Renal Pathology

Renal Pathology

The Renal Pathology group, formerly led by Dr. Robert Colvin since 1975, and currently led by Dr. Yael K. Heher, has provided renal biopsy diagnostic services to Massachusetts General Hospital and outside nephrologists in the United States and abroad, and to the Transplant Center at Mass General Hospital. Alumni fellows of the Surgical Pathology Fellowship have generally become academic pathologists, several of whom hold prominent positions today.

Major research efforts since 1975 with colleagues in the Massachusetts General Hospital Transplant Center, and the Transplantation Biology Research Center (TBRC) laboratories have produced many important contributions to the diagnosis, pathogenesis, and treatment of renal allograft rejection, and are supported by several NIH and industrial grants. The TBRC Laboratories in the Center for Transplantation Sciences (CTS) comprises two laboratories: Genetic Engineering Laboratory and the Organ Transplantation Tolerance & Xenotransplantation Laboratory. New efforts in the Colvin Laboratory 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 mechanisms and in vivo assessment of fibrosis. These are funded by grants from the NIH, including program projects and several multicenter clinical trials grants.

Clinical Program

Case Mix

The Renal Pathology Service receives diagnostic biopsies from the Mass General  (72%) as well as outside consult cases. In 2019 approximately 600 biopsies and nephrectomies were examined, of which 24% were allografts. Primary and second opinion cases are sent to us from all over the United States and abroad. The Renal service is the reference diagnostic pathology site for several NIH and industry-sponsored multicenter trials, which typically provide 300 to 500 additional samples per year. The laboratory receives thousands of serum samples for reference testing for anti-GBM antibodies, ANCA and anti-PLA2R.

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 Mass General (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. The Nanostring nCounter platform has been introduced into clinical research for transcript analysis of renal biopsies, using the Human Organ Transplant (HOT) panel developed by Dr. Colvin, Smith and Rosales and an international consortium.

Teaching and Educational Activities

Clinical

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. Read more about the

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

• The Cosimi/Kawai Laboratory in the Center for Transplantation Sciences (CTS) (A. Benedict Cosimi, MD, Senior Investigator, Co-Head)
• Transplantation Biology Research Center (David H. Sachs, MD, Scientific Director)
• Cardiothoracic Transplantation Laboratory (Joren Madsen)

Faculty

• Yael K. Heher, MD - Subspecialty Head of the Renal Pathology Service
• Robert B. Colvin, MD
• R. Neal Smith, MD, PhD

• Veronica Klepeis, MD, PhD