Curriculum‎ > ‎Electives‎ > ‎

Renal Pathology

Created By:     James Pullman, MD, PhD, and Daniel Schwartz, MD

                        Department of Pathology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY

Contact:          Zudith Lopez 

Approximately 630 native and transplant renal biopsies per year are received from MMC, affiliated hospitals and outreach facilities, such as the North Shore-LIJ system.  Residents will learn the basics of renal histology and pathobiology, and will be involved in the light, immunofluorescence, and electron microscopic diagnosis of each biopsy, and specimen processing. When appropriate, transplant and inflammatory/immune pathology in biopsies from other organ systems such as the heart will be reviewed to contrast and compare with renal pathology. In addition, teaching sets, archival material, and appropriate literature are available for resident review.  The resident will be encouraged to present at least one case in a clinical-pathology renal conference, particularly for 4 week rotations.   Conferences include Nephrology Grand Rounds, Renal Fellow Teaching Rounds, Nephrology Service Rounds (Moses and Weiler), Pediatric Nephrology working Rounds, Transplantation Rounds, and occasionally Rheumatology and Gerontology Rounds.

The ideal rotation length is 4 weeks, but a two week or even a one week rotation can provide a meaningful learning experience.

The teaching syllabus is outlined below. Note that the order of topics may change as a function of incoming biopsy material. 

             A.    Introduction to Renal Pathology

                                                1.      kidney structure, function and their clinical correlations

                                                2.      Renal disease based on  nephron substructures

                                                3.      Looking at renal biopsies: how to identify basic structures

                                                4.      causes of renal disease and their appearance on microscopy

a.       immune

b.      inflammatory

c.       ischemic

d.      toxic-metabolic

e.       hereditary

                                                5.      Identifying abnormalities

B.     Diseases of native kidneys

                                                1.      Common diseases: hypertension, diabetes

                                                2.      glomerular diseases, with clinical correlations

a.       nephrotic-children vs adults

i.        the role of EM in identification of podocyte injury

b.      nephritic-different types of immune complex diseases

i.        the role of immunofluorescence microscopy in identification of immune complexes

                                                3.      Vascular diseases

a.       Thrombotic diseases

b.      Inflammatory/immune diseases (vasculitis)

c.       Metabolic diseases (see B.1 above)

                                                4.      tubulo-interstitial diseases

a.       infectious (pyelonephritis)

b.      inflammatory/immune diseases (allergic interstitial nephritis)

c.       toxic and metabolic diseases

d.      ischemic disease

                                                5.      Hereditary diseases

C.     Diseases of Transplanted kidneys

                                                1.      The Banff classification

                                                2.      Rejection-acute and chronic

a.       T-cell mediated

b.      Antibody mediated

                                                3.      Acute tubular injury

                                                4.      Infections-viral and bacterial

a.       Polyoma virus (BK)

b.      pyelonephritis

                                                5.      drug toxicity

a.       CNI

b.      Antibiotic (allergic interstitial nephritis)

c.       Others

                                                6.      Non-specific chronic changes (IFTA)