RECURRENT DISEASES IN THE TRANSPLANTED KIDNEY
Stephen M. Bonsib, M.D.
III. FINAL COMMENT
The concern of recurrent disease, especially glomerulonephritis complicates the issue of the optimum evaluation of a renal allograft biopsy. For many years we (at Iowa) performed LM, DIF and EM on all biopsies. In the past year influenced by managed care issues and efforts to control costs, we have discouraged the use of frozen section diagnosis and have deleted DIF and EM for routine protocol biopsies. We now rely on the clinicians to alert us to any concern about glomerulonephritis before ancillary studies are performed. We may soon be forced to reconsider the extent to which multiple levels and special stains are required for diagnosis. The recent information regarding the potential of EM demonstration of peritubular capillary reduplication to separate chronic rejection from chronic cyclosporine toxicity prompts further reconsideration of the place of ancillary studies. At present we use the changes on one biopsy or the development of any new clinical features to influence the application of ancillary studies performed on a subsequent biopsy.
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Last Modified: March 21, 1996 9:19:35 AM
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