TOPICS IN RENAL BIOPSY AND PATHOLOGY Edited by Muhammed Mubarak and Javed I. Kazi Topics in Renal Biopsy and Pathology Edited by Muhammed Mubarak and Javed I. Kazi Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Adriana Pecar Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published April, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechopen.com Topics in Renal Biopsy and Pathology, Edited by Muhammed Mubarak and Javed I. Kazi p. cm. ISBN 978-953-51-0477-3 Contents Preface IX Part 1 Biopsy Methods 1 Chapter 1 Percutaneous Renal Biopsy 3 Louis-Philippe Laurin, Alain Bonnardeaux, Michel Dubé and Martine Leblanc Chapter 2 Renal Biopsy in the Pediatric Patient 17 Isa F. Ashoor, Deborah R. Stein and Michael J. G. Somers Chapter 3 Skin Biopsy as Alternative for Renal Biopsy in Acute Renal Failure and Suspected Cholesterol Emboli Syndrome 35 Martijn B. A. van Doorn and Tijmen J. Stoof Part 2 Biopsy Handling, Processing and Pathologic Interpretation 43 Chapter 4 Renal Biopsy Interpretation 45 Sakineh Amoueian and Armin Attaranzadeh Chapter 5 Diagnostic Algorithms in Renal Biopsy Interpretation Along with Case Samples 65 Şafak Güçer Part 3 Glomerular Diseases 91 Chapter 6 The Many Faces of Thin Basement Membrane Nephropathy; A Population Based Study 93 Kyriacos Kyriacou, Marianna Nearchou, Ioanna Zouvani, Christina Flouri, Maria Loizidou, Michael Hadjigavriel, Andreas Hadjisavvas and Kyriacos Ioannou Chapter 7 Update on IgM Nephropathy 115 Javed I. Kazi and Muhammed Mubarak VI Contents Chapter 8 Recent Developments in the Pathogenesis and the Pathological Classification of IgA Nephropathy 123 Muhammed Mubarak and Javed I. Kazi Chapter 9 Collapsing Glomerulopathy: The Expanding Etiologic Spectrum of a Shrinking Glomerular Lesion 139 Muhammed Mubarak and Javed I. Kazi Part 4 Renal Transplant Pathology 157 Chapter 10 Pathology of Renal Transplantation 159 Javed I. Kazi and Muhammed Mubarak Part 5 Pathophysiology and Renal Diseases 181 Chapter 11 Acute Kidney Injury (AKI) and Management of Renal Tumors 183 Yoshio Shimizu and Yasuhiko Tomino Chapter 12 Chronic Kidney Disease Update 197 Waqar H. Kazmi and Khurram Danial Chapter 13 Acute Renal Cortical Necrosis 259 Manohar Lal Chapter 14 Pathophysiological Approach to Acid Base Disorders 267 Absar Ali Preface We the editors, Drs. M. Mubarak and Javed I. Kazi, dedicate this book to our mentor, Professor Adeeb Rizvi, for his untiring efforts in creating a state of the art treatment facility in nephrology, urology, and transplantation, completely free for the poorest of the poor people of the third world, and having faith in us for establishing and running the renal and transplant pathology services at the SIUT. Richard Glassock has written so vividly in his foreword to a related book in nephrology by the InTech open access publishers entitled “An update on glomerulopathies-Clinical and treatment aspects” that “The study of the fundamental and clinical aspects of glomerular disease has expanded exponentially over the last several decades.” Undoubtedly, the major contribution to this exponential expansion of the knowledge of the kidney diseases has come from the systematic study of the renal biopsies. Renal biopsy is an important diagnostic and prognostic procedure that is widely used in the nephrology practice throughout the world these days. Percutaneous renal biopsy is the method of choice for the tissue diagnosis of the medical disorders of kidney, but a number of other approaches are also used in selected cases. Its indications are well established, but in practice vary considerably from center to center. In fact, as alluded to in the beginning of this preface, the systematic study of renal biopsy has revolutionized the understanding of renal pathology during the early phases of the disease evolution. Prior to the widespread use of percutaneous renal biopsy, the study of renal diseases was limited to the autopsy material, which revealed the advanced changes of end-stage renal disease with often no clue about the primary pathologic process. Moreover, renal biopsy also provided a useful raw material for the widespread application of two new techniques of pathological study, i.e., the Immunohistochemistry and the electron microscopic study in the 1960s and early 1970s. At the same time, the procedure is invasive and not entirely without risks. The later, however, have been dramatically reduced with the modern techniques available to the renal physician during the performance of renal biopsy. After procurement of renal tissue, its proper handling and processing require the highest standard of laboratory practice for an accurate pathological evaluation of the obtained material. The pathologic evaluation of renal biopsy is an integrated process, which requires not only an experienced pathologist but also input from the immunology, serology, immunoflourescene, and electron microscopy studies, and the nephrologists to arrive at a correct diagnosis. X Preface There is no dearth of high-quality books on renal biopsy and pathology in the market. These are either single author or multi-author books, written by world authorities in their respective areas, mostly from the developed world. The vast scholarly potential of authors in the developing countries remains underutilized. Most of the books share the classical monotony of the topics or subjects covered in the book. The current book is a unique adventure in that it bears a truly international outlook and incorporates a variety of topics, which make the book a very interesting project. The authors of the present book hail not only from the developed world, but also many developing countries. The authors belong not only to US but also to Europe as well as to Pakistan and Japan. The scientific content of the book is equally varied, spanning the spectrum of technical issues of biopsy procurement, to pathological examination, to individual disease entities, renal graft pathology, pathophysiology of renal disorders, to practice guidelines. The book has fourteen chapters that have conveniently been divided into five sections to encompass the variety of topics. Section one of the book has three chapters which describe the historical background and the methodology of renal biopsy procedure, its indications, procurement, complications, and handling of the tissue after biopsy procurement in detail. Renal biopsy in children is also being increasingly used throughout the world and there is a full chapter devoted to renal biopsy procedure in the pediatric population. A report describing an interesting alternative to the renal biopsy for the diagnosis of kidney disease, i.e., skin biopsy, has also been included in section one of the book. Section two has two chapters, one of which describes the post-biopsy handling and processing of the procured renal biopsy tissue for an optimal pathological evaluation. It also describes the normal microstructure of the kidney parenchyma to serve as a foundation for subsequent chapter on the pathological interpretation of the renal biopsy material. The later chapter describes an elegant algorithmic approach to the systematic study of renal biopsy tissue by the pathologists. Section three has four chapters; one chapter each devoted to recent updates on different aspects of some common medical disorders of the kidney which are at the forefront of renal research at present. These include; collapsing focal segmental glomerulosclerosis, IgA nephropathy, IgM nephropathy, and thin glomerular basement membrane disease. Section four contains one chapter, which describes in detail the pathological approach to the systematic evaluation of renal allograft pathology. The chapter is also supported by high quality images, which will facilitate a clear understanding of the increasingly complicated topic of transplant pathology. The final section describes the pathophysiology of renal diseases. It includes; acute kidney injury complicating neoplasms, acute renal cortical necrosis, an update on . TOPICS IN RENAL BIOPSY AND PATHOLOGY Edited by Muhammed Mubarak and Javed I. Kazi Topics in Renal Biopsy and Pathology Edited by Muhammed Mubarak and Javed I. Kazi . of renal biopsy procedure, its indications, procurement, complications, and handling of the tissue after biopsy procurement in detail. Renal biopsy in children is also being increasingly used. synchronization between respiratory movements and needle insertion, thereby minimizing risks of complications. 3.2 Relative contraindications Relative contraindications consist in conditions that may be