ABSTRACT
Renal biopsies are invaluable in the diagnosis and management of both adult and pediatric renal diseases and have become the gold standard in the detection and categorization of primary and secondary glomerular diseases. Renal biopsy interpretation is vitally important for the final diagnosis, to categorize and classify types of renal diseases, to assess the extent of their activity, severity and chronicity, and determine prognosis and response to treatment.
This book comprehensively documents the diagnostic features and current perspectives of rarer entities such as Renal-limited and systemic ANCA-mediated vasculitis, thrombotic microangiopathies, C3 glomerulopathy, paraproteinemias with organized glomerular immune deposits and HIV-associated nephropathy, IgG4 related nephritis and lupus nephritis. Biopsy interpretation of heredofamilial nephropathies and newer classifications in IgA nephropathy, diabetic nephropathy and transplant renal diseases have been elucidated.
The light microscopic, immunofluorescent and electron microscopic details in this book are intended to facilitate routine diagnostic reporting of renal biopsies by postgraduate residents, fellows and consultants, in the Departments of Pathology, Nephrology and Pediatric Nephrology.
Renal biopsies are invaluable in the diagnosis and management of both adult and pediatric renal diseases and have become the gold standard in the detection and categorization of primary and secondary glomerular diseases. The vast experience I have gained with God's guidance, from reporting renal biopsies for the Department of Pathology at the Christian Medical College (CMC) and Hospital, Vellore, from 1990 to the current date has yielded the skilled expertise required for their interpretation. The renal biopsy is vitally important for the final diagnosis, to categorize and classify types of renal diseases, to assess the extent of their activity, severity and chronicity, and determine prognosis and response to treatment.
The Christian Medical College at Vellore is a Tertiary Referral Medical Centre in South India. Therefore, renal biopsies from this institution, represent the types of renal disease prevalent in the Eastern, North Eastern and Southern states of India as well as neighboring countries and not exclusively from Vellore. Dr Anand Date pioneered renal biopsy reporting in India, and the Department of Pathology started its renal biopsy service over 4 decades ago. We currently report 2600 renal biopsies, each year, including renal transplant biopsies and referral biopsies.
A comparison of retrospective analysis of adult renal biopsies performed at CMC from 1986 to 2002 and an earlier cohort from 1971 to 1985, over 31 years, in the largest published Indian data1,2 has shown a statistically significant increase in the prevalence of focal segmental sclerosis, membranous and post infectious glomerulonephritis among the primary glomerular diseases. Minimal change disease predominated in biopsy proven pediatric renal disease, in another case series from CMC including children and adults,3 with an increase in IgA 2nephropathy, and a decreasing trend in the frequency of crescentic glomerulonephritis, membranoproliferative glomerulonephritis and focal proliferative glomerulonephritis. A decreasing trend was also reported in the occurrence of lupus nephritis, diabetic nephropathy, benign arteriolonephrosclerosis and amyloidosis among the systemic renal diseases in this series. The current prevalence and changing pattern of biopsy proven pediatric renal diseases in South Asia has been documented in a recent article from CMC.4
The present book aims to highlight the diagnostic features of renal diseases, including rarer entities such as Renal-limited and systemic ANCA-mediated vasculitis, thrombotic microangiopathies, C3 glomerulopathy, paraproteinemias with organized glomerular immune deposits and HIV-associated nephropathy. Biopsy interpretation of heredofamilial nephropathies with features of Alport's syndrome and lipid storage diseases, congenital nephrotic syndrome, podocytopathies and primary oxalosis have been elucidated. Diagnostic criteria for autoimmune diseases, such as subclasses of lupus nephritis and IgG4 sclerosing tubulointerstitial nephritis are detailed. Newer international classifications have been applied here that are useful to determine the predictive prognostic value of semi-quantitative scoring systems currently available for validation, of renal pauci-immune vasculitis, IgA nephropathy and diabetic nephropathy. The Banff diagnostic categories with current updates on acute and chronic antibody mediated rejection, scoring of T cell-mediated rejection and polyoma virus nephropathy in the allograft have also been comprehensively described in the interests of postgraduates.
The light microscopic, immunofluorescent and electron microscopic details in this book are intended to facilitate routine diagnostic reporting of renal biopsies by postgraduate residents, fellows and consultants in the Departments of Pathology, Nephrology and Pediatric Nephrology.
REFERENCES
- Narasimhan B, Chacko B, John GT, Korula A, Kirubakaran MG, Jacob CK. Characterization of kidney lesions in Indian adults: towards a renal biopsy registry. J Nephrol. 2006;19:205–10.
- Date A, Raghavan R, John TJ, Richard, Kirubakaran MG, Shastry JCM. Renal disease in adult Indians: a clinicopathological study of 2827 patients. Q J Med. 1987;64:729–37.
- Balakrisnan N, John GT, Korula A, Visalakshi J, Talauikar GS, Thomas PP, et al. Spectrum of biopsy proven renal disease and changing trends at a Tropical Tertiary Care Centre, 1990-2001. Indian J Nephrol. 2003;13;29–35.
- Mohapatra AM, Kakde S, Annapandian VM, Valson AT, Duhli N, Korula A, et al. Spectrum of biopsy proven renal disease in South Asian children: two decades at a tropical tertiary care centre. Nephrology (Carlton). 2017 August. Accepted for publication doi: 10.1111/nep.13160 (epub ahead of print).