This handbook provides a short, clear, useful and interesting guide to the findings in renal biopsy specimens. It is intended to be of practical help primarily to pathologists and trainee pathologists who look at these specimens, but also to nephrologists and transplant surgeons and their trainees, medical students, and others who have contact with anyone with renal disorders, including nurses on nephrology, dialysis and transplant units, and pharmacists.
This handbook shows how a diagnosis can be reached on a renal biopsy specimen and what information taken from a specimen is clinically significant and helpful. It shows how the diagnosis can be made starting from simple information, the clinical indication for biopsy, followed by interpretation of changes seen in the specimen. The emphasis is on common conditions and on the rule that diseases give characteristic clinical features.
Essential information needed for an understanding of renal disorders is given simply and concisely. This includes accounts of the clinical presentation of renal disorders, their causes and pathogenesis, and their likely outcome. Other features include practical tips on the differentiation between possible diagnoses and information about eponyms.
Author(s): Alec J. Howie
Edition: 2nd
Publisher: Springer
Year: 2007
Language: English
Commentary: 48518
Pages: 341
Tags: Медицинские дисциплины;Нефрология;
a.pdf......Page 1
front-matter.pdf......Page 2
Preface......Page 5
Contents......Page 7
Aims of the Book......Page 13
Introduction to Renal Disease from a Pathologist's Point of View......Page 14
Further Reading: Introduction......Page 15
Things to Remember About the General Rules......Page 16
Indications for Renal Biopsy......Page 17
Summary: General Points About Renal Biopsy Specimens......Page 20
Fixation and Processing of Specimens......Page 21
Arrangements for Electron Microscopy of Specimens......Page 24
Sectioning of Specimens......Page 25
Staining of Specimens......Page 26
Immunohistologic Study of Specimens......Page 27
Further Reading: Technical Handling of Renal Biopsy Specimens......Page 28
Immediate Study of Initial Sections......Page 29
Actions After Immediate Study of Initial Sections......Page 38
Summary: How to Look at a Renal Biopsy Specimen: Preliminary Study......Page 39
Initial Study of Tubules......Page 40
Assessment of Atrophy......Page 41
A Note on Hypertension and the Kidney......Page 44
Initial Study of Glomeruli: Glomerular Size......Page 47
Initial Study of Glomeruli: Distribution of Glomerular Abnormalities......Page 49
Initial Study of Interstitial Tissues......Page 53
Initial Study of Blood Vessels......Page 54
Summary: How to Look at a Renal Biopsy Specimen: Initial Study of the Kidney......Page 56
Further Reading: How to Look at a Renal Biopsy Specimen: Initial Study of the Kidney......Page 57
Introduction to the Nephrotic Syndrome......Page 58
Value of a Renal Biopsy in the Nephrotic Syndrome......Page 59
Approach to the Diagnosis in the Nephrotic Syndrome......Page 60
Initial Inspection of a Renal Biopsy Specimen in the Nephrotic Syndrome......Page 61
Diagnosis of Minimal Change Nephropathy......Page 64
Differential Diagnosis of Minimal Change Nephropathy......Page 65
Are Glomeruli Abnormal? Is There Membranous Nephropathy?......Page 66
Diagnosis of Membranous Nephropathy......Page 68
Differential Diagnosis of Membranous Nephropathy......Page 72
Are Glomeruli Abnormal? Is There a Segmental Sclerosing Disorder?......Page 74
Segmental Abnormalities at the Tubular Opening......Page 76
Segmental Abnormalities Not Only at the Tubular Opening......Page 83
Human Immunodeficiency Viral Infection and its Effects in the Kidney......Page 86
Diagnosis of Collapsing Glomerulopathy......Page 87
Other Findings in the Kidney in Human Immunodeficiency Viral Infection......Page 89
Is the Pathologist Told that the Person Biopsied Has Diabetes Mellitus? Is There Evidence of Diabetic Glomerulopathy?......Page 91
Value of Renal Biopsy in Diabetes Mellitus......Page 92
Diagnosis of Diabetic Glomerulopathy......Page 93
Differential Diagnosis of Diabetic Glomerulopathy......Page 97
Is the Pathologist Told that the Person Biopsied Has Systemic Lupus Erythematosus? Is There a Possibility of Lupus Nephritis?......Page 99
Value of Renal Biopsy in Systemic Lupus Erythematosus......Page 100
Diagnosis of Lupus Nephritis......Page 101
Classification of Lupus Nephritis......Page 104
International Society of Nephrology/Renal Pathology Society 2003 Classification......Page 107
Diagnosis of Amyloid......Page 113
Principles of Polarising Microscopy......Page 115
Determination of the Type of Amyloid......Page 121
Differential Diagnosis of Amyloid......Page 125
Acute Postinfective Glomerulonephritis......Page 127
Acute Postinfective Glomerulonephritis......Page 130
Other Findings in the Nephrotic Syndrome......Page 131
Further Reading: Nephrotic Syndrome......Page 145
Further Reading: Nephrotic Syndrome......Page 146
Introduction to Acute Renal Failure......Page 147
Value of a Renal Biopsy in Acute Renal Failure......Page 149
Acute Abnormalities in Tubules......Page 150
Is There Necrosis in the Kidney?......Page 153
