Our Service

Our mission is to provide the highest quality histo-pathologic diagnostic work up for your patients.

Comprehensive Biopsy Evaluation

• Meticulous sectioning and sampling of the biopsy.
• A range of special histochemical stains for standard renal biopsy evaluation, with additional stains as indicated.
• Immunofluorescence studies using a complete panel for immunoglobins, complement components, and light chains.
• Our histology and electron microscopy laboratories are equipped with experienced technicians and state-of-the-art processors to ensure high-quality biopsy processing.
• Modified workup for transplant biopsies, including immune-phenotyping of inflammatory cells, markers for antibody-mediated rejection, and detection of BK virus.

Timely Reporting of Results

• Preliminary diagnosis communicated directly to the nephrologist within 24 hours of receiving the biopsy.
• Expedited same-day processing and diagnosis available upon request.
• Biopsy reading available on Saturdays year-round.
• Our histology laboratory operates 24/7 to ensure timely service.

Direct Communication with Clinicians and Clinco-Pathologic Consultations

• Close interaction between pathologists and clinicians is critical to maximize the diagnostic yield of the biopsy. We communicate with the referring physicians, directly and immediately after preliminary results are available.
• Pathologists are available 24/7 to discuss cases and address any concerns.
• Biopsy reports are faxed to the referring pathology department and the referring physician.
• Secure online access is available for biopsy results and representative images.

User-Friendly Service

• Biopsy kits for tissue collection, including detailed instructions, are provided.
• Pre-paid and pre-addressed packaging for overnight shipping to our laboratory is included.
• A supportive administrative team is available for billing, reporting, and communication needs.

Who We Are

Dr. Luan D. Truong, M.D.
Director of Nephropathology at Houston Methodist Hospital
Professor of Pathology, Weill Medical College of Cornell University and adjunct Professor of Pathology & Renal Medicine, Baylor College of Medicine

Dr. Roberto Barrios, M.D.
Professor of Pathology and Laboratory Medicine Weill Medical College of Cornell University

Dr. Lillian W. Gaber, M.D.
Professor of Pathology and Laboratory Medicine Weill Medical College of Cornell University

Renal Biopsy Guidelines

Renal Biopsy Kit:

• Reagents
  • Zamboni fixative (yellow) to fix specimens for light microscopy and electron microscopy.
  • Zeus tissue transport fixative for specimens to be processed for immunofluorescence.
• Requisition form:
  • Please download and complete the Renal & Transplantation Biopsy Service form with clinical and insurance information.
• Prepaid, pre-addressed UPS Airbills for shipping the biopsy to Houston Methodist Pathology.

Protocol for Handling Renal-Core-Biopsy

• 18 G biopsy needle is recommended
• Ensure immediate fixation of the tissue biopsy to optimize tissue preservation
• At least 2 biopsy cores should be obtained, each 10-15 mm in length
• If on site evaluation for specimen adequacy is not possible place one core in Zamboni and the second in Zeus
• If specimen adequacy is performed with the aid of a dissecting microscope or a regular microscope
  • Place tissue on a glass slides with wetting amount of PRM tissue culture medium or saline. DO NOT LEAVE THE SAMPLE TO DRY and DO NOT LEAVE SUBMERGED FOR LONG PERIOD OF TIME
• On site evaluation for adequacy is recommended to ensure adequacy of the sample and for proper division and allocation of the biopsy
  • Renal cortex is recognized by the presence of glomeruli which appear as raised hemispheres with a reddish blush. Renal medulla is identified by striations that mark the collecting ducts.
  • If biopsies are divided, use a sharp razor or scalpel and avoid sheering motions to prevent tissue crushing
  • Adequate biopsy with at least two, 15-mm long, tissue cores is divided as follows
    • A larger portion of the biopsy cores representing cortex is submitted in vial containing Zamboni (yellow). This portion will be further divided in our laboratory for light microscopy and electron microscopy processed
    • A second portion of the biopsy sample, cortex included is placed in Zeus solution (clear) for immunofluorescence testing
  • Limited biopsy sample. Triaging the sample should be guided by the clinical data
    • Single adequate core:
      • Cut off the ends and place in Zeus, then place the remaining core (2/3 of the tissue core) in Zamboni
  • Minimal adequate material:
    • Allocation of tissue depends on the on the clinical data. In most cases, IF is probably preferred if glomerular disease is suspected e.g. rapidly progressive renal failure. IF possible a small portion should be fixed in (Zamboni)
    • Transplant biopsies with limited tissue: the following should be considered:
      • Tissue fixation in Zamboni takes priority since it allows for LM, EM and IHC examination
      • Renal medulla could be the only material submitted for IF to test for C4d deposition
      • A complete IF panel is important in cases with nephrotic range proteinuria
    • Once tissue is placed in the proper containers, secure the tops of the containers, and make sure that the containers are properly labeled for patients identification
    • Place containers in the enclosed padded envelope, along with completed data form. It is important to provide a summary of the clinical problem; if not available a copy of the nephrologist note could be attached.
    • It is important to provide contact information for your laboratory (pathologist name, phone and fax numbers, address), and for the treating nephrologist (name, pager, phone number)
    • Do not use ice or freeze samples

Shipping

• Properly label containers with patient’s identification
• Place the box in the provided pre-labeled, pre-addressed envelope
• Ship package at room temperature (no ice)
• Contact TMH pathology for notification (713-441-1447)
• If you are using a local courier, instruct direct delivery to “Houston Methodist Hospital Department of Pathology” and obtain a signed receipt to document specimen delivery