Yale Medical Renal Pathology

The Yale Medical Renal Pathology and Electron Microscopy Laboratory is a nationally recognized center for diagnostic renal pathology and electron microscopy. It provides the most effective methodologies available for light microscopic, ultrastructural and immunological diagnosis of kidney biopsies and surgical pathology specimen. These include transmission electron microscopy, immunohistochemistry and standard and confocal immunofluorescence microscopy. There is special emphasis on the diagnosis of glomerular, tubulointerstitial and vascular kidney diseases, as well as evaluation of transplant kidney biopsies.

Electron microscopy is further of value in the diagnosis of ciliary abnormalities, metabolic disorders, microbial identification, and tumor diagnosis. As one of the few clinical electron microscopy services with digital imaging capability in the nation, the Yale Renal Pathology Laboratory is well positioned to serve a wide geographic area with rapid turnaround time combined with expert consultative services.

The Yale Renal Pathology Service provides high quality electron micrographs/digital images for analysis of ultrastructural pathologic changes in organ tissue. We maintain the highest level of diagnostic accuracy coupled with rapid turnaround time for renal diseases, ciliary abnormalities, metabolic disorders, microbial identification, and tumor diagnosis. Diseases and conditions include but are not limited to: primary glomerular, tubulointerstitial, and vascular diseases of the kidney, renal genetic disease, lupus and systemic vasculitis, renal transplantation.

Although patients with all varieties of renal parenchymal disease have undergone renal biopsy, the biopsy is of greatest value in patients with large amounts of proteinuria, patients with systemic disease that involve the kidneys, certain patients with acute renal failure, and patients with an active urinary sediment. Important clinical information such as serum creatinine, serologic studies, and the degree of proteinuria are useful in assisting the interpretation of the renal biopsy. The renal biopsy provides significant information relative to the risk of progression by examining the degree of tubulointerstitial scarring. The potential to respond to therapy is generally based on the presence or absence of acute inflammatory changes in the glomerulus and in the tubulointerstitial compartment. Important clinical information such as serum creatinine, serological studies for hepatitis and lupus, and the degree of proteinuria are generally useful in assisting in the interpretation of the renal biopsy.

The technique of a renal biopsy has been improved so that complications are very uncommon. It is relatively rare to have a serious complication, although it is not uncommon to have blood in the urine following a biopsy.?

Complete electron microscopy and renal biopsy consultation services are available to departments and physicians within YNHH, as well as outside hospitals and groups.

Complete electron microscopy and renal biopsy consultation services are available to departments and physicians within YNHH, as well as outside hospitals and groups. More information visit the Electron Microscopy Lab and Yale Pathology Labs.

The Renal Pathology and Electron Microscopy Lab provides training to pathology residents, nephrology fellows and to renal/GU pathology fellows in the diagnostic skills of kidney biopsy interpretation.

The Renal & Genitourinary Pathology Fellowship program at Yale is a one-year, ACGME-accredited fellowship program that aims to provide outstanding training in diagnostic pathology of medical renal biopsies and genitourinary tumor biopsies. The fellowship training is integrated in both the renal and genitourinary pathology services at Yale.

What are the indications for a renal biopsy?

Although patients with all varieties of renal parenchymal disease have undergone renal biopsy, the biopsy is of greatest value in patients with large amounts of proteinuria, patients with systemic disease that involve the kidneys, certain patients with acute renal failure, and patients with an active urinary sediment. Important clinical information such as serum creatinine, serologic studies, and the degree of proteinuria are useful in assisting the interpretation of the renal biopsy.

Can the biopsy assess the risk of progression and the potential for response to therapy?

The renal biopsy provides significant information relative to the risk of progression by examining the degree of tubulointerstitial scarring. The potential to respond to therapy is generally based on the presence or absence of acute inflammatory changes in the glomerulus and in the tubulointerstitial compartment.

What clinical information will assist in the evaluation of the renal biopsy?

Important clinical information such as serum creatinine, serological studies for hepatitis and lupus, and the degree of proteinuria are generally useful in assisting in the interpretation of the renal biopsy.

Does a needle biopsy provide an adequate sampling?

It is generally felt that needle biopsy of the kidney gives a sufficient sampling for most processes that involve the glomerular or tubulointerstitial compartments.?

What types of infectious diseases are identified by electron microscopy?

Electron microscopy has proven useful in the diagnosis of a wide range of viral diseases and in the diagnosis of unusual infectious agents such as spirochetes, microsporidia, and protozoa mechanisms. Electron microscopy is also very helpful in identifying a bacterial infection as underlying etiology for a glomerulonephritis.

Why do I need a renal biopsy?

While your doctor may be able to tell you that you have a disease, which affects your kidneys, laboratory tests and physical examination are generally insufficient to give the accurate diagnosis your doctor needs to plan your therapy and management. The exact kidney disease is often only correctly identified through a tissue diagnosis, which the biopsy provides.

What are the potential complications of a needle biopsy?

The technique of a renal biopsy has been improved so that complications are very uncommon. It is relatively rare to have a serious complication, although it is not uncommon to have blood in the urine following a biopsy.