This video demonstrates the essential and time-sensitive procedure for handling a fresh transplant kidney biopsy. Rapid processing is crucial to prevent tissue degradation and ensure diagnostic quality. The specimen must be triaged immediately into three sections for different microscopic studies: Electron Microscopy (EM), Light Microscopy (LM), and Immunofluorescence (IF). The tips of the cores, containing glomeruli, are fixed in Glutaraldehyde for EM. The remaining cores are prepared for LM using a specialized lens paper wrapping technique (avoiding sponges/bags) to prevent distortion, and the final portion is placed in Michelle's fixative for IF. The video stresses the importance of adequate fixative volume and consulting attending staff for poor-quality cores.
Handling a Fresh Transplant Kidney Biopsy
0:09 Critical Time Sensitivity: Handling a fresh kidney biopsy must be done quickly; the longer it remains unfixed or undivided, the more the quality degrades, potentially necessitating a repeat biopsy.
0:00 Biopsy Variation: Biopsies vary significantly in quality (core size/integrity). If unsure how to separate a poor-quality biopsy, always consult the attending physician first.
0:50 Fresh Specimen Handling: Fresh specimens (like transplant biopsies) must not be treated as routine samples (i.e., immediately placed in a cassette); ask questions about why it arrived fresh.
1:33 Electron Microscopy (EM) Sample: The first step is removing the tips of the cores, aiming for the areas containing glomeruli, and submitting them in Glutaraldehyde for EM.
2:20 Glutaraldehyde Requirements: Ensure there is plenty of Glutaraldehyde, as it penetrates tissue much slower than formalin.
3:13 Light Microscopy (LM) Sample: The smaller remaining cores are prepared for Light Microscopy. Crucially, do not use bags or sponges with fresh tissue as they cause distortion; use lens paper instead.
3:41 Lens Paper Folding Technique: The lens paper should be folded with overlapping corners ("bunny ears") to protect the sample and ensure the embedder can open the wrap easily without losing the minute sample.
4:33 Immunofluorescence (IF) Sample: The final portion of the sample is placed in its original labeled container and fixed using Michelle’s fixative for immunofluorescence.
5:19 Key Takeaway: Do not allow the biopsy to sit in saline for too long, as this will rapidly degrade the tissue.