This two-month rotation is usually undertaken in the third year of the program. It provides an introduction to the principles and practice of renal pathology.
By the end of the rotation the trainee should also be able to evaluate fresh renal biopsies for tissue adequacy when received in the laboratory and, based on consultation with the clinician, should be able to give directions as to how to apportion the tissue for different examination modalities.
Whereas experience is acquired with time, a two-month rotation on the renal pathology service should help the trainee achieve two concrete goals, namely:
- Familiarity with how to handle a renal biopsy specimen
- The acquisition of a system to examine renal biopsies and synthesize the pathologic and clinical information into a diagnosis
- Articulate the elementary mechanisms of glomerular injury
- Spell out a scheme for systematic examination of renal biopsies by brightfield microscopy
- Recognize deviations from normalcy in renal biopsy sections
- Recognize the immunofluorescence patterns most frequently encountered in renal biopsies
- Identify the different ultrastructural compartments of the glomerulus, look for immune complex-type deposits and determine their localization, and evaluate the architecture of the different components of the glomerular capillary wall
- Spell out the histologic, immunofluorescence, electron microscopic and clinical findings in the common medical diseases of the kidney
- Synthesize information obtained from the three modalities used in examination of renal biopsies together with clinical information to reach a diagnosis
- Describe the salient features of transplant rejection, the Banff scheme for classifying transplant rejection and the most prominent pathologic lesions associated with anti-rejection medications
The residents are encouraged to attend the monthly renal biopsy conference and the unknown renal biopsy conference for the nephrology fellows.