I. Adequacy of renal biopsy specimens
For focal segmental glomerulosclerosis: lesions with diagnostic significance are more likely to be manifested in the paramedian glomeruli, and if the renal biopsy specimen is limited to the outer 2/3 of the renal cortex, it may not be representative even if it contains many glomeruli. Zou Hequn, Department of Nephrology, Third Affiliated Hospital of Southern Medical University
Second, false positive and false negative
1, defects of light microscopy: some lesions cannot be detected in light microscopy, so we do not advocate issuing pathology reports with only light microscopy without immunofluorescence and electron microscopy.
2, Immunopathology technology defects: Immature immunofluorescence technology often leads to errors in pathological diagnosis; Immunohistochemistry technology is easy to appear false positive background, often leading to errors in pathological diagnosis.
3, sectioning technology defects: immature sectioning technology, also often may lead to pathological diagnostic errors.
4, reading technology defects: immature reading technology, also often may lead to the pathological diagnosis of the error.
Third, the problem of specificity
In a kidney biopsy specimen, only few morphological types of kidney disease have characteristic, typical or prognostic judgment value. The same etiology and pathogenesis can cause different types of glomerular lesions, such as different types of lupus nephritis.
(A) Non-specific lesions
1. IgA-dominant immune deposition is not necessarily IgA nephropathy. It is common in China to discuss IgAN as a single disease, which causes confusion for many patients with complex diseases. In fact, IgAN can also be other diseases such as: hepatitis B kidney, HSP, vasculitis, MCD.
The pathological diagnosis of “acute intracapillary proliferative and exudative glomerulonephritis” is not the same as the clinical diagnosis of “post-streptococcal glomerulonephritis”. Even if the immunofluorescence and electron microscopic features are completely consistent with the lesions of post-streptococcal glomerulonephritis, it is not conclusive.
(B) Idiopathic and secondary
1. “Membranoproliferative glomerulonephritis” may be the result of the following diseases.
(1) idiopathic.
(2) Cryoglobulinemia,
(3) Systemic lupus erythematosus,
(4) Post-infectious glomerulonephritis,
(5) diabetic nephropathy.
2, “focal segmental glomerulosclerosis” may be the following diseases.
(1) a variety of glomerulonephritis
(2) Various tubulointerstitial nephritis
(3) systemic diseases
(4) transplantation nephropathy
Fourth, the scientific aspects of the pathology report
1. “Diffuse proliferative glomerulonephritis” may be the following diseases.
(1) APGN
(2) Lupus nephritis
(3) Primary IgA nephropathy
(4) Chronic active liver disease secondary to IgA nephropathy
2. “Mild thylakoid hyperplasia” may be the result of the following diseases.
(1) APGN recovery phase
(2) IgA nephropathy
(3) IgM nephropathy
(4) tubulointerstitial nephritis
(5) Systemic disease