Test Catalog

Test Id : RPCWT

Renal Pathology Consultation, Wet Tissue

Useful For
Suggests clinical disorders or settings where the test may be helpful

Evaluating and managing patients with kidney disease

 

Following the progression of known renal disease or response to therapy

 

Determining the cause of dysfunction in the transplanted kidney (allograft)

Reflex Tests
Lists tests that may or may not be performed, at an additional charge, depending on the result and interpretation of the initial tests.

Test Id Reporting Name Available Separately Always Performed
LV4RP Level 4 Gross and Microscopic, RB No No
EMR EM, Renal Biopsy No No
SS2PC SpecStain, Grp II, other No No
IFPCI IF Initial No No
IFPCA IF Additional No No

Testing Algorithm
Delineates situations 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. Published standards by the Renal Pathology Society are followed for the diagnostic evaluation and reporting of non-neoplastic renal disease.(1)

 

Light Microscopy:

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.

 

Immunofluorescence:

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.

 

Alport (collagen IV, alpha 2 and alpha 5) staining is performed in the setting of biopsy findings that are consistent with hereditary nephritis/Alport syndrome.

 

Phospholipase A2 Receptor (PLA2R) staining is performed in the setting of membranous nephropathy/glomerulonephritis to aid in determining whether it is most likely primary/idiopathic or secondary. 

 

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 or if there are findings that raise concern for so-called "masked deposits"

 

Electron Microscopy:

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

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Method Name
A short description of the method used to perform the test

Pathology Consultation

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Renal Pathology

Aliases
Lists additional common names for a test, as an aid in searching

Kidney Allograft Biopsy

Kidney Biopsy

Kidney Transplant Biopsy

RBPC

Renal Allograft Biopsy

Renal Biopsy

Renal Transplant Biopsy

Native Kidney Biopsy

Testing Algorithm
Delineates situations 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. Published standards by the Renal Pathology Society are followed for the diagnostic evaluation and reporting of non-neoplastic renal disease.(1)

 

Light Microscopy:

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.

 

Immunofluorescence:

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.

 

Alport (collagen IV, alpha 2 and alpha 5) staining is performed in the setting of biopsy findings that are consistent with hereditary nephritis/Alport syndrome.

 

Phospholipase A2 Receptor (PLA2R) staining is performed in the setting of membranous nephropathy/glomerulonephritis to aid in determining whether it is most likely primary/idiopathic or secondary. 

 

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 or if there are findings that raise concern for so-called "masked deposits"

 

Electron Microscopy:

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

Specimen Type
Describes the specimen type validated for testing

Kidney Biopsy

Shipping 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.

Necessary Information

Note: Requisitions for this procedure cannot be processed unless the listed necessary information  is supplied.

1. All requisitions must be labeled with:

-Patient name

-Date of birth

-Medical record number

-Ordering physician

-Anatomic site

-Collection date

2. All specimens must be labeled with:

-Two patient identifiers (first and last name, date of birth or medical record number).

-Anatomic site

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Specimen Type: Tissue

Supplies: Renal Biopsy Kit (T231)

Source: Kidney

Specimen Volume: Entire specimen

Collection Instructions: Collect specimens according to the instructions in Renal Biopsy Procedures for Handling Tissue for Light Microscopy, Immunohistology, and Electron Microscopy

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Forms

1. Renal Biopsy Patient Information in Special Instructions

2. Renal Biopsy Procedures for Handling Tissue for Light Microscopy, Immunohistology, and Electron Microscopy

3. If not ordering electronically, complete, print, and send a Renal Diagnostics Test Request (T830) with the specimen.

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory

See Specimen Required

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Kidney Biopsy Ambient (preferred)
Refrigerated

Useful For
Suggests clinical disorders or settings where the test may be helpful

Evaluating and managing patients with kidney disease

 

Following the progression of known renal disease or response to therapy

 

Determining the cause of dysfunction in the transplanted kidney (allograft)

Testing Algorithm
Delineates situations 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. Published standards by the Renal Pathology Society are followed for the diagnostic evaluation and reporting of non-neoplastic renal disease.(1)

 

Light Microscopy:

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.

 

Immunofluorescence:

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.

 

Alport (collagen IV, alpha 2 and alpha 5) staining is performed in the setting of biopsy findings that are consistent with hereditary nephritis/Alport syndrome.

 

Phospholipase A2 Receptor (PLA2R) staining is performed in the setting of membranous nephropathy/glomerulonephritis to aid in determining whether it is most likely primary/idiopathic or secondary. 

 

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 or if there are findings that raise concern for so-called "masked deposits"

 

Electron Microscopy:

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

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 non-neoplastic 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.

Interpretation
Provides information to assist in interpretation of the test results

Both a verbal report and a faxed report are provided to nephrologists for Mayo Clinic Laboratories cases.

 

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.

Clinical Reference
Recommendations for in-depth reading of a clinical nature

1. Chang A, Gibson IW, Cohen AH, et al: A position paper on standardizing the nonneoplastic kidney biopsy report. Clin J Am Soc Nephrol 2012;7:1365-1368

2. Heptinstall RH: Heptinstall's Pathology of the Kidney. Edited by JC Jennette. Lippincott Williams and Wilkins, 2007

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Method Description
Describes how the test is performed and provides a method-specific reference

Gross and microscopic examination of tissue. Ancillary testing is ordered at the discretion of the Mayo pathologist. The results of all testing will be provided in the context of the final pathology report.(Unpublished Mayo method)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday through Friday

Rush (same day as receipt) interpretation is 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.

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

2 to 10 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

Dependent on sample type

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their Regional Manager. For assistance, contact Customer Service.

Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

Not Applicable

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 Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

88305 (If appropriate)

88348 (If appropriate)

88313 (If appropriate)

88346 (If appropriate)

88350 (If appropriate)

 

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports