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22857 Renal Biopsy

Renal Biopsy
Test Code: HMISC
Synonyms/Keywords
​Histology, Immunofluorescence Antibodies, Kidney, Direct FA Renal Biopsy, DIF, IF, Surgical Pathology
Test Components

Surgical Pathology, Gross and Microscopic Examination H&E Surgical Pathology, Gross and Microscopic Examination H&E (G&M)

Special Stains – PAS, Masson Trichrome, Jones, and Congo Red

2. Electron Microscopy (EM)

3. Direct Immunofluorescence (DIF) - IgA IF, IgG IF, IgM IF, C3 IF, Fibrinogen IF, C1q IF, Kappa IF, and Lambda IF.

Useful For
​The evaluation and diagnosis of kidney disease, including ultrastructure examination.
To evaluate the outcome of the disease
To evaluate the efficacy of treatment
Specimen Requirements
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
​Tissue - Renal Cortex (G&M) See Collection Processing Instructions​ ​Leak proof vial 2 cores (each 1-2 cm in length) needle biopsy ​ ​
​Tissue-Renal Cortex (EM) ​12.0 mL Glass Vial with Electron Microscopy Fixative (2.5% Glutaraldehyde) ​Small, leak proof rigid container

​Optimum size of tissue pieces:
2 x 2 x 1 mm

 ​One piece of tissue ​One piece of tissue
​Tissue - Renal Cortex (DIF) ​See Collection Processing Instructions ​Leak proof vial ​1-2 mm thick portions of a needle biopsy ​ ​
Collection Processing Instructions

Surgical Pathology, Gross and Micro (Light Microscopy) must be ordered along with Electron Microscopy and Direct Immunofluorescence, all of which will be charged separately.

Marshfield Center: Place fresh specimen in a petri dish with biopsy on gauze moistened with saline and hand delivered to the histology lab.

Other Testing Locations: Samples should be placed into the respective vials of fixative/preservative as soon as possible to limit drying and fixation artifacts. Renal kits can be ordered from Marshfield Labs.
Supplies included in these kits are:
1. A vial of 10% neutral buffered formalin for Gross & Micro, Light Microscopy (LM).
 2. A vial of Zeus tissue fixative (or Michel’s) for Immunofluorescence (IF), If Zeus is not available, call the lab for instructions on possible specimen freezing and shipping. The fresh biopsy should be placed in a vial of Zeus transport media (or Michel’s) immediately upon excision. Be certain that the tissue is immersed in the media and not stuck to the edge of the vial or snap cap before tightly replacing the cap.
3. A vial of 2.5% buffered glutaraldehyde for electron microscopy (EM). Specimens must be 1.0 mm or less in one dimension to insure proper penetration of the fixative before autolysis occurs. Tissue must be placed into fixative within one-half hour of removal from patient.
Do not freeze any of these specimens at any time.
Label specimens with patient name, date of birth, and fixative type. Submit completed histology requisition containing patient history, clinical and relevant laboratory test information, requesting physician, collection date, and tissue source, must accompany the specimen. Electronic orders are acceptable, but a hard copy must be sent with the specimen.

Acceptable Body Sites
​Renal
Acceptable Specimen Types
Tissue
Specimen Stability Information
Specimen Type Temperature Time
Renal Biopsy or Wedge Tissue (G&M) ​ ​Room Temperature/Ambient ​Follow fixative expiration date
Renal Biopsy or Wedge Tissue (EM) ​ Store fixative refrigerated until ready to use.  Once specimen is added, store and ship at room temperature/Ambient Follow fixative expiration date or six months, whichever is earliest.
Renal Biopsy or Wedge Tissue (Zeus Transport Media) ​ ​Room temperature/Ambient ​A low frequency of false negative results may occur if tissues are stored in Zeus media for periods longer than 5 days.
Interference

1. EM - Handling that will interfere with results include:
    a. Tissue placed in formalin fixative 
    b. Frozen or yellowed glutaraldehyde fixative that has degraded and will not preserve the tissue adequately. 
        Please order fresh fixative and keep refrigerated until ready to use.
    c. Tissues removed from the patient more than one hour before being placed in the fixative 
    d. Samples that have become dried out before being placed in the fixative d. Samples that have become   dried out before being placed in the fixative
2. Immunofluorescence – Tissues transported in expired, cloudy, crystalline, or frozen Zeus transport media or tissue that has been frozen and thawed may interfere with results.

Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Marshfield ​Monday through Friday ​2 days G&M, Paraffin Embedded
​Marshfield ​Monday through Friday ​3 days ​Hitachi 7700 Transmission electron Microscope
​Marshfield ​Monday through Friday ​2 days ​DIF
Test Information

This test was developed and its performance characteristics determined by Marshfield Labs.  It has not been cleared or approved by the US Food and Drug Administration.  This test is used for clinical purposes.  It should not be regarded as investigational or for research.

