Renal Pathology Consultation, Wet Tissue
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
The evaluation and management of patients with kidney disease
Following the progression of known renal disease and/or response to therapy
Determining the cause of dysfunction in the transplanted kidney (allograft)
Reflex Tests Lists test(s) that may or may not be performed, at an additional charge, depending on the result and interpretation of the initial test(s)
|Test ID||Reporting Name||Available Separately||Always Performed|
|4986||Renal Bx, Electron Microscopy||No||No|
|20500||RenalPath, Level IV, Wet Ts||No||No|
|9840||Periodic Acid-Schiff (PAS) ST||No||No|
|9828||Masson's Trichrome ST for Conn Ts||No||No|
|9889||Jones' Methenamine Silver ST||No||No|
|84226||Immunofluorescent C4d Stain||No||No|
|62196||RenalPath Consult, Outside Slide||No||No|
|62197||RenalPath Consult, w/Slide Prep||No||No|
|62198||RenalPath Consult, w/Comp Rvw of His||No||No|
|60301||IgA IF, Renal||No||No|
|60302||IgG IF, Renal||No||No|
|60303||IgM IF, Renal||No||No|
|60304||Lambda IF, Renal||No||No|
|60305||Kappa IF, Renal||No||No|
|60306||C1q IF, Renal||No||No|
|60307||C3 IF, Renal||No||No|
|60308||Albumin IF, Renal||No||No|
|60309||Fibrinogen IF, Renal||No||No|
|60328||IgG1 IF, Renal||No||No|
|60329||IgG2 IF, Renal||No||No|
|60330||IgG3 IF, Renal||No||No|
|60331||IgG4 IF, Renal||No||No|
|60285||C1q Paraffin IF, Renal||No||No|
|60287||IgA Paraffin IF, Renal||No||No|
|60288||IgG Paraffin IF, Renal||No||No|
|60289||IgM Paraffin IF, Renal||No||No|
|60290||Kappa Paraffin IF, Renal||No||No|
|60291||Lambda Paraffin IF, Renal||No||No|
Testing Algorithm Delineates situation(s) when tests are added to the initial order. This includes reflex and additional tests.
The Renal Pathology Consultation is performed by a Mayo Clinic renal pathologist and entails the performance of appropriate procedures and stains based on the material received, patient information and specific findings on the case in order to determine a diagnosis. Optimal/standard diagnostic interpretation of a medical kidney biopsy requires integration of the light microscopy, immunofluorescence, and electron microscopy findings together with the clinical and laboratory data for the patient. We follow published standards by the Renal Pathology Society (Chang, A., et al. Clin J American Society of Nephrology, 2012; 7:1365-1368) for the diagnostic evaluation and reporting of non-neoplastic renal disease.
Wet/unprocessed tissue submitted for light microscopy routinely includes the preparation of stains, which include hematoxylin and eosin (H and E), periodic acid Schiff (PAS), Masson trichrome, and Jones methenamine silver stains.
Wet/unprocessed tissue submitted for immunofluorescence may include the following stains in order to render an accurate diagnosis. These stains include: IgA, IgG, IgM, C1q, C3, albumin, fibrinogen, kappa light chain, and lambda light chain stains with C4d added if the biopsy is an allograft.
The IgG subtypes (IgG1, IgG2, IgG3, IgG4) are typically only utilized if the biopsy shows features suspicious for a monoclonal/monotypic deposition process involving IgG.
Paraffin-based Immunofluorescence Stains
The paraffin-based immunofluorescence stains listed above would only be utilized in the special circumstance when there is no tissue or inadequate tissue available for standard immunofluorescence.
Wet/unprocessed tissue submitted for electron microscopy will be processed for transmission electron microscopy. A formal interpretive report is issued, incorporating the findings from all tests performed for diagnostic purposes.
See Pathology Consultation Ordering Algorithm in Special Instructions.
