Scheduling policies are in place to maximize patient access to renal biopsy procedures without limiting access to other services provided by the laboratory.

Rapid onsite specimen adequacy is provided by histology technicians.

Technical interpretaton of adequacy is the sample visibly contains cortical tissue and is satisfactory for evaluation or cortical tissue is not identifiable and is unsatisfactory for evaluation. Any glomerular counts given are in good faith and are not to be considered as a definitive count.  

Surgical Pathology provides service on renal biopsy procedures pre-scheduled starting at 8:00am and until 2:00pm, Monday through Friday. The latest procedure is scheduled in the afternoon to ensure completion by 3:30pm. Transplant Clinic biopsy procedures should occur during the reserved scheduling block of 10:00am - 12:00pm, Monday through Friday. The service or unit performing the procedure is required to notify the UWH Renal Pathology Lab at 608-263-8442. Renal biopsy procedures should be scheduled at least 1 day in advance. If a biopsy procedure is scheduled during the requested time, an alternative time will be requested. Scheduled procedures take precendence over unscheduled procedures. Same day procedures can be requested but there is no guarantee that coverage will be provided; ability to add-on same day requests will be dependent on other scheduled procedures at that time. 

The on-call resident/staff pathologist should be notified if a biopsy is to be performed on a weekend or holiday. The pathologist will coordinate with the appropriate staff to assure proper processing.

Renal start time delays of an hour or more are not guaranteed histology technician involved adequacy assessment due to other pre-scheduled procedures. The renal pathology service should be informed ASAP of delays to maximize coverage.

Cancelled procedures must be communicated to Renal Pathology as soon as confirmed, to allow access for other patient biopsy procedures.

Renal pathology assessment services are not provided within the UWH operating rooms or on procedures not completed by 3:30pm. In these instances, adequacy assessment can be determined by the attending provider. Aee Additional Information for guidance. A dissecting scope is available in both Ultrasound and Transplant Clinic.

Surgical pathology services are provided by board certified pathologists.  Areas of subspecialization include breast and gynecologic, hematopathology, gastrointestinal and liver, genitourinary, neuropathology, pediatric, pulmonary, renal including electron microscopy, soft tissue and bone, transplant, eye, and ENT pathology.

Samples collected without histolgy technician involvement should be submitted to the renal pathology laboratory for sample division and processing on saline-moistened gauze or filter paper. Specimens placed on dry gauze or telfa may result in specimen inadequacy due to the removal of mosture from the specimen.

Biopsy specimens must be handled gently when removed from the biopsy needle. To avoid crush artifact, roll the specimen onto saline-moistened gauze or normal saline can be used to wash the sample off the needle. Pulling or stretching the tissue during removal should be avoided.

Specimens referred to the UWH Renal Pathology Laboratory from outside UWH should contact the laboratory at (608)263-8442 to receive shipping information and transport materials. Please notify the laboratory prior to the specimen being shipped to assure proper follow-up.

 Renal Biopsy Kit Contents:

• 3 vials containing 10% neutral buffered formalin, 2.5% glutaraldehyde fixative and Zeus Scientific media
• Tissue Requisition Form
• Clinical History Form
• Biohazard Bag
• Prefilled, prepaid Fed Ex Airbills, for First Overnight Delivery
• Fed Ex shipping bags
• Fed Ex trasport boxes
• Instructions for core distribution
  
  

Specimen Distribution Guidelines:

Electron Microscopy (EM) Specimen

• Place the 2, 1-2 mm cut pieces of kidney biopsy (cut from each end of a core) in the vial containing 2.5 % glutaraldehyde fixative.
• Label with patient name, and unique patient id# or date of birth.
• Be sure to wash off any excess fixative on the end of the blade with saline before touching the blade to another biopsy core.

Immunofluorescence (IF) Specimen

• Place the remaining cut core in Zeus Scientific media for immunofluorescence.
• Label with patient name, and unique patient id# or date of birth.

Light Microscopy (LM) Specimen

• Place one remaining core in the vial of 10% neutral buffered formalin.  For a two-core protocol, place the larger core in formalin.
• Label with patient name, and unique patient id# or date of birth.
• Be sure to wash off any excess fixative on the end of the blade with saline before touching the blade to another biopsy core.

NOTE:  If the cores are of greatly differeing lengths, take two 1 mm segments from each end of the larger core for EM.  Place the smallest core (of the two after EM tissue is removed) in Zeus Scientific media and place largest core in formalin.

The patholoigst will provide an interpretative report.

Situations may exist that would require results prior to the routine turnaround time.  The authorizing physician should consult with the Renal Pathologist to evaluate the circumstances and make arrangments for non-routine processing.

The renal laboratory provides processing of native, allograft, autotranplant, and donor renal biopsies. Light microscopy, special stains, immunofluorescence and electron microscopy services are provided as determined by the renal pathologist.

Evaluation of specimen adequacy;

The use of a dissecting microscope can be of assistance in assessing sample adequacy. An alternative to the dissecting scope is use of a standard light microscope. For evaluation using a standard light microscope, place the tissue on a glass slide with normal saline. Renal cortex can be recognized as circular red areas containing glomerulus capillaries. Samples containing sclerotic or low functioning glomerular filtration will appear pale red to tan circular areas or "bumps".  Renal medulla consists of reddish vasculature but contains no glomeruli.