Testing Algorithm

The Renal Pathology Consultation is performed by a Mayo Clinic renal pathologist and entails the performance of appropriate procedures and stains based on the material received, patient information, and specific findings on the case in order to determine a diagnosis. Optimal/standard diagnostic interpretation of a medical kidney biopsy requires integration of the light microscopy, immunofluorescence, and electron microscopy findings together with the clinical and laboratory data for the patient. Published standards by the Renal Pathology Society are followed for the diagnostic evaluation and reporting of non-neoplastic kidney disease.(1)

Light Microscopy:

Wet/unprocessed tissue submitted for light microscopy routinely includes the preparation of stains, which include hematoxylin and eosin, periodic acid Schiff, Masson trichrome, and Jones methenamine silver stains.

Immunofluorescence:

Wet/unprocessed tissue submitted for immunofluorescence may include the following stains to render an accurate diagnosis. These stains include IgA, IgG, IgM, C1q, C3, albumin, fibrinogen, kappa light chain, and lambda light chain stains with C4d added if the biopsy is an allograft.

The IgG subtypes (IgG1, IgG2, IgG3, IgG4) are typically only utilized if the biopsy shows features suspicious for a monoclonal/monotypic deposition process involving IgG.

Alport (collagen IV, alpha 2 and alpha 5) staining is performed in the setting of biopsy findings that are consistent with hereditary nephritis/Alport syndrome.

Phospholipase A2 receptor staining is performed in the setting of membranous nephropathy/glomerulonephritis to aid in determining whether it is most likely primary/idiopathic or secondary.

Paraffin-Based Immunofluorescence Stains:

The paraffin-based immunofluorescence stains listed above would only be utilized in the special circumstance when there is no tissue or inadequate tissue available for standard immunofluorescence or if there are findings that raise concern for so-called "masked deposits."

Electron Microscopy:

Wet/unprocessed tissue submitted for electron microscopy will be processed for transmission electron microscopy. A formal interpretive report is issued, incorporating the findings from all tests performed for diagnostic purposes.

For more information see Pathology Consultation Ordering Algorithm.