Practicing quality nephropathology in a developing country; challenges and solutions

Editorial Implication for health policy/practice/research/medical education: Nephropathology is a highly specialized field of surgical pathology that deals with the diagnosis, management and prognostication of medical renal diseases. It is important for the nephropathologists to have a close liaison with the nephrologists, immunologists, molecular biologists, and more recently geneticists in order to facilitate accurate diagnosis of the renal diseases. Please cite this paper as: Mubarak M. Practicing quality nephropathology in a developing country; challenges and solutions. N ephropathology is a highly specialized field of surgical pathology that deals with the diagnosis, management and prognostication of medical renal diseases (1). It is considered the most difficult area of pathology by most surgical pathologists, not only in developing part of the world but also the developed world. There are several reasons for this thinking. Nephropathological diagnosis is nowadays almost always made on percutaneous needle biopsies, a tissue sample often abhorred by the majority of diagnostic pathologists, but one which has enriched the study of the natural course and the evolution of the nephrological diseases (2-4). Prior to its widespread use, the study of renal pathology was based almost entirely on autopsy pathology, which in most instances, showed only extreme examples of pathological processes in acute renal failure or end-stage renal disease (ESRD) with chronic renal failure, with little insight of the preceding events leading to the final picture (2). With percutaneous renal biopsies it became possible to study the disease process at different stages of the disease and often during the early phase. In some centers, serial biopsies in individual patients illustrated the progression of the disease process very nicely. In addition, as will be discussed shortly hereafter, the renal disease proved an ideal topic for the application of two techniques which were also relatively new at the time; electron microscopy (EM) and the use of antibodies to localize antigens in tissue sections (2). With this came the challenges of designating the disease processes that were hitherto undiscovered by the autopsy-based practice and labeling the histological lesions not previously reported in the autopsy-based literature. Moreover, a strong need was felt for the standardization of the nomenclature of the renal pathological lesions and uniform system for classification of the diseases to facilitate international communication and comparison of studies. These challenged were tackled amicably and admirably by the World Health Organization (WHO) Collaborating Center for the Histological Classification of Renal Diseases, established in 1974 and …