Archetype : openEHR-EHR-CLUSTER.microscopy_renal_biopsy_non_neoplastic

Norwegian openEHR Repository

Name

Microscopy renal biopsy non neoplastic

Description

Microscopic findings related to a non-neoplastic renal biopsy

Keywords

histopathology pathology renal laboratory

Purpose

To record detailed findings about a non-neoplastic renal biopsy

Use

To record detailed findings about microscopic examination of tissue related to glomerular, tubulointerstitial and vascular renal diseases. Use as a component archetype in the context of a suite of archetypes that make up a histopathology report i.e. OBSERVATION.lab_test.histopathology

Misuse

Not designed to be used within any other archetype other than OBSERVATION.lab_test.histopathology.

References

Chang A, Gibson IW, Cohen AH, Weening JW, Jennette JC, and Fogo AB (2012). A position paper on standardizing the nonneoplastic kidney biopsy report. Hum Pathol 43:1192-1196.

Farris AB, Adams CD, Brousaides N, Della Pelle PA, Collins AB, Moradi E, Smith RN, Grimm PC, and Colvin RB (2011). Morphometric and visual evaluation of fibrosis in renal biopsies. J Am Soc Nephrol 22:176-186.

Berden AE, Ferrario F, Hagen EC, Jayne DR, Jennette JC, Joh K, Neumann I, Noel LH, Pusey CD, Waldherr R, Bruijn JA, and Bajema IM (2010). Histopathologic classification of ANCA-associated glomerulonephritis. J Am Soc Nephrol 21:1628-1636.

Koss MN. Handling and interpretation of the medical renal biopsy (2014). Methods Mol Biol; 1180: 323-336

Racusen LC, Solez K, Colvin RB et al. The Banff 97 working classification of renal allograft pathology. Kidney International 1999; 55: 713-723

Solez K, Colvin RB, Racusen LC et al. Banff 07 classification of renal allograft pathology: Updates and future directions. American Journal of Transplantation 2008; 8: 753-760

Jennette JC, D'Agati VD, Olson JL, Silva F. Heptinstall's Pathology of the Kidney. LWW, Philadelphia: 2014;

Weening JJ, D'Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, Balow JE, Bruijn JA, Cook T, Ferrario F, Fogo AB, Ginzler EM, Hebert L, Hill G, Hill P, Jennette JC, Kong NC, Lesavre P, Lockshin M, Looi LM, Makino H, Moura LA, Nagata M. The classification of glomerulonephritis in systemic lupus erythematosus revisited. J Am Soc Nephrol. 2004 Feb;15(2):241-50. Erratum in: J Am Soc Nephrol. 2004 Mar;15(3):835-6.

Working Group of the International IgA Nephropathy Network and the Renal Pathology Society, Roberts IS, Cook HT, Troyanov S, Alpers CE, Amore A, Barratt J, Berthoux F, Bonsib S, Bruijn JA, Cattran DC, Coppo R, D'Agati V, D'Amico G, Emancipator S, Emma F, Feehally J, Ferrario F, Fervenza FC, Florquin S, Fogo A, Geddes CC, Groene HJ, Haas M, Herzenberg AM, Hill PA, Hogg RJ, Hsu SI, Jennette JC, Joh K, Julian BA, Kawamura T, Lai FM, Li LS, Li PK, Liu ZH, Mackinnon B, Mezzano S, Schena FP, Tomino Y, Walker PD, Wang H, Weening JJ, Yoshikawa N, Zhang H. The Oxford classification of IgA nephropathy: pathology definitions, correlations, and reproducibility. Kidney Int. 2009 Sep;76(5):546-56.

Archetype Id

openEHR-EHR-CLUSTER.microscopy_renal_biopsy_non_neoplastic.v0

Licencing

This work is licensed under the Creative Commons Attribution-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/4.0/.

