-----Original Message-----
From: Richard Cartun <Rcartun@harthosp.org>
To: TABrecken@aol.com <TABrecken@aol.com>; histonet@pathology.swmed.edu
<histonet@pathology.swmed.edu>
Date: Monday, September 11, 2000 9:56 AM
Subject: Renal biopsies -Reply


This function should be considered an "intra-operative consultation" and
should be carried out by a pathologist or someone (PhD/PA) with specialized
training under the supervision of a pathologist.  Yes, in the past we have
used technologists with advanced training perform this evaluation under a
pathologist's supervision, but clearly there are enormous ramifications of
making a decision that requires that the radiologist or nephrologist perform
another needle core biopsy or stating that the biopsy is "adequate" when,
after reviewing the permanent sections, it is not.  Currently, our Director
of Electron Microscopy (a PhD) or myself (also a PhD) perform this function
at our hospital under the supervision of a pathologist.  We issue an
intra-operative consultation that appears on the surgical pathology report
and we bill for it.  We keep a microscope in Radiology and, after placing
the fresh tissue in tissue culture media on a glass slide, can usually tell
if the biopsy is adequate by looking at it under low power magnification
(for example 4x or 10x).  Please remember that it may be difficult to
visualize glomeruli using this method when the kidney has advanced disease
since there are few RBCs in the damaged capillary loops.

Richard W. Cartun, Ph.D.
Director, Immunopathology
Co-Director, Histology