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Renal Pathology Consultation Service
Amani Bashir, MBBS and Danni Holanda, MD
                                            
A national anatomic and clinical pathology reference laboratory
affiliated with UI Health Care

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Consultation Overview

Identifying Glomeruli

Requisition

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Department of Pathology

Renal Biopsy Consultation Overview

The University of Iowa Department of Pathology provides a full range of Renal Pathology consultation services. We provide advanced technologies and professional expertise. Danniele Holanda MD, Director of Renal Pathology is available for consultation for all referred materials.

The preliminary diagnosis is called if final results are not available within 24 hours. Final reports are faxed and final copies are mailed. Written reports indicate patient information, accession number, slide/blocks examined, stains performed and interpretation.

How to send a Renal Biopsy:
1. Complete the Renal Pathology Requisition. Questions about completing the requisition can be directed to: University of Iowa Diagnostic Laboratories (UIDL) at 319-384-7212 or toll free at 866-844-2522.

a. A completed requisition must accompany all requests. It should contain: the patient name, identification number, date of biopsy, tissue source, biopsy site, clinical history, Lab data (BUN , Creat.) question(s) to be answered and diagnosis if known.

b. Include other pertinent history and findings, such as radiographic findings, cancer history or treatment history.

2. Specimen Preparation. Supplies are available from UI Diagnostic Laboratories. Please call 319-384-7212 or toll free at 866-844-2522 to obtain supplies.

a. All containers must be labeled with patient name, identification number, and tissue source.

b. Specimens may be obtained by needle (core) biopsy or an open wedge biopsy. Optimal results are obtained with 2 needle (cores) biopsies. Please divide the tissue as follows:

What a biopsy kit contains:

1)  3 vials containing formaldehyde, 2.5% glutaraldehyde fixative and Michel's transport medium
2)  Requisition Form
3)  History Form
4)  Prefilled, prepaid Fedex forms, for First Overnight Delivery
5)  Instructions for core distrubution

Distribution of Specimen for Light Microscopy (LM), Electron Microscopy (EM) and Immunofluorescence (IF):

Two cores of tissue


a. 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, unique patient id# or date of birth and collection date.
  • Be sure to wash off any excess fixative on the end of the blade with saline before touching the blade to another biopsy core.

b. Immunofluorescence (IF):

  • Place the remaining the cut core in Michel's Transport Media or Immunoflourescence.
  • Label with patient name, unique patient id# or date of birth and collection date.

c. Light Microscopy (LM):

  • Place one remaining core in the vial of 10% buffered formalin. For a two-croe protocol, place the larger core in formalin.
  • Label with patient name, unique patient id# or date of birht and collection date
  • 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 cores are of greatly differing lengths, take two 1 mm segments from each end of larger core for EM. Place smallest core (of the two after EM tissue removed) in Michel’s fixative and place largest core in formalin.

One core samples:
If difficulties are encountered in obtaining biopsy such that only one core can be obtained, it is still desirable to put a small piece (2-3mm) for immunofluorescence in Michel’s solution. Talk to the local nephrologist or call Danniele Holanda, MD, to decide how best to triage the tissue based on clinical information (Telephone: 319-356-7000, #1488).

How to maximize your success in identifying glomeruli:
Place the tissue core on a glass slide and view with an ordinary microscope with 4X (occasionally 10X objective can be helpful but not really necessary). I find this much better than a dissecting microscope. Glomeruli will be seen as in figure below. One can also easily identify connective tissue and medulla.

3. Specimen Packaging

a. Label containers with "Formaldehyde precaution".
b. Use the 95kPa Specimen Transport Bag for the specimen containers with the requisition in the outside pocket of the bag.
c. Place the double-bagged specimen into a box with adequate absorbent material in case of leakage.
d. Securely seal the shipping container.
e. Indicate on the exterior of the box "Formaldehyde Caution" and/or "Glutaraldehyde Precaution".
f. Ship at ambient temperature. DO NOT FREEZE.
g. These specimens can be sent by our Courier services within our service area or by overnight express airmail.

4. Specimen Transportation

UI Diagnostic Laboratories can usually provide for specimen transport either through our own courier services or through other transportation providers such as overnight carriers. If you need assistance or information in transporting specimens to our laboratories, please contact Client Services and a representative will provide assistance in determining the most appropriate shipping arrangement.

319-384-7212 (local)
1-866-844-2522 (toll free)

Shipping address:
University of Iowa Healthcare
UI Diagnostic Laboratories
200 Hawkins Drive, Room 6240 RCP
Iowa City, IA 52242-1087