Thin basement membrane nephropathy cannot be diagnosed reliably in deparaffinized, formalin-fixed tissue.
In diagnostic renal pathology, electron microscopy is ideally performed on glutaraldehyde-fixed, plastic resin-embedded tissue (EM-G). When no glomeruli are present in the portion of the biopsy fixed in glutaraldehyde, formalin-fixed, paraffin-embedded tissue can be reprocessed for electron microscopy (EM-F). The usefulness of this salvage technique for the diagnosis of thin basement membrane nephropathy (TBMN) has not been studied systematically. Here we compare the glomerular basement membrane (GBM) thickness by EM-G vs EM-F in 21 renal biopsies, including TBMN (eight patients), normals (two patients), minimal change disease (MCD) (six patients) and diabetic nephropathy (DN) (five patients). There was significant reduction of the GBM thickness by EM-F compared with EM-G across all diagnostic categories in all 21 cases. The mean percentage reduction in GBM thickness was 23% for the TBMN cases, 40% for the normal/MCD cases and 34% for the DN cases. Four patients with MCD had a mean GBM thickness by EM-F that fell below the defining threshold for diagnosis of TBMN. For the TBMN cases, the 99th percentile for GBM thickness by EM-F was 194 nm, suggesting that the diagnosis of TBMN by EM-F can be excluded with confidence if the GBM thickness is above 200 nm. No clear criteria could be established to diagnose TBMN by EM-F. Renal pathologists should be aware that reprocessing of paraffin tissue for EM causes artifactual GBM thinning that precludes accurate diagnosis of TBMN.
Nasr
Samih H
SH
Department of Pathology, Columbia University, College of Physicians and Surgeons, 630 West 168th Street, VC14-224, New York, NY 10032, USA. sn386@columbia.edu
Markowitz
Glen S
GS
Valeri
Anthony M
AM
Yu
Zhimin
Z
Chen
Liqun
L
D'Agati
Vivette D
VD
D016477:Artifacts; D001706:Biopsy; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000473:pathology; D005557:Formaldehyde; D050533:Glomerular Basement Membrane / Q000473:pathology* / Q000648:ultrastructure; D015433:Glomerulonephritis, Membranous / Q000175:diagnosis* / Q000473:pathology*; D006652:Histological Techniques / Q000379:methods*; D006801:Humans; D007678:Kidney Glomerulus / Q000473:pathology / Q000648:ultrastructure; D046529:Microscopy, Electron, Transmission; D009402:Nephrosis, Lipoid / Q000175:diagnosis / Q000473:pathology; D016612:Paraffin Embedding; D015203:Reproducibility of Results
D005557:Formaldehyde