Reference Range Information
Performing Location Reference Range
​Marshfield ​Interpretative Report
Interpretation
A formal interpretive surgical pathology report is issued, incorporating the findings from all tests performed, including patients clinical and laboratory data, for diagnostic purposes. The results include diagnosis, descriptor, and interpretation of staining patterns. Studies submitted for complete examination include Light Microscopy, Electron Microscopy, and Immunofluorescence.
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​88348 ​ ​1 Surgical Pathology, Electron Microscopy, Diagnostic
88305 ​ 1 Surgical Pathology, Gross and Microscopic Examination, Level IV - Level of complexity (Level I through VI, as defined by CPT code book) is determined during examination ​Includes H&E stain
88346​ ​ ​1 Immunofluorescent (DIF) Antibody IgA (IVD) ​First stain
​88350 ​ ​1 ​Additional (DIF) Antibody IgG (IVD) ​All other stains or same specimen
​88350 ​ ​1 ​Additional (DIF) Antibody IgM (IVD) ​
​88350 ​ ​1 ​Additional (DIF) Antibody IC3 (IVD) ​
​88350 ​ ​1 ​Additional (DIF) Antibody Fibrinogen (IVD) ​
​88350 ​​ ​1 ​Additional (DIF) Antibody C1q (IVD) ​
​88350 ​ ​1 ​Additional (DIF) Antibody Kappa (ASR) ​
​88350 ​ ​1 ​Additional (DIF) Antibody Lambda (ASR) ​
​88313 ​ ​1 ​Special Stain - PAS (3) ​
​88313 ​ ​1 ​Special Stain - Masson Trichrome (1) ​
​88313 ​ ​1 ​Special Stain - Jones (2) ​
​88313 ​ ​1 ​Special Stain - Congo Red (1) Usually not performed on patients younger than 15 years and younger
Classification

This test was developed and its performance characteristics determined by Marshfield Labs.  It has not been cleared or approved by the US Food and Drug Administration.  This test is used for clinical purposes.  It should not be regarded as investigational or for research.

Synonyms/Keywords
​Histology, Immunofluorescence Antibodies, Kidney, Direct FA Renal Biopsy, DIF, IF, Surgical Pathology
Test Components

Surgical Pathology, Gross and Microscopic Examination H&E Surgical Pathology, Gross and Microscopic Examination H&E (G&M)

Special Stains – PAS, Masson Trichrome, Jones, and Congo Red

2. Electron Microscopy (EM)

3. Direct Immunofluorescence (DIF) - IgA IF, IgG IF, IgM IF, C3 IF, Fibrinogen IF, C1q IF, Kappa IF, and Lambda IF.

Ordering Applications
Ordering Application Description
​All ​Renal Biopsy
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
​Tissue - Renal Cortex (G&M) See Collection Processing Instructions​ ​Leak proof vial 2 cores (each 1-2 cm in length) needle biopsy ​ ​
​Tissue-Renal Cortex (EM) ​12.0 mL Glass Vial with Electron Microscopy Fixative (2.5% Glutaraldehyde) ​Small, leak proof rigid container

​Optimum size of tissue pieces:
2 x 2 x 1 mm

 ​One piece of tissue ​One piece of tissue
​Tissue - Renal Cortex (DIF) ​See Collection Processing Instructions ​Leak proof vial ​1-2 mm thick portions of a needle biopsy ​ ​
Collection Processing

Surgical Pathology, Gross and Micro (Light Microscopy) must be ordered along with Electron Microscopy and Direct Immunofluorescence, all of which will be charged separately.

Marshfield Center: Place fresh specimen in a petri dish with biopsy on gauze moistened with saline and hand delivered to the histology lab.

Other Testing Locations: Samples should be placed into the respective vials of fixative/preservative as soon as possible to limit drying and fixation artifacts. Renal kits can be ordered from Marshfield Labs.
Supplies included in these kits are:
1. A vial of 10% neutral buffered formalin for Gross & Micro, Light Microscopy (LM).
 2. A vial of Zeus tissue fixative (or Michel’s) for Immunofluorescence (IF), If Zeus is not available, call the lab for instructions on possible specimen freezing and shipping. The fresh biopsy should be placed in a vial of Zeus transport media (or Michel’s) immediately upon excision. Be certain that the tissue is immersed in the media and not stuck to the edge of the vial or snap cap before tightly replacing the cap.
3. A vial of 2.5% buffered glutaraldehyde for electron microscopy (EM). Specimens must be 1.0 mm or less in one dimension to insure proper penetration of the fixative before autolysis occurs. Tissue must be placed into fixative within one-half hour of removal from patient.
Do not freeze any of these specimens at any time.
Label specimens with patient name, date of birth, and fixative type. Submit completed histology requisition containing patient history, clinical and relevant laboratory test information, requesting physician, collection date, and tissue source, must accompany the specimen. Electronic orders are acceptable, but a hard copy must be sent with the specimen.

