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Diagnosing Kidney Disease

  • A kidney biopsy is evaluated using the latest technology, electron microscopy
  • For people whose doctors suspect kidney disease based on symptoms such as blood in the urine
  • The next step may be treatment with medication or in severe cases dialysis or transplantation
  • Involves Pathology and Nephrology

Overview

With one of the country’s first renal pathology labs, the Yale Medicine Department of Pathology is well-known for its expertise in renal (kidney) disease. “We have a longstanding tradition of excellence in kidney pathology,” says pathologist Gilbert Moeckel, MD. “We have a great deal of experience and a large repository of previous cases,” he says. “We have the opportunity to study and compare tens of thousands of kidney biopsies, right here in our biopsy repository.” 

“To make the best diagnosis on the kidney biopsy,” Dr. Moeckel says, “it’s important to have electron microscopy. That equipment is not found in every hospital or private practice physician clinic. We can do very detailed tests that nobody else can do.”

What is renal failure?

The kidneys are tasked with filtering waste products from the blood. A variety of conditions—including kidney stones, diabetes and high blood pressure—can interfere with kidney function and disable one or both kidneys. It’s possible to live a full life with only one functioning kidney. However, if both kidneys fail, dialysis (a mechanical system that cleans the blood) or a kidney transplant is needed. Kidney failure can happen suddenly or over a period of time. 

Which symptoms suggest the need for a kidney biopsy?

Symptoms include swelling, uncontrollable high blood pressure, seizures and even falling into a coma. A kidney biopsy may be recommended because a person notices blood in his or her urine. Physicians may order a biopsy if excess protein is detected in a routine urine sample, or if kidney disease is suspected or has been previously diagnosed. The biopsy will provide important information about the cause of renal disease. Most kidney biopsies are outpatient procedures performed under local anesthesia. A needle or scope is used to remove a tiny piece of tissue from one or both kidneys for close examination by a pathologist.

What do pathologists look for when examining a kidney biopsy?

“It’s our job to find out what is going on with the person’s kidney,” Dr. Moeckel says. The visual evaluation is used to detect the presence of cells with certain characteristics that will in turn point toward a diagnosis. Potential results could include the following: inflammation, scarring, hypertension-mediated injury of the kidney, diabetic injury of the kidney, or cancer.

How does a pathologist’s findings affect treatment of renal disease?

Treatment of renal disease is dictated by the kidney biopsy, Dr. Moeckel says. If the cause of the kidney failure is an infection, it may be treated with antibiotics. If inflammation is the suspected cause, then steroid treatment may be recommended. If a patient’s kidney biopsy shows evidence of extensive damage to the kidney, the patient may need dialysis or a kidney transplant, he notes.

What makes Yale Medicine’s approach to the diagnosis of renal disease unique?

As a pioneer in the field of renal pathology, Yale Medicine has become a national leader, known for leading-edge technology and extensive experience in its use. “To make the best diagnosis on the kidney biopsy,” Dr. Moeckel says, “it’s important to have electron microscopy. That equipment is not found in every hospital or private practice physician clinic. We can do very detailed tests that nobody else can do.”

He says that the electron microscope is a valuable diagnostic tool. However, Dr. Moeckel adds, "it’s not only about having the best technology, but you also need people who have experience using it. Our technologists have a combined experience of more than 50 years in immunofluorescence and electron microscopy.”