Original Author

Sabine Leh
Haukeland University Hospital

Date Originally Authored

2014-06-08

Name	Card	Type	Description
Renal biopsy overall description	0..1	CLUSTER	Describes tissue types in the renal biopsy specimen. CLUSTER
Cortex	0..1	CHOICE OF DV_CODED_TEXT DV_QUANTITY DV_PROPORTION	Cortical tissue present, alternatively core length with cortical tissue, alternatively proportion of cortical tissue in relation to the core with renal tissue. Constraint for DV_CODED_TEXT Present [Cortical tissue present.] Absent [Cortical tissue absent.] Indeterminate [Presence of cortical tissue has not been determined.] DV_QUANTITY DV_PROPORTION
Medulla	0..1	CHOICE OF DV_CODED_TEXT DV_QUANTITY DV_PROPORTION	Medullary tissue present, alternatively core length with medullary tissue, alternatively proportion of medullary tissue in relation to the core with renal tissue. Constraint for DV_CODED_TEXT Present [Medullary tissue present.] Absent [Medullary tissue absent.] Indeterminate [Presence of medullary tissue has not been determined.] DV_QUANTITY DV_PROPORTION
Renale capsule	0..1	DV_TEXT	A statement whether the renal capsule is present.
Other tissue elements	0..1	CHOICE OF DV_CODED_TEXT DV_TEXT	Description of other tissue elements, e.g. muscle tissue. Constraint for DV_CODED_TEXT Sceletal muscle and/or fat tissue and/or connective tissue [Sceletal muscle and/or fat tissue and/or connective tissue present.] Renal pelvis mucosa [Renal pelvis mucosa present.]
Glomeruli	0..1	CLUSTER	Description of glomerular changes. CLUSTER
Glomeruli	0..1	DV_COUNT	The maximum number of glomeruli irrespective of size present in one section; structures consisting of Bowman's capsule with empty Bowman's space are excluded.
Scorable glomeruli	0..1	DV_COUNT	The number of glomeruli judged as adequate for scoring by the reporting pathologist.
Glomeruli solely with necrosis	0..1	DV_COUNT	The number of glomeruli showing fibrinoid necrosis without crescent formation.
Glomeruli with crescents	0..1	DV_COUNT	The number of glomeruli showing cellular or fibrocellular crescents.
Glomeruli with ischemic changes	0..1	DV_COUNT	The number of glomeruli showing some degree of tuft retraction and wrinkling of capillary walls. Chronic ischemic changes might show fibrosis of Bowman's capsule.
Glomeruli with adhesions	0..1	DV_COUNT	The number of glomeruli showing coneective tissue connections between the tuft and Bowman's capsule without overt sclerosis.
Glomeruli with segmental sclerosis	0..1	DV_COUNT	The number of glomeruli showing obliteration of capillary lumen by extracellular matrix in a portion of the tuft area with or without adhesions to the Bowman capsule, hyaline lesions, foam cells.
Glomeruli with global sclerosis	0..1	DV_COUNT	The number of glomeruli showing scarring with obliteration of capillary lumen by extracellular matrix in the entire or nearly entire glomerular tuft.
Normal glomeruli	0..1	DV_COUNT	The number of glomeruli which appear normal without major changes.
Mesangium	0..1	CLUSTER	Description of mesangial changes. CLUSTER
No abnormality detected	0..1	DV_BOOLEAN	Statement that no abnormality was detected on examination of the mesangial areas.
Details of the mesangium	0..1	DV_TEXT	A narrative description of mesangial changes.
Mesangial matrix increase	0..1	CHOICE OF DV_CODED_TEXT DV_BOOLEAN	Visual assessment of the amount of mesangial matrix. Constraint for DV_CODED_TEXT Absent [Mesangial matrix is not increased.] Slight [Mesangial matrix is slightly increased.] Moderate [Mesangial matrix is moderately increased.] Severe [Mesangial matrix is severely increased.] Equivocal [It is uncertain, whether mesangial matrix is increased.] Indeterminate [Mesangial matrix increase could not be assessed. e.g. due to bad morphology.]
Mesangial hypercellularity	0..1	CHOICE OF DV_CODED_TEXT DV_BOOLEAN	A visual assessment of the cellularity of the mesangium. Normally there are 1 - 3 cells per mesangial area. The score is based on the most cellular mesangial area. Mesangial areas adjacent to the vascular stalk should not be scored. Comment Definitions based on Roberts et al, 2009. Constraint for DV_CODED_TEXT Absent [There is no increase in mesangial cells.] Slight [There is a slight increase in mesangial cellularity, usually 4-5 cells per mesangial area.] Moderate [There is a moderate increase in mesangial cellularity, usually 6-7 cells per mesangial area.] Severe [There is a severe increase in mesangial cellularity, usually 8 or more cells per mesangial area.] Equivocal [It is uncertain whether there is an increase in mesangial cellularity or not.] Indeterminate [Mesangial cellularity could not be assessed, e.g. due to bad morphology or thick sections.]
