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Abstract: TH-PO557

Renal Pathology Global Practice Variation

Session Information

  • Pathology and Lab Medicine
    November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pathology and Lab Medicine

  • 1700 Pathology and Lab Medicine

Authors

  • Gaut, Joseph, Washington University in St Louis School of Medicine, St Louis, Missouri, United States
  • Roelofs, Joris, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, Netherlands
  • Seshan, Surya V., Weill Cornell Medicine, New York, New York, United States
  • Henderson, Joel M., Boston University, Boston, Massachusetts, United States
  • Akilesh, Shreeram, University of Washington, Seattle, Washington, United States
  • Gowrishankar, Swarnalata, Apollo Hospitals, Hyderabad, Telangana, India
  • Wiech, Thorsten, Universitatsklinikum Hamburg-Eppendorf, Hamburg, Hamburg, Germany
  • Moura, Luiz A., Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil
Background

Renal pathology relies on special histologic stains and ancillary techniques. Global practice variation is not well documented. This study aims to examine global renal biopsy pre-analytic and analytic variability in the current era.

Methods

The Renal Pathology Society membership was surveyed between Aug 24, 2021 - Oct 22, 2021 with 66 questions. 126 members responded.

Results

Respondents represented 47% North America, 26% Asia, 19% Europe, 4% South America, 3% Central America, 1% Australia, and 1% Africa. Most have a practice processing 500 - 1000 biopsies annually, most being native kidney biopsies. The survey consisted of questions regarding general practice variables, tissue preparation, and processing for light, immunofluorescence, and electron microscopy. The most variable survey responses are summarized in Table 1. The remaining responses that were more consistent were not shown.

Conclusion

There is significant variation in renal biopsy processing and extent of pathologic evaluation across the globe. Paraffin immunofluorescence is not widely available nor are THSD7A, collagen IV isoform, and DNAJB9 immunostains. EM is only used routinely in ~50% of biopsies. Morphometric measurement of fibril thickness varies in practice. Despite the wide range of resources available in differing global settings, most pathologists have access to many ancillary tests. Improved access to adequate resources is needed to standardize global renal biopsy practice. These data reveal many potential sources of variability across all processing phases and microscopic techniques. Further study is needed to understand the impact on renal pathology practice.

Table 1
QuestionResponse (%)
Where are renal biopsies divided for LM, IF, EM?Bedside/procedure (32); lab (56); nephrologists/radiologists (42)
Who divides the biopsy?Pathologist (44); trainee (16); tech (56); surgeon (6); nephrologist (33); radiologist (16)
Total # slides prepared for 1 biopsy4-5 (18); 6-8 (30); 9-10 (21); >10 (30)
# H&E slides for 1 biopsy1 (16); 2 (37); 3 (32); 4(15)
# PAS slides for 1 biopsy1 (34); 2 (27); 3 (28); 4 (10)
# Silver slides for 1 biopsy0 (2); 1 (53); 2 (25); 3 (16); 4 (4)
Section thickness for Congo Red<5 um (12); 5 um (18); 7 um (24); >7 um (44); do not use (2)
Do you offer paraffin IF?Yes (49); No (51)
PLA2R immunostainingYes IF (26); Yes IHC (32); Yes sendout (17); No (26)
DNAJB9 immunostainingYes IF (4); Yes IHC (23); Yes sendout (23); No (50)
THSD7A immunostainingYes IF (5); Yes IHC (13); Yes sendout (19); No (63)
Collagen IV isoforms stainingYes IF (27); Yes IHC (3); Yes sendout (22); No (48)
Morphometric fibril thickness – how many measurements?<10 (26); 10-20 (24); 20-50 (10); >50 (3); minimum (13); No (25)