Papel del patólogo ante los retos de la nefrología moderna. En busca de una solución

The high incidence of renal diseases leading to chronic renal failure is a serious health problem, due to their significant morbidity and significant financial burden on health care services. Despite the improvement in the outcome of renal transplants due to advances in diagnostic and therapeutic methods, the role of the pathologist and the overall importance of renal biopsy evaluation continues to be crucial. In recent years it has become evident that renal biopsy provides not only the histopathological diagnosis, but is also of paramount importance in establishing therapeutic and prognostic guidelines. The correct management of the biopsy is essential for an accurate diagnosis. Methods required for histopathological study of renal biopsies include routine light microscopy, immunofluorescence and/or immunohistochemistry, ultrastructural evaluation and, increasingly, the use of molecular biology. The maximum benefit should be obtained from any diagnostic test, for both scientific as well as ethical reasons, and due to the complicities of renal pathology and the high financial costs involved, a successful outcome can only be achieved with efficient and experienced renal pathologists. For this reason, subspecialization in almost all branches of pathology is increasingly becoming both an ethical requirement and a practical necessity. In Spain, hospital organization frequently results in duplication of services in different departments and thus many centres may examine only small numbers of samples, making it difficult for renal pathologists to improve their experience. A joint strategy is suggested to address this problem: centralization of the interpretation of renal biopsies in centres adequately equipped for multidisciplinary collaboration, together with the support of a nephropathology training programme with courses and fellowships sponsored by the various renal pathology associations or societies. This joint strategy is the only successful way to solve the problems and resolve the issues related to renal pathology.