Mesangial nodularity	0..1	CHOICE OF DV_CODED_TEXT DV_BOOLEAN	A visual assessment of the presence of acellular PAS positive mesangial nodules. Constraint for DV_CODED_TEXT Absent [Mesangial nodules are absent.] Present [Mesangial nodules are present.] Equivocal [It is uncertain whether mesangial nodules are present.] Indeterminate [Presence of mesangial nodules could not be assessed, e.g. because of bad sections.]
Capillaries	0..1	CLUSTER	Description of glomerular capillary changes. CLUSTER
No abnormality detected	0..1	DV_BOOLEAN	Statement that no abnormality was detected on examination of the glomerular capillaries.
Details of glomerular capillaries	0..1	DV_TEXT	A narrative description of glomerular capillary changes.
Capillary wall thickening	0..*	CHOICE OF DV_CODED_TEXT DV_BOOLEAN	A visual assessment of the capillary wall thickness. Constraint for DV_CODED_TEXT Absent [Glomerular capillary walls are not thickened.] Focal [Glomerular capillary walls are focally thickened.] Diffuse [Glomerular capillary walls are diffusely thickened.] Segmental [Glomerular capillary walls are segmentally thickened.] Global [Glomerular capillary walls are globally thickened.] Equivocal [It is uncertain whether glomerular capillary walls are thickened.] Indeterminate [Glomerular capillary wall thickness could not be assessed, e.g. due to section thickness.]
Capillary wall duplication	0..*	CHOICE OF DV_BOOLEAN DV_CODED_TEXT	A visual assessment of the presence of capillary wall duplication. Constraint for DV_CODED_TEXT Absent [Capillary wall duplication is not present.] Focal [Capillary wall duplication is focally present.] Diffuse [Capillary wall duplication is diffusely present.] Segmental [Capillary wall duplication is segmentally present.] Global [Capillary wall duplication is globally present.] Equivocal [It is unceratin whether capillary wall duplication is present.] Indeterminate [Capillary wall thickening could not be assessed, e.g. due to bad morphology.]
Mesangial cell interposition	0..1	CHOICE OF DV_TEXT DV_CODED_TEXT	A visual assesment of the presence of interposed cells in the capillary periphery. Constraint for DV_CODED_TEXT Present [Mesangial interposition is present.] Absent [Mesangial interposition is absent.] Equivocal [It is uncertain whether mesangial interposition is present.] Indeterminate [Mesangial interposition could not be assessed, e.g. because of bad sections.]
Capillary lumen	0..1	CLUSTER	Description of changes in the capillary lumens. CLUSTER
Thrombi	0..1	CLUSTER	Findings related to intracapillary thrombi. CLUSTER
Thrombi	0..1	CHOICE OF DV_CODED_TEXT DV_TEXT	Visual assessment of intracapillary thrombi. Constraint for DV_CODED_TEXT Absent [Intracapillary thrombi are absent.] Focal [Intracapillary thrombi are present in less than half of the glomeruli.] Diffuse [Intracapillary thrombi are present in more than half of the glomeruli.] Segmental [Intracapillary thrombi are present only in a part of the glomerular tuft.] Global [Intracapillary thrombi are present in the whole glomerular tuft.] Equivocal [It is uncertain whether intracapillary thrombi are present or not.] Indeterminate [Presence of intracapillary thrombi could not be assessed, e.g. because of bad sections.]
Thrombus type	0..1	DV_CODED_TEXT	Type of intracapillary thrombi. Constraint for DV_CODED_TEXT Hyalin [The intracapillary thrombi are mainly hyalinous.] Fibrin [The intracapillary thrombi consist mainly of fibrin.]
Endocapillary hypercellularity	0..1	CLUSTER	Findings related to endocapillary cellularity. CLUSTER
Endocapillary hypercellularity	0..1	CHOICE OF DV_CODED_TEXT DV_BOOLEAN	Visual assessment of endocapillary hypercellularity. Constraint for DV_CODED_TEXT Absent [Endocapillary hypercellularity is not present.] Focal [Endocapillary hypercellularity is focally present.] Diffuse [Endocapillary hypercellularity is diffusely present.] Segmental [Endocapillary hypercellularity is segmentally present.] Global [Endocapillary hypercellularity is globally present.] Equivocal [It is uncertain whether there is endocapillary hypercellularity.] Indeterminate [Endocapillary cellularity could not be assessed, e.g. due to bad morphology.]
Cell type	0..*	CHOICE OF DV_TEXT DV_CODED_TEXT	Composition of intracapillary cells. Constraint for DV_CODED_TEXT Endothelial cells [Endothelial cells are part of the intracapillary infiltrate.] Macrophages [Macrophages are part of the intracapillary infiltrate.] Neutrophil granulocytes [Neutrophil granulocytes are part of the intracapillary infiltrate.] Lymphocytes [Lymphocytes are part of the intracapillary infiltrate.] Atypical cells [Atypical cells are part of the intracapillary infiltrate.]
Podocytes	0..1	CLUSTER	Description of podocyte changes. CLUSTER
No abnormality detected	0..1	DV_BOOLEAN	Statement that no abnormality was detected on examination of podocytes.
Details of podocytes	0..1	DV_TEXT	A narrative description of podocyte changes.