Acceptable Body Sites
​Renal
Acceptable Specimen Types
Tissue
Specimen Stability Information
Specimen Type Temperature Time
Renal Biopsy or Wedge Tissue (G&M) ​ ​Room Temperature/Ambient ​Follow fixative expiration date
Renal Biopsy or Wedge Tissue (EM) ​ Store fixative refrigerated until ready to use.  Once specimen is added, store and ship at room temperature/Ambient Follow fixative expiration date or six months, whichever is earliest.
Renal Biopsy or Wedge Tissue (Zeus Transport Media) ​ ​Room temperature/Ambient ​A low frequency of false negative results may occur if tissues are stored in Zeus media for periods longer than 5 days.
Interference

1. EM - Handling that will interfere with results include:
    a. Tissue placed in formalin fixative 
    b. Frozen or yellowed glutaraldehyde fixative that has degraded and will not preserve the tissue adequately. 
        Please order fresh fixative and keep refrigerated until ready to use.
    c. Tissues removed from the patient more than one hour before being placed in the fixative 
    d. Samples that have become dried out before being placed in the fixative d. Samples that have become   dried out before being placed in the fixative
2. Immunofluorescence – Tissues transported in expired, cloudy, crystalline, or frozen Zeus transport media or tissue that has been frozen and thawed may interfere with results.

Useful For
​The evaluation and diagnosis of kidney disease, including ultrastructure examination.
To evaluate the outcome of the disease
To evaluate the efficacy of treatment
Test Components

Surgical Pathology, Gross and Microscopic Examination H&E Surgical Pathology, Gross and Microscopic Examination H&E (G&M)

Special Stains – PAS, Masson Trichrome, Jones, and Congo Red

2. Electron Microscopy (EM)

3. Direct Immunofluorescence (DIF) - IgA IF, IgG IF, IgM IF, C3 IF, Fibrinogen IF, C1q IF, Kappa IF, and Lambda IF.

Reference Range Information
Performing Location Reference Range
​Marshfield ​Interpretative Report
Interpretation
A formal interpretive surgical pathology report is issued, incorporating the findings from all tests performed, including patients clinical and laboratory data, for diagnostic purposes. The results include diagnosis, descriptor, and interpretation of staining patterns. Studies submitted for complete examination include Light Microscopy, Electron Microscopy, and Immunofluorescence.
For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Marshfield ​Monday through Friday ​2 days G&M, Paraffin Embedded
​Marshfield ​Monday through Friday ​3 days ​Hitachi 7700 Transmission electron Microscope
​Marshfield ​Monday through Friday ​2 days ​DIF
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​88348 ​ ​1 Surgical Pathology, Electron Microscopy, Diagnostic
88305 ​ 1 Surgical Pathology, Gross and Microscopic Examination, Level IV - Level of complexity (Level I through VI, as defined by CPT code book) is determined during examination ​Includes H&E stain
88346​ ​ ​1 Immunofluorescent (DIF) Antibody IgA (IVD) ​First stain
​88350 ​ ​1 ​Additional (DIF) Antibody IgG (IVD) ​All other stains or same specimen
​88350 ​ ​1 ​Additional (DIF) Antibody IgM (IVD) ​
​88350 ​ ​1 ​Additional (DIF) Antibody IC3 (IVD) ​
​88350 ​ ​1 ​Additional (DIF) Antibody Fibrinogen (IVD) ​
​88350 ​​ ​1 ​Additional (DIF) Antibody C1q (IVD) ​
​88350 ​ ​1 ​Additional (DIF) Antibody Kappa (ASR) ​
​88350 ​ ​1 ​Additional (DIF) Antibody Lambda (ASR) ​
​88313 ​ ​1 ​Special Stain - PAS (3) ​
​88313 ​ ​1 ​Special Stain - Masson Trichrome (1) ​
​88313 ​ ​1 ​Special Stain - Jones (2) ​
​88313 ​ ​1 ​Special Stain - Congo Red (1) Usually not performed on patients younger than 15 years and younger
Classification

This test was developed and its performance characteristics determined by Marshfield Labs.  It has not been cleared or approved by the US Food and Drug Administration.  This test is used for clinical purposes.  It should not be regarded as investigational or for research.

For most current information refer to the Marshfield Laboratory online reference manual.