The Ohio State University Health System
Department of Pathology – Renal/EM Lab
RENAL BIOPSY ACQUISITION AND PROCESSING
Written By:
Gyongyi Nadasdy, M.D.
Date Adopted:
1-1-03
Supersedes Document #:
Review Date:
Revision Date:
Signature:
Purpose: To provide detailed instructions for residents and SP fellows to process kidney biopsies.
Principal: Renal biopsies are preserved in three different ways in order to achieve the best results for all three
diagnostic methods; Light microscopy (LM), Immunofluorescence (IF), Electron microscopy (EM) that are
employed in native renal biopsy diagnostic testing. After procuring the biopsies and ensuring the presence of
cortical tissue, the samples are divided and appropriately preserved in order to allow the application of a wide
range of diagnostic methods. This crucially important work is performed a specifically trained person
immediately after the specimen is received.
Renal biopsy specimens are divided and submitted in the following order of priority:
1. LM (largest piece, should contain >20 glomeruli)
2. IF (>5 glomeruli)
3. EM (>2 glomeruli)
As a general rule approximately 70% of the biopsy should go to LM, 20% to IF and 10% for EM. The actual
size and proportion of samples will depend on the amount of tissue available and the clinical history. If the
sample is small, the renal pathologist on service should be contacted for further instructions.
Protocol/Procedure:
a) When the Surgical Pathology Gross Room receives a kidney biopsy the specimen is accessioned
immediately.
b) The Surgical Pathology Fellow/resident is notified that a kidney biopsy needs to be triaged.
c) The Surgical Pathology Fellow/resident triages the specimen based on the following criteria:
 Native kidney: LM, IF and EM.
 Transplant kidney treated as native, (Included are cases transplanted more than a year
ago or the clinical history suggests recurrent or de novo glomerular disease or symptoms
like proteinuria, hematuria): LM, IF (full panel and C4d) and EM
 Transplant Kidney (recent transplants): LM and IF (C4d only)
In case of questions, please call the renal pathologist on service.
Note: If the specimen is a “Rush” case including but not limited to all transplant biopsies received before
11 AM on weekdays hand delivered to histology for processing accompanied with a copy of the
requisition slip.
d)
Gather utensils (wooden application stick, surgical blade, ruler, glass slide, saline). Label all containers
(Zeus transport medium and 3% glutaraldehyde is located in the gross room refrigerator), cassettes you
will need and prepare the gross dictation sheet (located in the left upper drawer under the two-headed
microscope in the frozen section area).
d) Very gently use a wooden application stick to handle specimen. Make sure that no exposure to any
fixative occurs at this stage.
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Renal/EM Lab
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The Ohio State University Health System
Department of Pathology – Renal/EM Lab
e)
Examine tissue under the stereo microscope and identify glomeruli. Triage the biopsy under the stereo
microscope with the specimen immersed in one drop of 0. 9% saline.
f) If there are two or more cores with glomeruli, place one piece with glomeruli (minimum size is 2mm) in
3% glutaraldehyde for EM, place a piece with glomeruli (minimum size is 3mm) in Zeus tissue transport
medium for IF and the rest of the tissue is processed in 10% buffered formalin for LM.
g) If the specimen is too small (only one core with some cortex) contact the renal pathologist on service.
h) While triaging the biopsy, complete the gross dictation. After you finished with the triaging, time stamp
the gross sheet.
i) Give the formalin fixed tissue and the paperwork to a biopsy technician for dictation or during the
weekend to the histotechnologist on-call. On the weekend the original paperwork remains in the gross
room at the accessioners area, that the staff can finish accessioning the specimen Monday morning.
j) The biopsy technician dictates the case and places the cassette and additional containers to their
appropriate place.
k) On the weekend or after hours the tissue for IF and EM is collected in the IF bucket at the accessioning
area with a copy of the requisition.
l) If the specimen is a “Rush” case including but not limited to all transplant biopsies received before
11 AM on weekdays hand delivered to histology for processing accompanied with a copy of the
requisition slip.
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Renal/EM Lab
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The Ohio State University Health System
Department of Pathology – Renal/EM Lab
RENAL BIOPSY GROSS DICTATION SHEET
SP number:
Patient’s name:
A. Received from ________________, without fixative/ in 2/3 container/s with saline, formalin, transport
medium/Zeus fixative and glutaraldehyde, labeled as “ L/R native/transplant” kidney biopsy are
_________pieces of 0.1 cm tan-pink cylindrical soft tissue fragments with an aggregate length of
_____cm. One/two _____cm piece/s is/are submitted for electron microscopy, One/two ___cm piece/s
is/are submitted for immunofluorescence and the rest of the tissue is submitted for light microscopy. TE
1
Summary of sections: A1-__ pieces.
Processing: (circle one)
Same Day (HE only)
Overnight
Saturday (HE only)
Monday
Triaged by:
Date and time:
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