Residency & Fellowship Programs: AP Rotations

Renal Pathology

ABOUT RENAL PATHOLOGY:
Cytogenetics Laboratory Director:


Genetics Diagnostic Laboratory Co-Director:


Cytogenetics Laboratory Location:



Recommended Rotation Length:
 

Core Competencies Linked to the Goals and Objectives of the rotation

Diagnostic and patient care activities:

  1. Familiarize yourself with the most common diagnostic entities encountered in renal pathology
    1. For first-time rotators: become familiar with the clinical and pathologic features of the most commonly encountered renal disorders including: minimal change disease, FSGS, membranous glomerlopathy, IgA nephropathy, membranoproliferative glomerulonephritis, acute postinfectious glomerulonephritis, lupus nephritis, anti-GBM nephritis, ANCA-associated GN, hypertensive nephrosclerosis, diabetic nephropathy, and transplant pathology (acute cellular rejection, antibody-mediated rejection, chronic rejection, infection, and medication toxicity).
    2. For advanced rotators: Review the most common diagnostic entities (listed above) in-depth and expand your diagnostic knowledge to include rare disease categories such as paraproteinemias and hereditary nephropathies.
  2. Light microscopy in renal pathology:
    1. First-time rotators: Become familiar with the staining panel used in renal biopsy interpretation (H&E, PAS, Trichrome and JMS). Understand the diagnostic features that each of these stains can highlight and how to integrate the findings to come to a diagnosis or create a differential diagnosis.
    2. Advanced rotators: Review the diagnostic features highlighted by each special stain used in renal pathology. Learn to integrate findings on light microscopy with those on immunofluorescence and electron microscopy.
  3. Gain experience with immunofluorescence (IF) microscopy:
    1. First-time rotators: review interesting IF cases with the attendings or the renal pathology fellow. Gain an appreciation for expected levels of background staining. Understand the scoring system used to quantify positive staining. Learn the expected IF staining patterns of the most common diseases encountered.
    2. Advanced rotators: Review IF cases on your own before sign-out and compare your interpretation with that of the attending signing out the case.  Use the IF findings to form a differential diagnosis for each case you review.
  4. Review electron micrographs:
    1. First-time rotators: Become familiar with the basic ultrastructural features of the glomerular, tubulointerstitial and vascular compartments of the kidney.  Review classic EM findings such as those in minimal change disease, membranous glomerulopathy, lupus and others.  Classic cases can be found in the renal biopsy teaching set, complete with corresponding light and immunofluorescence microscopy.
    2. Advanced rotators: Continue to work through the teaching set to become familiar with EM findings. Review, and if possible, help write EM reports for current cases.
  5. Integrating clinical information:
    1. First-time rotators: Appreciate the important role that clinical information plays in the interpretation of renal biopsies.  Learn to use basic clinical information to create a basic differential diagnosis before looking at biopsy specimens.
    2. Advanced rotators: Review clinical information for cases prior to sign-out and formulate a differential diagnosis for each case.  When clinical information is lacking, determine what pieces of additional clinical information are needed to make a definitive biopsy diagnosis. If the patient is in-house, try to obtain this information.

Interpersonal and Communication Skills:

Obtaining clinical information and providing clinical results:

  1. First-time rotators: Observe interactions (usually over the phone) between the renal pathologist and nephrologist. Appreciate the critical role that accurate and effective communication of clinical information and biopsy results plays in patient care. When possible, help obtain clinical information on in-house biopsy cases and serve as a liaison to the plasmapheresis team for in-house patients who are getting apheresis.
  2. Advanced rotators: Continue in role as above. Present interesting renal biopsy cases at clinical conferences(Blue Tray or the renal biopsy conference).

Medical knowledge and its application:

Renal physiology:

  1. First-time rotators: Review the most commonly provided laboratory values important to the interpretation of the renal biopsy and understand the physiologic basis of each value. Understand the physiologic differences among broad categories of renal diseases (i.e. podocytopathies vs. diseases of the tubulointerstitium or vascular compartments) and how these differences are reflected in the laboratory work-up of the patient and in the biopsy findings.
  2. Advanced rotators: Gain a more in depth understanding of the clinical nephrology in the most common renal biopsy diagnoses.  Read current literature to gain a more in depth understanding of renal disease mechanisms.

System-Based Practice

  1. Integrate clinical information, light microscopy, IF and EM:
    1. First-time rotators: Review clinical information, light, IF and EM findings with attendings and understand how each piece of information is used in coming up with a unified diagnosis.
    2. Advanced rotators: Preview clinical information and slides for cases.  Formulate a unifying diagnosis based on the clinical information and various diagnostic modalities.
  2. Triaging specimens:
    1. First-time rotators: Understand the limits of individual techniques (LM, IF and EM) and how this influences the triaging of limited specimens.  Become familiar with salvage techniques (such as pronase-IF) and how/when they are used.
    2. Advanced rotators: Take and active role in the triaging of fresh specimens that arrive in the renal biopsy laboratory.  Gain a solid understanding of which diagnostic modalities are applied in various clinical circumstances to maximize diagnostic utility of tissue and improve cost-effectiveness.

Professionalism:

  1. Sign-out:
    1. First-time rotators: Reliably attend sign-out with one of the attendings. Rotate among attendings to gain an appreciation of different sign-out styles.
    2. Advanced rotators: Sign out with attendings (as above). Take a more active role in gathering information related to cases and integrating clinical information with pathologic findings.
  2. Protecting patient confidentiality:
    • First-time rotators/Advanced rotators: Be sure to protect confidential patient information when discussing cases or presenting at conferences.

Practice-based learning and improvement:

Evaluate your diagnostic ability:

  1. First-time rotators: By the end of the rotation you should be comfortable using clinical information to create a basic differential diagnosis and then progressively narrowing the differential using light microscopy, IF and if needed, EM.  Use the teaching set to test yourself throughout the elective.
  2. Advanced rotators: Preview cases (when possible) prior to discussing them with attendings to gauge your progress in integrating the clinical information from each case and the light, IF and EM findings.  Continue using the teaching set to test your abilities.

 

 
 
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