Education & Scientific, Ian Roberts, Chair
Members: Laura Barisoni, Ian Gibson, Pat Walker

RPS Education and Scientific Committee: roles and responsibilities

A major function of the RPS is the provision of educational opportunities in renal pathology to its members and also the dissemination of information on new developments in the field, in both basic and clinical science, thus maintaining standards in the clinical practice of renal pathology. The E&S Committee plays an important role in developing these functions.

As membership has expanded and the society has become a truly international one, the current challenge is to ensure that these educational opportunities are equally available to all members. Mechanisms for disseminating new information include the organization of scientific and educational meetings and providing information on the RPS website. The RPS can offer: lines of communication, organization, financial assistance (directly or indirectly). For discussion: the role of the RPS in facilitating international scientific initiatives, e.g., IgA Working Group. Current activities of the E&S committee:

        1. RPS annual satellite conference: The E&S committee is responsible for all aspects of administration: venue (2/3 years in North America, 1/3 elsewhere in the world, satellite to an international pathology or nephrology meeting), programme and registration.
        2. American Society of Pediatric Nephrology Congress: pathology programme (Pat Walker).
        3. American Board of Pathology re-certification examination, renal (Pat Walker).
        4. RPS involvement in national and regional renal pathology meetings around the world. This may take the form of administrative assistance, posting a flyer on the RPS website or funding a visiting overseas speaker. This type of activity provides direct benefits to our international members, many of whom cannot easily attend North American meetings, and thus encourage new membership. Close links with the Nephropathology Working Group of the ESP will be required for the organization of the 2007 RPS satellite conference.

Possible future developments:

  1. Web-based educational material. Members could be invited to submit cases that are of particular interest. These could then be posted on the RPS website – a “case of the month”; each would include a short clinical history, a limited number of images, diagnosis, learning points and relevant references. They could be mini-self assessments or requests for opinions on difficult cases. The educational and scientific committee could administer this, collecting a bank of cases and selecting one each month for the website.
  2. External quality assessment/ proficiency testing: EQA schemes have been employed in some countries for many years for testing the diagnostic proficiency of pathologists in all specialities. These can run as purely educational schemes, but in the UK accredited schemes have the power to report sub-standard performers to the Royal College of Pathologists, the organisation that administers all clinical pathology in the UK, with the power of deciding who is fit to practice. Some schemes in the UK are moving away from circulation of glass microscope slides to web-based EQA. The RPS could potentially develop this internationally for renal pathology.

 

RPS Education and Scientific Committee Report, February 2006

RPS annual satellite conference 2006
This will be held as a satellite meeting to the IAP meeting in Montreal, September 16-21. The RPS meeting will be a half day meeting on Wednesday 20th September.

Venue: Delta C-V Hotel (the main conference hotel for the IAP meeting)

The format will be unchanged from the successful 2005 meeting. Could RPS members encourage trainees to contribute to the case presentation session, in order to broaden participation at the meeting. 

Programme:  Symposium on the classification of glomerular disease

                        ISN/RPS classification of lupus nephritis
14.00-14.15            What are the changes and why were they made?                        Terry Cook
14.15-14.30            Clinical and prognostic correlations.                                                Steve Bonsib
14.30-14.45            Reproducibility: is it any better than the WHO?                        Peter Furness
14.45-14.55             Discussion

                        Focal segmental glomerulosclerosis
14.55-15.10            Clinical relevance of the Columbia classification                        David Thomas
15.10-15.25            Glomerular tip lesions and relationship to FSGS                        Alec Howie
15.25-15.40            Classification of podocytopathies based on biomarkers            Laura Barisoni
15.40-15.50            Discussion
 Break
16.10-16.40            New developments in dense deposit disease                                   Patrick Walker
16.40-18.00            Case presentations
Future meetings
As agreed previously, the following RPS satellite meeting will be outside North America. The planned venue is at the European Congress of Pathology in Istanbul, September 2007. This may enable a combined meeting with the Nephropathology Section of the ESP. Potential symposia include IgA nephropathy (the International IgA nephropathy Working Group will have completed its report by then) and quality control/proficiency testing in renal pathology.

