The Continuing Need for Electron Microscopy in Examination of Medical Renal Biopsies: Examples in Practice

Area of Science:

• Nephrology
• Pathology
• Medical Diagnostics

Background:

• Transmission electron microscopy (EM) has been a cornerstone in diagnosing medical renal biopsies for six decades.
• Its use is vital for both native and allograft renal biopsies.
• Despite cost and labor concerns, EM remains indispensable for accurate diagnosis.

Purpose of the Study:

• To review the continued diagnostic value of EM in renal biopsy evaluation.
• To highlight cases where EM was essential for correct diagnosis.
• To advocate for the continued use of EM in renal pathology.

Main Methods:

• Review of clinical cases where EM significantly impacted diagnosis.
• Analysis of the role of EM in diagnosing glomerular lesions and rare kidney diseases.
• Comparison of diagnostic capabilities of EM versus other methods like immunohistochemistry (IHC).

Main Results:

• EM remains essential for accurate diagnosis in a significant fraction of renal biopsies.
• Examples provided demonstrate EM's critical role in diagnosing various kidney conditions.
• Advances in IHC have not fully replaced the unique diagnostic information provided by EM.

Conclusions:

• EM is an indispensable tool in the diagnostic evaluation of medical renal biopsies.
• Failure to perform EM in select cases can result in incorrect diagnoses and adverse clinical outcomes.
• Recommendations are made to store tissue for EM and perform ultrastructural studies for native and allograft renal biopsies.