• Use the ureter to orient the organ.  Measure and weigh the organ.  Measure the length of the ureter and renal vessels.
• Before opening the kidney, try to determine why it was removed, via the requisition form, the electronic medical record, or the submitting physician.  Common reasons for removal of a kidney not suspected of containing tumor include:  traumatic injury, hydronephrosis, cystic disease, rejected transplant, and non-functioning (end-stage) organ.
• For non-trauma pediatric cases, consult with the pediatric pathologist before sectioning the specimen.
• Cut the kidney sagittally, then strip the capsule and use scissors to open the pelvis, calyces, and ureter.  In cases of hydronephrosis, it is useful to inject the unopened kidney through the ureter (+/- renal artery) with formalin, then ligate the ureter (and artery) to prevent formalin from escaping, and allow it to “fix” overnight, submerged in formalin, before sectioning.
• Determine the presence or absence of pericapsular fat, its thickness, and adherence to the renal cortex.  Note the degree of ease or difficulty in stripping the capsule.  Examine the external surface of the kidney and describe its texture (smooth vs. pitted, size and shape of scars, number and size of cysts).  Measure the thickness of the cortex and medulla individually, note their color and the arrangement of cortical striations/medullary rays (orderly vs. inapparent), and assess whether the cortico-medullary junction is distinct.  Examine the pelvocalyceal system and ureter (dilatation/ blunting/stricture, stones – number/size/shape).  Note any abnormalities in the vessels (plaque, thrombus, stenosis).
• Take photographs before and after opening the kidney.
• If requested, submit stones for chemical analysis.

• Kidney parenchyma:  3 sections, one each from upper pole, lower pole, and between.  Include cortex and medulla in each.
• Pelvis:  2 sections from different areas.
• Ureter:  1 section.
• Lesion(s):  if present, include with at least some of the above sections.

Internal use only

Received in formalin, labeled _____ and “_____” is a left/right total nephrectomy specimen weighing __g and measuring __ x __ x __ cm.  There is no surrounding pericapsular fat.  The attached segment of ureter is __ cm in length x __ cm in diameter at the resection margin.  Renal vessels are cut flush with the pelvis and are ligated with suture.  The capsule strips with no/mild/much difficulty from the external surface, which is smooth/focally pitted/diffusely pitted and has no/some/extensive broad scarring up to __ cm in diameter.  There are__ cysts, ranging from __ to __ cm in diameter and filled with translucent yellow fluid, within the cortex/replacing the majority of the renal parenchyma.  The cortex is red-brown and __ cm in thickness, with orderly/inapparent striations.  The cortico-medullary junction is distinct.  The medulla is pink tan and __ cm in thickness, with orderly/inapparent rays.  The pelvis is/is not dilated to __ x __ cm, and the calyces are/are not blunted.  No stones are identified.  The ureter is patent and without lesions.

#__ = upper pole with cyst; __ pieces.

#__ = middle section of kidney; __ pieces.

#__ = lower pole with scar; __ pieces.

#__ & #__ = pelvis; __ pieces.

#__ = ureter at resection margin; __ pieces.

__blocks, __H&E