CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
July 2019—New from CAP Press is Medical Kidney Diseases—Morphology-Based Novel Approach to Renal Biopsy, by Huma Fatima, MD, assistant professor and director of the renal pathology laboratory, Department of Pathology, University of Alabama at Birmingham. It presents a simple and practical approach to renal biopsy by providing a pertinent differential diagnosis related to various patterns of injury involving renal parenchyma by light microscopy and reaching a correct diagnosis by assimilating immunofluorescence and electron microscopy findings. The 90-page book contains 66 cases, two of which we are reprinting here.
CAP TODAY asked Dr. Fatima a few questions about the new book. Her comments and the cases follow.
You write that the book is the outcome of a question that nephrology fellows have asked you several times since you started practicing in 2011. Can you explain?
I have been teaching renal pathology to medical students, pathology residents, nephrology fellows, and foreign scholars since I joined UAB in 2011. On several occasions, nephrology fellows asked me, Is there any good resource we can use for our boards? I realized that most of the currently available material is quite extensive and may be overwhelming for those who are not renal pathologists. This led me to write the book—keeping in mind those who are outside the realm of renal pathology practice—to provide them pertinent information in a simple way that will be useful to them, not only for their board examination but also in practical life.
Can you tell us how the book is organized and how the information is presented?
The book is divided into four sections: glomerular, vascular, tubulointerstitial, and transplant renal pathology. Each section is divided into multiple subsections based on the morphologic pattern of injury by light microscopy. A pertinent differential diagnosis is provided for each pattern of injury, accompanied by relevant cases. Each case includes a brief clinical history, renal biopsy findings along with light microscopy, immunofluorescence and electron microscopy images, diagnosis, key morphologic features required for the diagnosis of that particular disease, and several clinically relevant points at the end.
For whom is the book best suited?
I have written this book, as a quick and easy guide, focusing on those physicians who are not renal pathologists but do need to know renal pathology either for their exams or in real practice like pathology residents, general pathologists, nephrology fellows, and nephrologists. It will also help international physicians by providing a simple and practical approach to renal biopsy interpretation, as renal pathology is a challenging field worldwide with a very limited number of pathologists who can claim expertise in this subspecialty.
You use real-life cases from your own practice, selected, I assume, for their educational value and interest. Is that correct?
Yes, this is true. All of the cases discussed in the book are real-life cases that I have accumulated during the course of my practice.
Is there anything on the market that is similar to your book?
Not to my knowledge. Most books written on medical renal diseases are organized according to the clinical syndrome instead of morphology. This is a different approach and will be useful, especially for people with limited knowledge of renal pathology. I got this idea from Dr. Agnes Fogo’s article, “Approach to renal biopsy,” published in the American Journal of Kidney Diseases (2003;42[4]:826–836), which helped me develop a basic understanding of renal biopsies during the early days of my renal pathology fellowship. This approach will most surely help and guide others as it helped me, even when I had minuscule knowledge of renal pathology.
To order (PUB129), call 800-323-4040 option 1. CAP member price: $68; for others, $85. The ebook (ebooks.cap.org) is $64. If you are interested in writing a book for publication by CAP Press, contact Caryn Tursky at ctursky@cap.org.
Below is a case from the chapter titled “Pattern of Glomerular Lesions.”
Case: A 73-year-old woman with acute lymphoblastic leukemia/lymphoma (ALL) presents with serum creatinine of 4.8 mg/dL, hematuria, 3+ proteinuria, and low C3 and C4. Serum free light chains ratio of 2.87 (normal <1.65) with normal lambda and elevated kappa light chain.
Renal Biopsy Findings
Light microscopy: The glomeruli show mesangial hypercellularity, infiltration of the capillary lumina by inflammatory cells (endocapillary hypercellularity), and rare intraluminal, glassy appearing deposits (pseudo thrombi) obliterating the capillary lumina (Jones silver Figure 1-57). The intraluminal homogeneous, glassy appearing deposits are strongly PASH positive (PASH Figure 1-58).
Immunofluorescence: There is strong granular and chunky peripheral capillary loop and intraluminal staining for IgG (Figure 1-59), IgM (Figure 1-60), and kappa (Figure 1-61), as well as weak staining for lambda (Figure 1-62). The large immune complex deposits along the capillary loops appear sausage shaped with smooth outer contours indicative of the subendothelial location of these deposits.