Drs. D’Agati and Mengel provide an excellent review on the history and evolution of kidney pathology. The article clearly highlights how the important contributions of nephropathologists have improved our understanding of kidney diseases and recognizes the landmark contributions of many of the most important figures in this field. Being a renal pathologist, the review reassured me of the role of our work. On the other hand, nephropathology is a collaboration with nephrology. I am fortunate to know most of the prominent figures in kidney pathology listed in the review. I learned a great deal from them through personal interaction and/or by reading their works. My other important sources of learning have been my nephrology colleagues, mainly through daily interactions, case discussions, and kidney biopsy conferences. My approach to kidney biopsy interpretation has been greatly influenced by them. One cannot become a good nephropathologist without insight into the clinical background of kidney disorders.

In my opinion, a truly excellent renal pathologist has to think, at least to some degree, as a nephrologist. Kidney biopsy interpretation is a complex task. One has to integrate light microscopy, immunofluorescence, and electron microscopy with the clinical findings to create a meaningful kidney biopsy report that can provide useful information to nephrologists. This interpretation can assist in designing the best treatment approaches. Early in my career, I calculated that the evaluation of an average kidney biopsy took me at least four hours of work. This time can be cut if the nephropathologist has excellent support personnel and modern digital technologies; still preparing a kidney biopsy report is time-consuming. Unfortunately, at some institutions, departmental administrators and even other pathologists may not fully appreciate and understand the complexity of our work. Therefore, we need the support of our nephrologist colleagues on two fronts: 1) The interaction between nephrologists and nephropathologists is crucial to optimizing the information gleaned from specimens. 2) Nephrologists need to support nephropathologists by emphasizing to pathology administrators how important and time-consuming their work is and how relevant their input is to patient management.

Tibor Nadasdy, MD
eAJKD Contributor and AJKD Kidney Biopsy Teaching Case Advisory Board member

Stay tuned for a nephrologist’s perspective on this article. To view the article (freely available), please visit AJKD.org.