Renal Pathology Society Survey of Global Renal Pathology Practice Variation in Preanalytic and Analytic Phases

This study aimed to examine current global renal biopsy preanalytic and analytic variability according to country income status. Technology access, pathologist workforce, and case volume variations were evaluated and organized based on country income status. The study identified gaps in technology access and guideline variations.

The Renal Pathology Society membership was surveyed for general practice variables, tissue preparation, and processing for light, immunofluorescence, and electron microscopy (EM) between August 24, 2021, and October 22, 2021, with 66 questions. Respondent countries were stratified based on income status using the World Bank classification.

One hundred twenty-six members responded, representing 47% from North America, 26% from Asia, 19% from Europe, 4% from South America, 3% from Central America, 1% from Australia, and 1% from Africa. The majority processed 500 to 1000 biopsies anually, predominantly native kidney biopsies. Respondents from lower- middle-income and upper-middle-income status countries reported greater biopsies and fewer nephropathologists. There was significant variation in tissue processing and pathologic evaluation that further depended on country income status. Paraffin immunofluorescence was not widely available nor were THSD7A, collagen IV, and DNAJB9 immunostains. EM was routine in ∼50% of biopsies.

Based on country income status, there were major gaps in access to various technologies, including EM, mass spectrometry, and genetic testing. Improved access to adequate resources was needed to standardize global renal biopsy practice. These data reveal many potential sources of variability across all processing phases and microscopic techniques. Further study is needed to understand the impact on renal pathology practice and diagnostics worldwide.