Johns Hopkins Pathology: Consultations

Renal Pathology

The Renal Pathology Laboratory, a nationally known center for renal biopsies, serves nephrologists, transplant surgeons, and others by providing the most effective methodology available for diagnosing renal disease and managing renal patients.

We provide renal biopsy interpretation for nephrologists throughout the country. As one of the few such services in this region, we are particularly well positioned to serve the mid-Atlantic states with rapid turnaround. Our lab can also accommodate central slide review for selected clinical studies.

Lab Hours
8:00 a.m. to 5:30 p.m., Monday through Friday. Weekend biopsy interpretation available on request.

Experience

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.

Expertise

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.

Timely Results

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.

Faculty

Lorraine C. Racusen, MD, FCAP

Phone:	410-955-3437
Fax:	410-550-5158
E-mail:	lracusen@jhmi.edu

Professor of Pathology
Director, Renal Pathology Laboratory

Education and Training

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

Professional Interests
Nephropathology

Notable Accomplishments
Co-author of the major schema used for renal allograft rejection diagnosis. Funded laboratory investigator.

Major Professional Leadership

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

Serena M. Bagnasco, M.D.

Phone:	410-502-0812
Fax:	410-614-7110
E-mail:	sbagnas1@jhmi.edu

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

Education and Training

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

Professional Interests
Nephropathology, Research in Renal Physiology

Major Professional Leadership

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

Tests

To order, call Consult office at 410-955-2405 between 8:00 a.m. and 5:00 p.m.

To send laboratory specimens
Forward specimens by courier or express mail to:

Johns Hopkins Medical Laboratories
600 North Wolfe Street
Meyer B-130
Baltimore, MD 21287-7070
Phone 410-955-2405
Fax 410-614-0455

To send consult slides
Forward slides by courier or express mail to:

Johns Hopkins Medical Laboratories
1620 McElderry Street
Reed Hall Rm 315
Baltimore, MD 21205
Phone 410-955-2405
Fax 410-614-7712

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 for light microscopy and immunofluorescence - 1 day
Routine processing and interpretation for electron microscopy - 5 days
Rush processing for LM and IF, on request - 4 to 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 to 2 days
Immunoelectron microscopy - within 3 to 4 days

Special Ordering Instructions

Standard Specimen Processing
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):

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.
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):

Place the biopsy in saline-moistened gauze inside a sealed Petri dish. The specimen should not be floated in saline.
Place the Petri dish in ice in an insulated box and send via the fastest method.

FOR BOTH METHODS:

For shipping, please use ice, NOT dry ice.
Frozen specimens will have a large amount of artifact and may not be interpretable.
Please include a form with clinical information for each; we provide a standardized form for this purpose.

Johns Hopkins Pathology