Special Instructions and Forms Describes specimen collection and preparation information, test algorithms, and other information pertinent to test. Also includes pertinent information and consent forms to be used when requesting a particular test
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
RenalPath Consultation, Wet Tissue
Kidney Allograft Biopsy
Kidney Transplant Biopsy
Renal Allograft Biopsy
Renal Transplant Biopsy
Kidney Transplant Biopsy
Renal Allograft Biopsy
Renal Transplant Biopsy
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Container/Tube: Renal Biopsy Kit (Supply T231)
Specimen Volume: Entire specimen
Collection Instructions: Collect specimens according to the instructions in Renal Biopsy-Procedures of Handling Tissue for Light Microscopy, Immunohistology, and Electron Microscopy in Special Instructions.
1. Advise shipping specimens in Styrofoam transportation coolers to avoid extreme hot or cold temperatures to ensure specimens are received at required specimen stability temperature.
2. Attach the green pathology address label included in the kit to the outside of the transport container
Forms: Renal Biopsy Patient Information Sheet in Special Instructions
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
The Mayo Renal Pathology service is staffed by board-certified pathologists who have a special interest in nonneoplastic diseases of the kidney.
Kidney biopsy has proven to be of value in the clinical evaluation and management of patients with kidney disease, including acute and chronic renal insufficiency, nephrotic syndrome, nephritic syndrome, proteinuria and hematuria, and in the overall management of renal transplant recipients.
Optimal interpretation of a kidney biopsy requires integration of clinical and laboratory results with light microscopic, immunofluorescent histology, and electron microscopy findings.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
An interpretive report will be provided.
A verbal report of the findings is typically communicated by phone to the submitting nephrologist, and an initial report based on the light microscopic and immunofluorescent histology interpretation is also faxed to the nephrologist. A report is also sent to the submitting pathology laboratory.
Representative electron microscopy images and significant positive immunofluorescent stain findings can be provided on a CD upon request.
In most cases, the electron microscopy results are reported as an addendum and a final report is issued including these findings. This final report is again faxed to the submitting nephrologist and mailed to the submitting pathology laboratory, along with a representative set of the light microscopy slides.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Accurate and timely interpretation of a kidney biopsy requires integration of light microscopic, immunofluorescent histology, and electron microscopic findings with clinical and laboratory data. Failure to provide the relevant clinical history and laboratory results may result in a delay in the interpretation or the inability to adequately correlate the biopsy findings with the clinical picture.
Method Description Describes how the test is performed and provides a method-specific reference
The results of all testing will be provided in the context of the final pathology report.
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Monday through Friday
Rush (same day as receipt) interpretation is also available on Saturday and holidays for clinically emergent cases (eg, acute renal failure, rapidly progressive glomerulonephritis, acute kidney allograft dysfunction) but requires advanced notification and approval by a Mayo renal pathologist.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
4 working days (from receipt) for the light microscopy and immunofluorescence report. May take up to 25 days from receipt for the electron microscopy report.
Performing Laboratory Location The location of the laboratory that performs the test
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
88305-Surgical pathology, gross and microscopic examination (for kidney biopsy)
88313-Special stain, including interpretation and report, group II (x3 for PAS, Jones, and Trichrome)
88321-Consultation and report on referred slides prepared elsewhere (for review of sent in slides for light microscopy)
88323-Consultation and report on referred material requiring preparation of slides (for review of sent in slides for light microscopy with additional preparation of light microscopy slides)
88325-Consultation, comprehensive with review of records and specimens with report on referred material (for sent in slides for light microscopy with comprehensive review of clinical info, labs, etc.)
88346-Immunofluorescence study, each antibody, direct method (x9 for IgA, IgG, IgM, C1q, C3, albumin, fibrinogen, kappa light chain, and lambda light chain
88347-Immunofluorescence study, each antibody, indirect method (for the C4d immunofluorescence stain; transplant biopsies only)
88348-Electron microscopy, diagnostic
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
|Result ID||Reporting Name||LOINC Code|
|70068||Ref Path/Phys Address||In Process|
|70069||Final Diagnosis:||In Process|
|70071||Microscopic Description:||In Process|
|70076||Tissue Description:||In Process|
|70077||*Previous Report Follows*||N/A|