How does the presence of the pathologist affect the tissue adequacy and what are the factors affecting the pathologist in proficiency assessment, during percutaneous kidney biopsy?

Objectives: For optimal histomorphological examination, adequacy of kidney biopsy tissue should be obtained. In this study, the effect of a pathologist informing the radiologist about tissue adequacy during the biopsy procedure on obtaining tissue adequacy was examined. Furthermore, we aimed to determine the criteria that the pathologist considered in determining tissue adequacy and the conditions affecting the decision to increase the number of core biopsies, as these have not been previously examined in the literature. Materials and Methods: Tissues containing less than 10 glomeruli were considered inadequate. In some patients, a pathologist accompanied the radiologist during the procedure. Tissue adequacy ratios and biopsy sample numbers were calculated between the two conditions. In the samples taken with the pathologist, the factors affecting the locality decision of the pathologist (cortex/medulla amount, presence of glomerular pathology(global, segmental, crescentic glomeruli) presence of tubular injury, proteinuria; interstitial inflammation and interstitial fibrosis/tubular atrophy ratios, account of normal glomeruli) were examined. Results: Giving tissue adequacy information during the biopsy procedure had a positive effect on tissue adequacy. The amount of cortex is one of the qualification criteria for the pathologist. The presence of proteinuria and 50% or more inflammation in tissues with sufficient cortex increased the number of biopsy samples. Conclusion: Determination of tissue adequacy during kidney biopsy is an important and necessary method. The amount of cortex is one of the important parameters in tissue adequacy.