The Renal Pathology group provides renal biopsy diagnostic services to MGH and outside nephrologists in the United States and abroad, and to the transplantation service at MGH.

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Renal Pathology

The Renal Pathology group, led by Dr. Robert Colvin since 1975, has provided renal biopsy diagnostic services to MGH and outside nephrologists in US and abroad, and to the transplantation service at MGH. Fellows trained by this group have generally become academic pathologists, several in prominent positions. Major research efforts since 1975 with colleagues in the MGH Transplantation Unit and Transplant Biology Research Center have produced a long series of important contributions to the diagnosis, pathogenesis and treatment of renal allograft rejection and currently are supported by several NIH and industrial grants. New efforts focus on mechanisms of inducing tolerance to kidney allografts in humans using mixed chimerism approaches, the mechanisms of antibody mediated chronic rejection, the role of T regulatory cells (Foxp3) in graft acceptance, and in vivo imaging of cells in renal allografts in mice. These are funded by grants from the NIH, including program projects and several multicenter clinical trials grants.

Faculty

Clinical Program

Case Mix
The Renal Pathology Service receives diagnostic biopsies from the MGH (72%) as well as outside consult cases. In 2009 we had approximately 400 cases, of which 37% are transplants. The sources include local community nephrologists, the National Kidney Institute in Manila, The Philippines, and contracts with WorldCare (Saudi Arabia) and with the United Arab Emirates. Second opinion cases are received from many US sources. In addition we serve as the reference diagnostic pathology site for several NIH and industry sponsored multicenter trials, which typically provide 300 to 500 additional samples per year.

Innovations
The group developed and implemented rigorous ELISA and Western blot based anti-GBM tests that are widely used as a reference test. The anti-neutrophil cytoplasmic antigen (ANCA) test based on purified target antigens was first developed and reduced to clinical practice at MGH (Proteinase 3, one of the two antigens was first cloned by Dr. McCluskey and colleagues). The group has done much to promote the detection of the complement component, C4d, as a measure of acute humoral allograft rejection and were the first to recognize a chronic variant of humoral rejection. We now perform the C4d stain as a reference test for other centers and provide training in the performance and interpretation of the test.

Academic and Research Accomplishments

See Immunopathology / Transplantation for description of funded research activities.

Teaching and Educational Activities

Clinical Service
Weekly clinicopathologic conferences are held in the Pathology Department in which all renal biopsies are discussed with the renal clinical staff and residents. A consensus conference is held twice a week to review the ongoing cases with residents, staff and students.

Residents
A monthly conference is held with the Pathology Residents to review instructive teaching cases. A working consensus conference occurs twice weekly around a multiheaded microscope with all the renal pathology staff, renal pathology resident in rotation, fellows and technical director of the immunopathology laboratory.

CME Courses
Renal Pathology Annual Course, Columbia University (Vivette D'Agati, M.D., Course Director). USCAP Renal Pathology Subspecialty Session, Annual Meeting; Various International Renal Pathology and Transplant Pathology Workshops and Seminars.

Alumni Fellows

Shane Meehan, MD, Assistant Professor, Univ Chicago (1997-1998)
Akira Shimizu, MD, Assistant Professor, Japan (1997-1999)
Hiroshi Kobyashi, MD, Assistant Professor, Japan (1999-2000)
Volker Nickleit, MD, Assistant Professor, Univ. North Carolina (2001)
Shamila Mauiyyedi, Assistant Professor, Univ. Texas, Houston (2001)
R. Neal Smith, MD, PhD, Assistant Professor, MGH (2001)
Sam Rotman, MD , Assistant Professor, Univ. Lausanne (2004-2005)
Sonia Chicano, MD , Assistant Professor, National Kidney & Transplant Institute, Phillipines (2004-2005)
Lynn Cornell, MD, Assistant Professor, Mayo Clinic, Rochester MN (2005-2008)
Francisco Veronese, MD, Associate Professor, (2006)
Francesca Minnei, MD, Assistant Professor, Pisa, Italy (2008)
Brad Farris, MD, Assistant Professor, Emory University, Atlanta GA (2008-2009)
Diana Taheri, MD
Alesander Vasilyev, MD, PhD

Collaborations
Transplantation Unit (A.B. Cosimi, MD, Chief); Transplantation Biology Center (David H. Sachs, MD, Director), Renal Unit and Pediatric Service, various investigators.