Renal Path Review 1

Question 1

indications for renal biopsy

Answer 1

*isolated glomerular hematuria with proteinuria or renal insufficiency
*isolated non-nephrotic proteinuria (<2g/day)
*nephrotic syndrome
*acute nephritic syndrome
*unexplained acute or subacute renal failure

Question 2

contraindications for renal biopsy

Answer 2

*uncorrectable bleeding diathesis
*small kidneys, indicative of chronic damage
*severe hypertension
*multiple bilateral cysts
*hydronephrosis
*active renal/perirenal infection
*uncooperative patient

Question 3

acute tubular injury - biopsy findings

Answer 3

*loss of brush border
*large lumens
*tubule simplification
*peritubular (interstitial) edema

note - ATI can be due to ischemia or toxins

Question 4

membranous nephropathy - biopsy findings

Answer 4

*light microscopy: diffuse capillary and GBM thickening, “spike and dome” appearance

*immunofluorescence: GRANULAR capillary wall IgG staining (due to immune complex deposition, subepithelial)

*electron microscopy: subepithelial granular electron-dense deposits, separated by basement membrane spikes