Hypertrophy	0..1	CHOICE OF DV_CODED_TEXT DV_TEXT DV_BOOLEAN	Enlarged podocytes often with amphophil cytoplasm. Constraint for DV_CODED_TEXT Absent [Podocyte size is normal.] Slight [Podocytes are slightly enlarged.] Moderate [Podocytes are moderately enlarged.] Severe [Podocytes are severely enlarged.] Equivocal [It is uncertain whether podocyte size is normal or enlarged.] Indeterminate [Podocyte size could not be assessed, e.g. due to bad morphology.]
Bi- or multinucleated podocytes	0..1	DV_CODED_TEXT	Podocytes with 2 or more nuclei. Constraint for DV_CODED_TEXT Absent [Bi- or multinucleated podocytes are not seen.] Present [Bi- or multinucleated podocytes are seen.] Equivocal [Presence of bi- or mulitnucleated podocytes is equivocal.] Indeterminate [Presence of bi- or mulitnucleated podocytes has not been determined.]
Resorption droplets	0..1	DV_CODED_TEXT	Podocytes with PAS positive resorption droplets. Constraint for DV_CODED_TEXT Absent [Podocytes with resorption droplets are not present.] Singular cells [One or few podocytes with resorption droplets are present.] Numerous cells [Numerous podocytes with resorption droplets are present.] Equivocal [It is uncertain whether podocytes with resorption droplets are present or not.] Indeterminate [Presence of podocytes with resorption droplets could not be assessed, e.g. due tof bad morphology.]
Pseudocysts	0..1	DV_CODED_TEXT	Podocytes with pseudocysts. Constraint for DV_CODED_TEXT Absent [Podocytes with resorption droplets are not present.] Singular [One of few podocytes with resorption droplets are present.] Numerous [Numerous podocytes with resorption droplets are present.] Equivocal [It is uncertain whether podocytes with resorption droplets are present or not.] Indeterminate [Presence of podocytes with resorption droplets could not be assessed, e.g. due to bad morphology.]
Details of specific glomerular changes	0..*	Slot (Cluster)	Slot for detailed description of specific glomerular changes. Include: openEHR-EHR-CLUSTER.glomerulus_segmental_glomerulosclerosis_classification.v1. Slot Slot
Description of glomeruli	0..1	DV_TEXT	A narrative description of glomerular findings, e.g. mesangial and endocapillary cellularity, capillary wall changes, podocytes, Bowman's space. For structured description of specific renal diseases use appropriate cluster (IgA nephropathy, lupus nephritis).
Tubules	0..1	CLUSTER	Description of tubular changes. CLUSTER
No abnormality detected	0..1	DV_BOOLEAN	A statement that no abnormality was detected in renal tubules.
Tubular epithelial cell changes	0..*	DV_CODED_TEXT	Description of tubular epithelial cell changes. Multiple choices possible. Constraint for DV_CODED_TEXT Hyaline droplet change [PAS positive absorption droplets in the epithelium of proximal tubules, usually indicating glomerular proteinuria.] Fine vacuolization [Fine, even vacuolization of the proximal tubular epithelium. Hydropic change is a synonym. If related to infusion of hypertonic solutions, the change is also described as osmotic nephrosis. If related to cyclosporin therapy, the change is called isometric vacuolization.] Coarse vacuolization [Irregular and coarse vacuolization of the tubular epithelium. The change might be associated with hypokaliemia or tubulotoxicity.] Fatty change [Fine vacuoles containing lipid, often at the base of the tubular epithelial cells. Fat can be demonstrated by lipid stains on frozen sections.] Giant mitochondria [Enlarged mitochondria visuable as eosinophilic bodies in tubular epithelial cells.]
Casts in tubules	0..*	DV_CODED_TEXT	Choose the type of casts present in tubuli. Multiple choices possible. Constraint for DV_CODED_TEXT Tamm Horsfall protein [Presence of intratubular Tamm Horsfall protein.] Hyaline casts [Presence of hyalin casts in tubular lumen.] Granular casts [Presence of granular casts in tubular lumen.] Detached cells [Detached cells, commonly epithelial cells, present in the tubular lumen.] Red blood cells [Collections of red blood cells or red blood cell casts present in tubular lumen.] Granulocytes [Presence of neutrophil granulocytes in tubular lumen.] Mixed casts [Casts consisting of more than one component.] Pigmented casts [Discolorated casts e.g. due to hemoglobin, myoglobin, drug pigments, bilirubin, melanin.] Myeloma casts [Characteristic myeloma casts, often surrounded by reactive tubular epithelial cells. or multinucleated cells, present in tubular lumen.] Crystals [Crystals present in tubular lumen.]
Tubular casts	0..1	CLUSTER	Structured report of kind of tubular casts present. CLUSTER
Tamm Horsfall protein	0..1	DV_BOOLEAN	Presence of intratubular Tamm Horsfall protein.
Hyaline casts	0..1	DV_BOOLEAN	Presence of hyalin casts in tubular lumen.
Granular casts	0..1	DV_BOOLEAN	Presence of granular casts in tubular lumen.
Detached cells	0..1	DV_BOOLEAN	Detached cells, commonly epithelial cells, present in the tubular lumen.
Red blood cells	0..1	DV_BOOLEAN	Collections of red blood cells or red blood cell casts present in tubular lumen.