Is There the Expected Number of Tubules in the Kidney?......Page 155
Common Findings in Renal Biopsy Specimens in Acute Renal Failure......Page 156
Is There Evidence of Renal Vasculitis?......Page 158
Diagnosis of Vasculitic Glomerulonephritis......Page 159
Clinical Conditions with Renal Vasculitis......Page 166
If There is Renal Vasculitis, Are There Clues to Recognisable Conditions?......Page 172
Conditions That Can be Differentiated from Pauci Immune Vasculitic Glomerulonephritis......Page 173
Conditions That Can be Differentiated from Pauci Immune Vasculitic Glomerulonephritis......Page 178
Conditions That Can be Differentiated from Pauci Immune Vasculitic Glomerulonephritis......Page 180
Diagnosis of Acute Postinfective Glomerulonephritis......Page 183
Diagnosis of Subendothelial Membranoproliferative Glomerulonephritis......Page 184
Has a Glomerular Disorder Been Excluded? Is There a Clue in Interstitial Tissues to the Cause of Acute Renal Failure?......Page 185
Diagnosis of Acute Interstitial Nephritis......Page 186
Causes and Associations of Acute Interstitial Nephritis......Page 189
Has a Glomerular Disorder Been Excluded? Is There a Clue in Tubules to the Cause of Acute Renal Failure?......Page 191
Findings in Tubules: Myeloma Kidney......Page 192
Findings in Tubules: Myoglobinuria or Crystals......Page 194
Has a Glomerular Disorder Been Excluded? Is There a Clue in Blood Vessels to the Cause of Acute Renal Failure?......Page 196
Changes in Blood Vessels: Vasculitis or Embolism......Page 197
Acute Renal Ischemia......Page 198
Diagnosis of Small Vessel Vasculopathy, also Called Thrombotic Microangiopathy......Page 200
Disorders Associated with Small Vessel Vasculopathy......Page 202
Further Reading: Acute Renal Failure......Page 208
Further Reading: Acute Renal Failure......Page 209
Introduction to Chronic Renal Failure......Page 210
Stages of Chronic Kidney Disease......Page 211
Causes of Chronic Renal Failure......Page 212
Findings in Renal Biopsy Specimens in Chronic Renal Failure......Page 213
Is There a Glomerular Disorder?......Page 214
Differentiation of Types of Segmental Sclerosing Glomerular Disorders......Page 216
Is There Evidence of Another Glomerular Disorder?......Page 221
Is There No Evidence of a Glomerular Disorder?......Page 222
Is There Evidence of Chronic Ischemic Damage?......Page 224
Is There Evidence of a Medullary Disorder......Page 226
Is There Evidence of a Medullary Disorder?......Page 227
Is There Evidence of a Cystic Disorder in the Cortex?......Page 230
Is There Evidence of a Tubular Disorder?......Page 232
Is There Evidence of an Interstitial Nephritis?......Page 236
Summary: Chronic Renal Failure......Page 238
Further Reading: Chronic Renal Failure......Page 239
Detection of Hematuria......Page 240
Value of a Renal Biopsy in Hematuria......Page 241
Approach to the Study of Renal Biopsy Specimens in Hematuria......Page 242
Initial Assessment of Orthodox Light Microscopic Sections......Page 243
Diagnosis of IgA Nephropathy......Page 244
Henoch-Schönlein Nephritis......Page 247
If IgA Nephropathy Has Been Excluded, Is There an Abnormality on Electron Microscopy?......Page 251
Diagnosis of Thin Glomerular Basement Membrane Disease......Page 252
Diagnosis of Hereditary Nephropathy of Alport Type......Page 253
Other Findings in Hematuria......Page 255
Further Reading: Hematuria......Page 257
Further Reading: Hematuria......Page 258
Types of Proteinuria......Page 259
Findings in Proteinuria......Page 260
Approach to Study of Renal Biopsy Specimens in Proteinuria......Page 261
Is There a Segmental Glomerular Disorder?......Page 262
Does the Request Form Give Information About a Systemic Disorder?......Page 263
Does the Specimen Appear Normal or Nearly Normal on Light Microscopy?......Page 264
The Unsatisfactory Nature of Terms......Page 265
Further Reading: Proteinuria......Page 267
Introduction to Renal Allograft Biopsy Specimens......Page 268
Reasons for Biopsy of an Allograft Other than Dysfunction......Page 269
Value of Biopsy of a Renal Allograft......Page 272
Approach to the Diagnosis in Renal Allograft Biopsy Specimens......Page 273
Antibody-mediated Rejection......Page 274
Conventional Acute Rejection......Page 276
Diagnosis of Acute Cellular Rejection, also Called Acute Tubulo-interstitial Rejection......Page 277
Diagnosis of Significant Acute Cellular Rejection......Page 279
Summary of Acute Rejection......Page 282
Is There Any Other Acute Abnormality Instead of Acute Rejection, or in Addition to It?......Page 283
Is There Evidence of Chronic Rejection?......Page 287
Differential Diagnosis of Late Damage in a Renal Allograft......Page 290
Is There a Glomerular Disorder?......Page 294
Is There Evidence of a Neoplastic Disorder, or Any Other Disorder?......Page 299
Summary: Renal Allografts......Page 300
Further Reading: Renal Allografts......Page 309
Investigation of Metabolic or Other Familial Disorders, and Disorders of Tubular Function......Page 310
Investigation of a Renal Mass......Page 311
Chance Finding of a Neoplasm in a Renal Biopsy Specimen......Page 313
Summary: Other Indications for Biopsy of Kidneys......Page 314
BookmarkTitle:......Page 320
Index......Page 321
