RENAL PATHOLOGY

Supervisor:

Donald C. Houghton, MD

Location:

OHSU

Duration:

At least one month

Organization and Responsibilities:
The rotation is centered on patient care activities of the renal biopsy service. The resident receives and reviews all renal biopsy cases, including immunofluorescence microscopy and electron microscopy, in most cases, prior to staff. The roles of the resident include:

• Responsibility for the management of the orderly work-up and evaluation of cases, under the supervision of the staff pathologist.
• Responsibility for the gathering of clinical information about the patient's conditions in consultation with referring physicians and by using on-line resources.
• Analysis of the findings in each case, using standard references, the literature, consultation with peers and faculty and on-line resources, as needed.
• Develop and manage any plan for further or detailed evaluation of the pathology cases under the supervision of the staff pathologist.
• Prepare materials of selected cases for addition to the renal biopsy teaching set.

1. Patient care:
   • Attend at least three pediatric and/or adult renal biopsy procedures and participate in the assessment of the sample adequacy and division of the tissue for the indicated testing.
2. Medical knowledge. Demonstrate:
   • The ability to conduct a systematic evaluation of the gross and histological features of the kidney and classify the abnormalities.
   • Use of standard terms to describe the nature, site and distribution of lesions in the kidney.
   • Ability to recognize the light, immunofluorescence and electron microscopic findings in the principal patterns of glomerular injury
   • Understanding of the principal implications of immunofluorescence microscopy findings in necrotizing and crescentic glomerulonephritis
   • Ability to recognize the characteristic vascular lesions of kidney.
   • Ability to recognize principal histological patterns of renal tubulo-interstitial diseases
   • Ability to identify the principal renal injury patterns associated with acute renal failure
   • Knowledge of the principal renal findings in systemic diseases
   • Ability to recognize the acute and progressive lesions in the renal allograft associated with allo-immune injury and calcineurin-inhibitor toxicity
3. Practice-based learning and improvement. Demonstrate:
   • Ability to gather and synthesize all appropriate and available clinical information necessary to interpret the renal biopsy using resources that include the clinical care team and the electronic clinical record
   • Facility in the use of standard reference sources in renal pathology, including texts, journals and electronic media
   • Knowledge of the principal indications for renal biopsy, and the corresponding differential diagnosis
   • Knowledge of the clinical settings of the principal primary and secondary glomerular diseases
4. Interpersonal and communication skills. Demonstrate:
   • The ability to write a concise and accurate description of the gross and histologic findings in the kidney.
   • The ability to present cases to the clinical services in a conference setting and at the multi-headed microscope.
5. Professionalism:
   • Maintains a respectful and productive relationship with peers, faculty support personnel and clinical team members at the medical center
6. Systems-based practice. Demonstrate:
   • Use of a systematic approach to sampling and sectioning a kidney biopsy consistent with diagnostic conventions, which is both economical (cost effective) and adequate to address the clinical questions.

Resources:
Current renal pathology reference texts, a study set of renal biopsy cases, all past renal pathology cases, a photographic study set of renal pathology, access to all major electronic medical journals and to the Renal Pathology Society web site.

Supervision:
All renal cases are reviewed with staff during the work-up of the case and all reports are reviewed and released by the attending pathologist. A goal of the experience is to give the resident increasing independent responsibility for presenting cases in conferences and communication with the referring physicians.

Evaluation:
The resident is evaluated at the end of the rotation according to the criteria listed in the Department's resident evaluation forum. The results of the evaluation are discussed with the resident prior to adding them to the resident file.

Reading:
Renal Biopsy Interpretation, edited by Silva, D'Agati and Nadasdy

Biopsy Pathology: The renal Biopsy, 3rd Ed, by Striker, Olson and Striker (Saunders). A short, concise reference.

Heptinstall's Pathology of the Kidney

Tisher and Brenner's Renal Pathology.


Surgical Pathology: Rosai and/or Sternberg chapters

Hill's Uropathology