Granulocytes	0..1	DV_BOOLEAN	Presence of neutrophil granulocytes in tubular lumen.
Mixed casts	0..1	DV_BOOLEAN	Casts consisting of more than one component.
Pigmented casts	0..1	DV_BOOLEAN	Discolorated casts e.g. due to hemoglobin, myoglobin, drug pigments, bilirubin, melanin.
Myeloma casts	0..1	DV_BOOLEAN	Characteristic myeloma casts, often surrounded by reactive tubular epithelial cells. or multinucleated cells, present in tubular lumen.
Crystals	0..1	DV_BOOLEAN	Crystals present in tubular lumen.
Tubular atrophy	0..1	CLUSTER	Semiquantitative or quantitative assessment of tubular atrophy. CLUSTER
Tubular atrophy semiquantitative	0..1	DV_CODED_TEXT	Semiquantitative visual assessment of tubular atrophy. Constraint for DV_CODED_TEXT Absent [Tubular atrophy is not present or minimal (few transsections).] Slight [Tubular atrophy in up to 25 % of the area of cortical tubules.] Moderate [Tubular atrophy involving 25 - 50% of the area of cortical tubules.] Severe [Tubular atrophy present in more than 50% of the area of cortical tubules.] Indeterminate [Tubular atrophy could not be assessed, e.g. due to bad sections.]
Tubules description	0..1	DV_TEXT	Desription of tubular changes, e.g. hyalin droplet change, acute epithelial damage, cytoplasmic vacuolation, sloughing of cells, loss of brush border.
Interstitium	0..1	CLUSTER	Interstitial changes, especially semiquantitative or quantitative assessment of interstitial fibrosis. CLUSTER
No abnormality detected	0..1	DV_BOOLEAN	A statement that no abnormality was detected in the renal interstitium.
Quantification of interstitial fibrosis	0..1	CLUSTER	Quantification of interstitial fibrosis by image analysis methods. CLUSTER
Image analysis details	0..*	Slot (Cluster)	To record details of the image analysis, e.g. software, algorithm. Slot Slot
Technique	0..1	CHOICE OF DV_CODED_TEXT DV_TEXT	Technique used to quantify fibrosis. Constraint for DV_CODED_TEXT Sirius red unpolarized [Sirius red stain unpolarized used for fibrosis quantification by image analysis] Sirius red polarized [Sirius red stain polarized used for fibrosis quantification by image analysis] Collagen III immunohistochemistry [Collagen III immunohistochemical stain used for fibrosis quantification by image analysis]
Percentage interstitial fibrosis	0..1	DV_QUANTITY	Percentage of the renal cortical tissue involved by fibrosis. DV_QUANTITY
Multimedia representation of image analysis	0..1	DV_MULTIMEDIA	Images, graphs and tables from automatic image analysis of interstitial fibrosis. DV_MULTIMEDIA
Cortical area with fibrosis estimated	0..1	DV_QUANTITY	Visual quantification of interstitial fibrosis; The fibrosis percentage is the percentage of abnormal cortical tissue with fibrosis. DV_QUANTITY
Fibrous tissue estimated	0..1	DV_QUANTITY	Visual quantification of interstitial fibrosis; The fibrosis percentage is the percentage of all cortical tissue (excluding tubules and glomeruli) occupied by fibrous tissue. DV_QUANTITY
Interstitium description	0..1	DV_TEXT	Description of interstitial changes, e.g. edema, inflammatory cells, deposits.
Vasculature	0..1	CLUSTER	Changes affecting arteries, arterioles, venes and peritubular capillaries. CLUSTER
No abnormality detected	0..1	DV_BOOLEAN	A statement that no abnormality was detected in the renal vasculature.
Number of arteries	0..1	DV_COUNT	Number of arteries in a renal biopsy.
Arteriosclerosis	0..1	CHOICE OF DV_CODED_TEXT DV_TEXT	Amount of arteriosclerosis in the most affected vessel. Constraint for DV_CODED_TEXT Not present/minimal [There is no intimal sclerosis or intimal sclerosis is minimal.] Mild [There is < 25% lumen narrowing by intimal fibrosis.] Moderate [There is 25% - 50% lumen narrowing by intimal fibrosis.] Severe [There is > 50% lumen narrowing by intimal fibrosis.]
Arteriolosclerosis	0..1	CHOICE OF DV_TEXT DV_CODED_TEXT	Amount of arteriolosclerosis in the most affected vessel. Constraint for DV_CODED_TEXT Absent [Arteriolosclerosis not present.] Present - nodular [Nodular arteriolosclerosis is present.] Present - circumferential [Circumferential arteriolosclerosis is present.]
Vasculature description	0..1	DV_TEXT	Description of vascular changes, e.g. vasculitis, venulitis. For description of severity of arteriosclerosis and arteriolosclerosis use coded text.
Amyloid	0..1	CLUSTER	Findings related to amyloid deposition. CLUSTER
Amyloid not detected	0..1	DV_BOOLEAN	A statement that no amyloid deposition was detected.
Details of amyloid deposition	0..*	Slot (Cluster)	Slot for detailed description of specific glomerular changes. Include: openEHR-EHR-CLUSTER.amyloid_deposition.v1 Slot Slot
Specific clinical situations	0..*	Slot (Cluster)	Detailed structured description for specific clinical situations, e.g. biopsy of renal transplant, lupus nephritis, IgA nephropathy. Slot Slot
Multimedia representation	0..1	DV_MULTIMEDIA	Images from lesions could be attached here. DV_MULTIMEDIA

