Renal Pathology Society Survey of Global Renal Pathology Practice Variation in Pre-analytic and Analytic Phases.

PURPOSE: This study aims to examine current global renal biopsy pre-analytic and analytic variability according to country income status. Technology access, pathologist workforce, and case volume variations are evaluated and organized by country income status. The study identifies gaps in technology access and guideline variations. METHODS: The Renal Pathology Society membership was surveyed for general practice variables, tissue preparation, and processing for light, immunofluorescence, and electron microscopy between Aug 24, 2021, and Oct 22, 2021, with 66 questions. Respondent countries were stratified by income status using the World Bank classification. RESULTS: 126 members responded representing 47% North America, 26% Asia, 19% Europe, 4% South America, 3% Central America, 1% Australia, and 1% Africa. The majority process 500-1000, predominantly native kidney biopsies annually. Respondents from low-middle and upper-middle income status countries reported greater biopsies and fewer nephropathologists. There is significant variation in tissue processing and pathologic evaluation that further depended on country income status. Paraffin immunofluorescence is not widely available nor are THSD7A, collagen IV, and DNAJB9 immunostains. Electron microscopy is routine in ∼50% of biopsies. CONCLUSIONS: Based on country income status, there are major gaps in access to various technologies including electron microscopy, mass spectrometry, and genetic testing. Improved access to adequate resources is needed to standardize global renal biopsy practice. These data reveal many potential sources of variability across all processing phases and microscopic techniques. Further study is needed to understand the impact on renal pathology practice and diagnostics worldwide.