Biopsy Specimens

Fine needle aspiration cytology (FNAC): less often performed now but usually in association with a renal core biopsy in the investigation of a mass lesion.

Percutaneous needle biopsy: this is more often used in the investigation of medical renal disease but is also used for the evaluation of a renal mass. This technique obtains a core of fresh renal tissue using a biopsy gun under radiological (ultrasound or CT) guidance. Medical renal biopsies require special collection procedures and should be done only in centres with appropriate facilities and after consultation with the pathologist. Two to three cores are taken with fresh tissue for immunofluorescence (IF), fixed tissue for light microscopy (some laboratories use special fixatives, e.g., Bouins) and electron microscopy (3% glutaraldehyde). Surgical renal biopsies are routinely fixed in 10% formalin.

Indications for renal biopsy include glomerular haematuria, some cases of proteinuria, and suspected renal neoplasm and following renal transplantation to distinguish rejection from other causes of deterioration in renal function. Interpretation of findings requires expertise in the cate gorisation of glomerulonephritis and other glomerulopathies (e.g., diabetes mellitus, amyloid, hereditary renal disease), interstitial nephritis and renal vascular disease, monitoring transplant rejection, diagnosis of drug toxicity and systemic disease affecting the kidneys (e.g., vasculitis).

Open renal biopsy: performed under general anaesthesia if core biopsy is not possible and more often in the transplant situation (donor and recipient) when there is uncertainty about the state of the kidney. They often consist only of superficial cortex.

Pelvi-ureteric junction obstruction specimen: The specimen may be funnel shaped if unopened and triangular if opened. The length, diameter at both ends and thickness of the wall are measured and the presence and size of any strictures described. The specimen is opened along the main axis. The mucosal surface is examined for lesions and irregularities in texture. The outer surface is examined for mass lesions and fibrosis. Multiple sections taken along the long axis are submitted.

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