Welcome to Tulane University Renal Pathology Dr. Suzanne Meleg-Smith

RENAL PATHOLOGY SERVICES
Department of Pathology and Laboratory Medicine

Suzanne Meleg-Smith, M.D.

Professor

Head, Renal Pathology

RENAL SAMPLE REQUIREMENTS
Adequate tissue for diagnosis of renal diseases may be obtained by needle biopsy or open biopsy. The diagnosis of native kidney biopsies is a complex procedure. In every case, the biopsy is investigated using 3 different techniques: light microscopy for glomerular and interstitial morphology and cellularity, immunohistochemistry using immunofluorescence for deposition of immune complexes and light chains, and electron microscopic examination for evaluation of deposits and ultrastructural pathology. Each of these 3 techniques requires a different sample, submitted in a specific fixative, as described below. When a renal allograft biopsy is performed in the clinical setting of suspected recurrent or de novo glomerular disease, it is submitted for the 3 techniques, like a native kidney biopsy. Conversely, when a renal allograft biopsy is performed specifically to evaluate only rejection, light microscopy alone is sufficient to render a diagnosis.

SAMPLE SUBMISSION
Biopsies may be submitted by courier or by mail. Upon request, the necessary requisition forms, kits and instructions for handling the biopsy samples will be supplied. The kit contains 3 fixatives: Zinc-Formalin for light microscopy, Zeus/Michel's transport media for immunofluorescence, and 3% glutaraldehyde for electron microscopy. Please note that the gluteraldehyde should be kept refrigerated and brought to room temperature before use. The requisition must include pertinent clinical data, telephone and FAX number of the physician to be notified of the diagnosis. These materials are mailed/sent to:

Manager of Anatomic Pathology
Tulane University Hospital & Clinic
1415 Tulane Ave. - HC49
Floor 2, Room #2400
New Orleans, LA 70112-2632

COLLECTION OF RENAL BIOPSY SAMPLES
Biopsy of native-kidney or of allograft with glomerular disease: The sample may consist of 2 needle cores or 1 wedge biopsy. Each core must measure 1.5-2 cm in length. If the cores measure less than 1 cm, 4 cores should be obtained. After obtaining the sample, it must be kept moist with saline to prevent dehydration.
Needle cores: With a new blade, section 0.1 cm from each end of the cores and place the 4 resected 0.1 cm sections in glutaraldehyde for electron microscopy. Place 1 core in formalin for light microscopy and the second core into Zeus/Michel's transport media for immunofluorescence.
Wedge Biopsy: Divide into 3 slices. Mince 1 slice into 0.1 cm fragments and place in glutaraldehyde for elctron microscopy. Place 1 slice in formalin for light microscopy and another slice into Zeus/Michel's transport media for immunofluorescence.
Allograft biopsy to rule out rejection: The sample may consist of 2 needle cores or 1 wedge biopsy. Place all samples in formalin.

Dr. Smith's E-mail

Tulane Medical Center