The Renal Pathology Lab has always been at the forefront of the field. We have performed and interpreted renal biopsies since the 1950s, and have been performing full-service biopsies with electron microscopy and immunofluorescence since the 1970s. We currently provide the latest in immunohistochemistry and molecular techniques. Our service was started by Dr. Heptinstall, one of the founders of the field of renal pathology and still active as a consultant here.

Expert consultation

The service is overseen by one of the best renal pathology groups in the country, with three internationally known specialists on the faculty. In addition to Dr. Lorraine Racusen, professor and Director of service, staff include Dr. Robert Heptinstall, Dr. Serena Bagnasco and Dr. Mark Haas. Faculty interests include glomerular diseases, tubular diseases and injury and allograft pathology. Faculty members provide ongoing consultation to laboratory customers and, as results are obtained, provide diagnosis, prognosis, and expert advice on how to treat and manage the patient.

Special capabilities and services

Staff can perform electron microscopy from paraffin-embedded tissue or unstained slides, immunofluorescence studies on paraffin-embedded tissue, and a variety of immunohistologic and selected molecular studies.

Tests results and diagnoses can be provided quickly,usually within 12-24 hours for histology and immunohistology. Interim results can be reported as soon as they are available, to be followed by a full written report.

Test results can be speeded by phone, fax, or e-mail. If requested, we can send representative microscopic slides, electron microscopy prints, or Kodachromes of immunohistology tests for you to review, verify, or present at clinical conferences. We are also equipped to send these documents digitally, via modem, for joint consultations by computer.

• Professor of Pathology
• Director, Renal Pathology Laboratory

• M.D., University of Vermont
• Postdoctoral Research Fellow, Yale-New Haven Hospital
• Residency in Pathology and Research Fellowship in Renal Pathology, The Johns Hopkins Hospital

• Editorial Board Member, Journal of the American Society of Nephrology.
• Councillor, Renal Pathology Society
• Member, Acute Renal Failure Advisory Group, American Society of Nephrology
• Co-organizer, International Symposia on Acute Renal Failure, 1988, 1991
• Co-organizer, Banff Conferences on Allograft Pathology, 1993, 1995, 1997, 1999, 2001, 2003
• Editor, Solid Organ Transplant Rejection
• Editor, Kidney Transplant Rejection, Editions 2 and 3
• Author of numerous chapters in other major renal pathology texts
• Author of over 80 articles in medical journals

• Associate Professor of Pathology
• Director, Electron Microscopy Laboratory

• M.D., Ph.D., Duke University
• Residency in Anatomic Pathology, Yale-New Haven Hospital
• Post-Doctoral Fellowship in Renal Pathology and Physiology, Yale University School of Medicine
• Board Certified in Anatomic Pathology, American Board of Pathology

• Editorial Board Member, Kidney International, 2002 - present.
• Editorial Board Member, American Journal of Kidney Diseases, 1999 - 2001.
• Editorial Board Member, American Journal of Physiology: Cell Physiology, 1993-1999
• Reviewer for over 30 medical and scientific journals
• Member of multiple NIH peer-review panels
• Author of more than 75 articles in medical and scientific journals

• Associate Professor of Pathology and Neurology
• Neuropathology Consultant, Office of the Chief Medical Examiner of Maryland

• M.D., University of Genova, Genova, Italy
• Research Training: Visiting Associate LKEM/NHLBI/NIH
  Residency in Anatomic Pathology, Northwestern University
• Postdoctoral Fellowship in Renal Pathology and Physiology, Johns Hopkins University

• Editorial Board Member, American Journal of Physiology Renal Physiology
• Reviewer for: Journal of the American Society of Nephrology, American Journal of Physiology Cell/Comparative/Gastrointestinal Physiology, The American Journal of Pathology, PNAS
• Member Peer Review Cardio-Renal Panel, American Heart Association
• Author of more than 30 articles in scientific journals

To send laboratory specimens Forward specimens by courier or express mail to: Johns Hopkins Medical Laboratories 600 N. Wolfe Street / Meyer B-130 Baltimore, MD 21287-7070 Fax: (410) 614-0455

To send consult slides Forward slides by courier or express mail to: Johns Hopkins Medical Laboratories 1620 McElderry St. Reed Hall Rm 315 Baltimore, MD 21205 Fax: (410) 614-7712 Phone: (410) 955-2405 / 8am - 5pm (To order tests, confer with faculty or handle processing and billing inquires, please call Customer Service at 1-800-997-5475.)

For technical questions, e-mail us at: renalpathology@pds.path.jhu.edu

Interpretations of standard and specialized studies are provided by experienced specialists of both native kidney and allograft pathology. Turnaround times for reporting results vary by test and are listed below.

Standard renal biopsy processing

The laboratory provides expert standard processing of native kidney and allograft renal biopsies, using light microscopy with immunofluorescence and/or electron microscopy as appropriate for each case. Studies can be done on tissue or on blocks of slides prepared elsewhere.

Available Tests

Light Microscopy (LM)

• H&E, trichrome, PAS, and silver stains

Immunofluorescence (IF)

• Immunoglobulins
• complement components
• light chains
• Alport panel (alpha chains of type 4 collagen)
• IgG subclasses

Electron microscopy (EM)

Turnaround time for:

• Routine processing and interpretation
• light microscopy and immunofluorescence (1 day)
• electron microscopy (5 days)
• Rush processing for LM and IF, on request -- 4-6 hours
• Electron microscopy -- 2 days, if needed

Specialized studies

Studies are available as needed on routinely processed specimens or can be applied to slides or tissue blocks sent in consultation.

Tests

• Immunoperoxidase
• immunoglobins
• immunoglobulin light chains
• immunoglobulin heavy chains
• amyloid AA
• viral antigens
• myoglobin
• cell surface markers
• Immunoelectron microscopy
• Preparation of EM specimens from paraffin-embedded material or tissue sections on slides
• In situ hybridization
• viral antigens

Turnaround time for:

• Immunoperoxidase and in situ hybridization (1-2 days)
• Immunoelectron microscopy (within 3-4 days)

There are two major options for preparing and sending renal biopsy material for evaluation:

• Method I (Use for transport times greater than a few hours):
  1. Place part of the biopsy in 10% buffered formalin and part in Michel's transfer medium (also called Zeus medium), each in a small, tightly closed specimen container. We order our medium from Wampole Laboratories, Division of Carter-Wallace, Inc., Cranbury, NJ 08512.
  2. Place the tightly closed containers in ice in an insulated box and send. These media will preserve tissue adequately for all studies, including immunofluorescence studies. Material will be fine for a few days as long as it is kept cold.
• Method II (Use for transport times of up to several hours):
  1. Place the biopsy in saline-moistened gauze inside a sealed Petri dish. The specimen should not be floated in saline.
  2. Place the Petri dish in ice in an insulated box and send via the fastest method.
• FOR BOTH METHODS:
  1. For shipping, please use ice, NOT dry ice.
  2. Frozen specimens will have a large amount of artifact and may not be interpretable.
  3. Please include a form with clinical information for each; we provide a standardized form for this purpose.