Introduction:
Optimum diagnosis of kidney diseases requires light microscopy (LM), immunofluorescence (IF) and electron microscopy (EM) studies of renal tissue. The ultrastructural examination of kidney biopsies allows recognition of certain critical findings not detected by light microscopy.
Methods:
Objective: In this study, we assessed the role of electron microscopy in the diagnosis, excluding a differential diagnosis, prognostication, and guiding therapies for kidney diseases.
Material and Methods: This was a retro-prospective observational study conducted at our tertiary care referral center over a 2-year period (June 2022- July 2024). EM was done in the background of LM & IF for native kidney biopsies in cases where diagnosis made on the basis of LM & IF had remained unclear. The final diagnosis was based on EM and the primary LM and IF results were compared to those of EM in order to assess the contribution rate of EM to the final diagnosis. The role of EM was categorized as essential, supportive, or non-contributory.
Results:
During the study period a total of 460 renal biopsies were done, out of which in 42 patients EM study was performed. 45.2% (19/42) of them were male and 54.7% (23/42) were female with a median age of 28.45 year (4-60 years). The most common diagnosis was minimal change disease (35.7%), followed by focal segmental glomerulosclerosis (19%), infection related glomerulonephritis (11.9%), lupus nephritis and IgA nephropathy (9.5%). Overall, EM was essential in 19% (8/42), supportive in 66.6% (28/42), and non-contributory in 15% (6/42) of all the cases.
Conclusions:
In more than half of the patients EM study played an important role in the more accurate diagnosis of kidney diseases and helped in excluding a differential diagnosis. This role has been found to be more prominent in inherited diseases and podocytopathies. Failure to perform ultrastructural studies in such cases would result in an incorrect diagnosis with likely clinical consequences. Hence, EM should be recommended as a useful diagnostic tool for routine pathologic study of renal biopsies when possible.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.