Web-based External Quality Assessment
EQA schemes based on circulation of pre-stained slides have been traditionally used but numbers of participants are limited by the number of sections that can be taken from a renal biopsy. For example, the UK Renal Pathology EQA scheme is limited to less than 100 participants. Peter Furness has recently trialled web-based EQA using virtual slide technology, running this immediately prior to the usual circulation of slides, with encouraging results. This system will broaden participation, enabling international schemes with large numbers of participants.

Pathology board recertification test-Renal pathology questions
Patrick Walker

Obviously there are many topics that are omitted and these are the areas we must examine. Are there subjects we would expect a non-renal pathologist to know, particularly given that this is a re-certification examination. Many people will be entrenched in their own sub-discipline or in the daily routine of general surgical pathology and/or clinical pathology. What are the minimum expectations of these pathologists?

  1. Primary Glomerular Diseases
    1. Nephrotic syndrome
      1. Definition
      2. Idiopathic Causes
        1. Minimal Change Disease
        2. Focal Segmental Glomerulosclerosis
        3. Membranous Nephropathy
    2. Acute Nephritic Syndrome
      1. Definition
      2. Idiopathic Causes
        1. Post-Infectious Glomerulonephritis
    3. Rapidly Progressive Glomerulonephritis
      1. Definition
      2. Causes
        1. Anti-Basement Membrane Antibody
        2. Immune Complex Mediated
        3. Pauci-Immune (ANCA-Associated)
    4. Asymptomatic Urinary Abnormalities – Hematuria
      1. Definition
      2. Causes
        1. IgAN/HSP
        2. Alports Syndrome
    5. Overlap Syndromes – Nephritic/Nephrotic
      1. Membranoproliferative Glomerulonephritis
      2. Association – Hepatitis C
  2. Secondary Glomerular Diseases
    1. Systemic Lupus
      1. Proliferative patterns v Membranous pattern
      2. Activity/Chronicity
      3. IF – Full House
    2. Diabetes Mellitus
      1. Most common cause of the nephrotic syndrome in the US
      2. Pathologic Features
        1. Kimmelstiel-Wilson lesion
        2. Protein lesions
        3. Afferent and Efferent Arteriolar Hyalinosis
    3. Amyloidosis
      1. Proteinuria and decreased renal function
      2. Pathologic Features
        1. Diffuse glomerular hyalin deposits, congo red positive with apple green birefringence
        2. Cross-hatched fibrillar deposits on EM
  3. Pathogenesis of Glomerular Diseases
    1. Immune Complex Mediated Disease
    2. Mediators of injury
      1. Complement system
      2. Cells including:
        1. Neutrophils
        2. Platelets
        3. Macrophages
        4. Mesangial cells
      3. Mediators including:
        1. Proteases
        2. Oxidants
        3. Cytokines
        4. Nitric oxide
  4. Tubulointerstitial Disease
    1. Acute Pyelonephritis
    2. Chronic Pyelonephritis/Obstructive Uropathy
    3. Acute Interstitial Nephritis
      1. Pathologic Features
        1. Chronic inflammatory cell infiltrate with eosinophils
        2. Tubulitis
      2. Causes
        1. Antibiotics
        2. NSAIDs
    4. Acute Tubular Necrosis
      1. Pathologic Features
      2. Causes
        1. Ischemia
        2. Toxins
  5. Vascular Disease
    1. Benign Nephrosclerosis
    2. Thrombotic Microangiopathy
      1. Malignant Hypertension
      2. SLE
      3. HUS/TTP
    3. Vasculitis
      1. Cryoglobulinemia, Microscopic Polyangiitis
      2. Wegener’s Granulomatosis
      3. Polyarteritis Nodosa
  6. Cystic Kidney Disease
    1. Simple Cysts
    2. Autosomal Dominant Polycystic Kidney Disease
    3. Autosomal Recessive Polycystic Kidney Disease
    4. Renal Dysplasia