core #2: take samples for EM, snap freeze the remainder for immunofluorescence
  • Wrap light microscopy specimens in lens paper prewetted with fixative (avoid sponges or plastic embedding bags)
  • If only one core or a small specimen is obtained, use tissue for EM and immunofluorescence because EM semi thin sections can also provide light microscopic information
  • Fixative: mercury fixatives (Zenker, Bouin, other) provide optimal architectural and cytologic detail; ethanol fixation helps find glycogen or crystals of urate / uric acid
  • Recommended to section through entire specimen, put 3 - 4 sections on each slide; for every batch of 5 slides, stain 1 with H&E, 1 with PAS and keep 3 unstained slides for possible future use
  • Can detect immune complexes with antibodies or using fluorescence microscopy of H&E stained sections, fixed in Hollande fixative (Mod Pathol 2002;15:988)
Microscopic (histologic) description

Images hosted on other servers:

A: renal cortex with
round red glomeruli;
B: renal medulla without
glomeruli

Immunofixation
  • Best performed on unfixed, frozen sections
  • Examine for IgG, IgM, IgA, IgH, C3, C1q, C4, fibrin, kappa and lambda
  • Should include positive and negative controls for each run
  • Immunoperoxidase may be a substitute (cheaper, can correlate with H&E, doesn’t fade) but complement antigens are difficult to detect, may have higher background staining
  • Minimum glomeruli:
    • 5 - 10 in general
    • 10 for crescentic disorders
    • 1 may be sufficient for diffuse lesions such as membranous glomerulonephritis
  • Immunohistochemistry: IgG, IgA, IgM, C1q, C3, C4, fibrinogen and fibrin
  • Frozen section: requested to determine adequacy (% sclerotic glomeruli) in donor kidney for transplant
  • Transplant biopsies: performed to assess rejection
Electron microscopy description
  • Uses osmium tetroxide or glutaraldehyde for fixation (cannot perform if tissue exposed to B5, Zenker or other mercury based fixatives; can reprocess tissue from paraffin block)
  • Embed in epoxy resin stain semithin (one micron thick) sections with toluidine blue or methylene blue
  • Obtain thin sections for EM stained with uranyl acetate and lead citrate