archetype (adl_version=1.4; uid=324df9ac-fdc6-4e36-ae8f-b78755354d87)
	openEHR-EHR-CLUSTER.microscopy_renal_biopsy_non_neoplastic.v0

concept
	[at0000]	-- Microscopy renal biopsy non neoplastic
language
	original_language = <[ISO_639-1::en]>
description
	original_author = <
		["name"] = <"Sabine Leh">
		["organisation"] = <"Haukeland University Hospital">
		["email"] = <"sabine.leh@helse-bergen.no">
		["date"] = <"2014-06-08">
	>
	details = <
		["en"] = <
			language = <[ISO_639-1::en]>
			purpose = <"To record detailed findings about a non-neoplastic renal biopsy">
			use = <"To record detailed findings about microscopic examination of tissue related to glomerular, tubulointerstitial and vascular renal diseases. Use as a component archetype in the context of a suite of archetypes that make up a histopathology report i.e. OBSERVATION.lab_test.histopathology">
			keywords = <"histopathology", "pathology", "renal", "laboratory">
			misuse = <"Not designed to be used within any other archetype other than OBSERVATION.lab_test.histopathology.">
			copyright = <"© Nasjonal IKT HF">
		>
	>
	lifecycle_state = <"in_development">
	other_contributors = <>
	other_details = <
		["licence"] = <"This work is licensed under the Creative Commons Attribution-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/4.0/.">
		["custodian_organisation"] = <"Nasjonal IKT">
		["references"] = <"Chang A, Gibson IW, Cohen AH, Weening JW, Jennette JC, and Fogo AB (2012). A position paper on standardizing the nonneoplastic kidney biopsy report. Hum Pathol 43:1192-1196.

