NEW APPROACHES TO RENAL BIOPSY ASSESSMENT IN ACUTE-RENAL-FAILURE - EXTRAPOLATION FROM RENAL-TRANSPLANTATION

Although frequently considered synonymous with acute tubular necrosis, acute renal failure may be brought about by primary disease in any of the four histologic components of the kidney: glomerular, tubular, in terstitial, or vascular. It is reasonable to ask whether our current c lassification system of renal pathology and descriptive approach to re nal biopsy interpretation in this setting is optimal. Assessment of re nal transplant biopsies performed in the setting of acute dysfunction is becoming much more quantitative, therapy-oriented, pathogenesis-bas ed, and standardized. It would be highly beneficial to the field if si milar changes occurred in the approach to native kidney biopsies in ac ute renal failure. Tighter linkage should be established between promi sing new developments in the research laboratory and the clinical prac tice of renal pathology with creation of therapy-oriented classificati ons which employ standardized quantitative lesion assessment. In a fie ld largely limited to traditional empirical therapies, new pathogenesi s-oriented therapeutic approaches to native kidney acute renal failure and allied conditions should be developed based on the products of en lightened renal pathology research.