Farris AB, Adams CD, Brousaides N, Della Pelle PA, Collins AB, Moradi E, Smith RN, Grimm PC, and Colvin RB (2011). Morphometric and visual evaluation of fibrosis in renal biopsies. J Am Soc Nephrol 22:176-186.

Berden AE, Ferrario F, Hagen EC, Jayne DR, Jennette JC, Joh K, Neumann I, Noel LH, Pusey CD, Waldherr R, Bruijn JA, and Bajema IM (2010). Histopathologic classification of ANCA-associated glomerulonephritis. J Am Soc Nephrol 21:1628-1636.

Koss MN. Handling and interpretation of the medical renal biopsy (2014). Methods Mol Biol; 1180: 323-336

Racusen LC, Solez K, Colvin RB et al. The Banff 97 working classification of renal allograft pathology. Kidney International 1999; 55: 713-723

Solez K, Colvin RB, Racusen LC et al. Banff 07 classification of renal allograft pathology: Updates and future directions. American Journal of Transplantation 2008; 8: 753-760
Jennette JC, D'Agati VD, Olson JL, Silva F. Heptinstall's Pathology of the Kidney.  LWW, Philadelphia: 2014;

Weening JJ, D'Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, Balow JE, Bruijn JA, Cook T, Ferrario F, Fogo AB, Ginzler EM, Hebert L, Hill G, Hill P, Jennette JC, Kong NC, Lesavre P, Lockshin M, Looi LM, Makino H, Moura LA, Nagata M. The classification of glomerulonephritis in systemic lupus erythematosus revisited. J Am Soc Nephrol. 2004 Feb;15(2):241-50. Erratum in: J Am Soc Nephrol. 2004 Mar;15(3):835-6.

Working Group of the International IgA Nephropathy Network and the Renal Pathology Society, Roberts IS, Cook HT, Troyanov S, Alpers CE, Amore A, Barratt J, Berthoux F, Bonsib S, Bruijn JA, Cattran DC, Coppo R, D'Agati V, D'Amico G, Emancipator S, Emma F, Feehally J, Ferrario F, Fervenza FC, Florquin S, Fogo A, Geddes CC, Groene HJ, Haas M, Herzenberg AM, Hill PA, Hogg RJ, Hsu SI, Jennette JC, Joh K, Julian BA, Kawamura T, Lai FM, Li LS, Li PK, Liu ZH, Mackinnon B, Mezzano S, Schena FP, Tomino Y, Walker PD, Wang H, Weening JJ, Yoshikawa N, Zhang H. The Oxford classification of IgA nephropathy: pathology definitions, correlations, and reproducibility. Kidney Int. 2009 Sep;76(5):546-56.

">
		["current_contact"] = <"Sabine Leh, Haukeland University Hospital, sabine.leh@helse-bergen.no">
		["original_namespace"] = <"no.nasjonalikt">
		["original_publisher"] = <"Nasjonal IKT">
		["custodian_namespace"] = <"no.nasjonalikt">
		["MD5-CAM-1.0.1"] = <"45ED5CF84F253443E59D1D1B2084F07C">
		["build_uid"] = <"be1b5cc5-9918-4c14-99ff-1709f66d79f4">
		["revision"] = <"0.0.1-alpha">
	>

definition
	CLUSTER[at0000] matches {	-- Microscopy renal biopsy non neoplastic
		items cardinality matches {1..*; unordered} matches {
			CLUSTER[at0001] occurrences matches {0..1} matches {	-- Renal biopsy overall description
				items cardinality matches {1..*; unordered} matches {
					ELEMENT[at0003] occurrences matches {0..1} matches {	-- Cortex
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0004, 	-- Present
									at0005, 	-- Absent
									at0006]	-- Indeterminate
								}
							}
							C_DV_QUANTITY <
								property = <[openehr::122]>
								list = <
									["1"] = <
										units = <"mm">
									>
								>
							>
							DV_PROPORTION matches {
								is_integral matches {True}
								type matches {2}
							}
						}
					}
					ELEMENT[at0007] occurrences matches {0..1} matches {	-- Medulla
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0008, 	-- Present
									at0009, 	-- Absent
									at0010]	-- Indeterminate
								}
							}
							C_DV_QUANTITY <
								property = <[openehr::122]>
								list = <
									["1"] = <
										units = <"mm">
									>
								>
							>
							DV_PROPORTION matches {
								is_integral matches {True}
								type matches {2}
							}
						}
					}
					ELEMENT[at0011] occurrences matches {0..1} matches {	-- Renale capsule
						name matches {
							DV_TEXT matches {*}
						}
						value matches {
							DV_BOOLEAN matches {
								value matches {True, False}
							}
						}
					}
					ELEMENT[at0012] occurrences matches {0..1} matches {	-- Other tissue elements
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0013, 	-- Sceletal muscle and/or fat tissue and/or connective tissue
									at0014]	-- Renal pelvis mucosa
								}
							}
							DV_TEXT matches {*}
						}
					}
				}
			}
			CLUSTER[at0015] occurrences matches {0..1} matches {	-- Glomeruli
				items cardinality matches {1..*; unordered} matches {
					ELEMENT[at0016] occurrences matches {0..1} matches {	-- Glomeruli
						value matches {
							DV_COUNT matches {*}
						}
					}
					ELEMENT[at0017] occurrences matches {0..1} matches {	-- Scorable glomeruli
						value matches {
							DV_COUNT matches {*}
						}
					}
					ELEMENT[at0019] occurrences matches {0..1} matches {	-- Glomeruli solely with necrosis
						value matches {
							DV_COUNT matches {*}
						}
					}
					ELEMENT[at0020] occurrences matches {0..1} matches {	-- Glomeruli with crescents
						value matches {
							DV_COUNT matches {*}
						}
					}
					ELEMENT[at0021] occurrences matches {0..1} matches {	-- Glomeruli with ischemic changes
						value matches {
							DV_COUNT matches {*}
						}
					}
					ELEMENT[at0208] occurrences matches {0..1} matches {	-- Glomeruli with adhesions
						value matches {
							DV_COUNT matches {*}
						}
					}
					ELEMENT[at0022] occurrences matches {0..1} matches {	-- Glomeruli with segmental sclerosis
						value matches {
							DV_COUNT matches {*}
						}
					}
					ELEMENT[at0023] occurrences matches {0..1} matches {	-- Glomeruli with global sclerosis
						value matches {
							DV_COUNT matches {*}
						}
					}
					ELEMENT[at0024] occurrences matches {0..1} matches {	-- Normal glomeruli
						value matches {
							DV_COUNT matches {*}
						}
					}
					CLUSTER[at0115] occurrences matches {0..1} matches {	-- Mesangium
						items cardinality matches {1..*; unordered} matches {
							ELEMENT[at0116] occurrences matches {0..1} matches {	-- No abnormality detected
								value matches {
									DV_BOOLEAN matches {
										value matches {True, False}
									}
								}
							}
							ELEMENT[at0118] occurrences matches {0..1} matches {	-- Details of the mesangium
								value matches {
									DV_TEXT matches {*}
								}
							}
							ELEMENT[at0119] occurrences matches {0..1} matches {	-- Mesangial matrix increase
								value matches {
									DV_CODED_TEXT matches {
										defining_code matches {
											[local::
											at0120, 	-- Absent
											at0121, 	-- Slight
											at0122, 	-- Moderate
											at0123, 	-- Severe
											at0124, 	-- Equivocal
											at0126]	-- Indeterminate
										}
									}
									DV_BOOLEAN matches {
										value matches {True, False}
									}
								}
							}
							ELEMENT[at0128] occurrences matches {0..1} matches {	-- Mesangial hypercellularity
								value matches {
									DV_CODED_TEXT matches {
										defining_code matches {
											[local::
											at0129, 	-- Absent
											at0130, 	-- Slight
											at0131, 	-- Moderate
											at0132, 	-- Severe
											at0133, 	-- Equivocal
											at0134]	-- Indeterminate
										}
									}
									DV_BOOLEAN matches {
										value matches {True, False}
									}
								}
							}
							ELEMENT[at0193] occurrences matches {0..1} matches {	-- Mesangial nodularity
								value matches {
									DV_CODED_TEXT matches {
										defining_code matches {
											[local::
											at0194, 	-- Absent
											at0195, 	-- Present
											at0196, 	-- Equivocal
											at0197]	-- Indeterminate
										}
									}
									DV_BOOLEAN matches {
										value matches {True, False}
									}
								}
							}
						}
					}
					CLUSTER[at0138] occurrences matches {0..1} matches {	-- Capillaries
						items cardinality matches {1..*; unordered} matches {
							ELEMENT[at0139] occurrences matches {0..1} matches {	-- No abnormality detected
								value matches {
									DV_BOOLEAN matches {
										value matches {True, False}
									}
								}
							}
							ELEMENT[at0142] occurrences matches {0..1} matches {	-- Details of glomerular capillaries
								value matches {
									DV_TEXT matches {*}
								}
							}
							ELEMENT[at0140] occurrences matches {0..*} matches {	-- Capillary wall thickening
								value matches {
									DV_CODED_TEXT matches {
										defining_code matches {
											[local::
											at0143, 	-- Absent
											at0144, 	-- Focal
											at0145, 	-- Diffuse
											at0146, 	-- Segmental
											at0147, 	-- Global
											at0148, 	-- Equivocal
											at0149]	-- Indeterminate
										}
									}
									DV_BOOLEAN matches {
										value matches {True, False}
									}
								}
							}
							ELEMENT[at0150] occurrences matches {0..*} matches {	-- Capillary wall duplication
								value matches {
									DV_BOOLEAN matches {
										value matches {True, False}
									}
									DV_CODED_TEXT matches {
										defining_code matches {
											[local::
											at0151, 	-- Absent
											at0152, 	-- Focal
											at0153, 	-- Diffuse
											at0154, 	-- Segmental 
											at0155, 	-- Global
											at0156, 	-- Equivocal
											at0157]	-- Indeterminate
										}
									}
								}
							}
							ELEMENT[at0188] occurrences matches {0..1} matches {	-- Mesangial cell interposition
								value matches {
									DV_TEXT matches {*}
									DV_CODED_TEXT matches {
										defining_code matches {
											[local::
											at0189, 	-- Present
											at0190, 	-- Absent
											at0191, 	-- Equivocal
											at0192]	-- Indeterminate
										}
									}
								}
							}
							CLUSTER[at0159] occurrences matches {0..1} matches {	-- Capillary lumen
								items cardinality matches {1..*; unordered} matches {
									CLUSTER[at0184] occurrences matches {0..1} matches {	-- Thrombi
										items cardinality matches {1..*; unordered} matches {
											ELEMENT[at0168] occurrences matches {0..1} matches {	-- Thrombi
												value matches {
													DV_CODED_TEXT matches {
														defining_code matches {
															[local::
															at0169, 	-- Absent
															at0178, 	-- Focal
															at0179, 	-- Diffuse
															at0180, 	-- Segmental
															at0181, 	-- Global
															at0182, 	-- Equivocal
															at0183]	-- Indeterminate
														}
													}
													DV_TEXT matches {*}
												}
											}
											ELEMENT[at0185] occurrences matches {0..1} matches {	-- Thrombus type
												value matches {
													DV_CODED_TEXT matches {
														defining_code matches {
															[local::
															at0186, 	-- Hyalin
															at0187]	-- Fibrin
														}
													}
												}
											}
										}
									}
									CLUSTER[at0170] occurrences matches {0..1} matches {	-- Endocapillary hypercellularity
										items cardinality matches {1..*; unordered} matches {
											ELEMENT[at0160] occurrences matches {0..1} matches {	-- Endocapillary hypercellularity
												value matches {
													DV_CODED_TEXT matches {
														defining_code matches {
															[local::
															at0161, 	-- Absent
															at0162, 	-- Focal
															at0163, 	-- Diffuse
															at0164, 	-- Segmental
															at0165, 	-- Global
															at0166, 	-- Equivocal
															at0167]	-- Indeterminate
														}
													}
													DV_BOOLEAN matches {
														value matches {True, False}
													}
												}
											}
											ELEMENT[at0171] occurrences matches {0..*} matches {	-- Cell type
												value matches {
													DV_TEXT matches {*}
													DV_CODED_TEXT matches {
														defining_code matches {
															[local::
															at0172, 	-- Endothelial cells
															at0173, 	-- Macrophages
															at0174, 	-- Neutrophil granulocytes
															at0175, 	-- Lymphocytes
															at0176]	-- Atypical cells
														}
													}
												}
											}
										}
									}
								}
							}
						}
					}
					CLUSTER[at0088] occurrences matches {0..1} matches {	-- Podocytes
						items cardinality matches {1..*; unordered} matches {
							ELEMENT[at0117] occurrences matches {0..1} matches {	-- No abnormality detected
								value matches {
									DV_BOOLEAN matches {
										value matches {True, False}
									}
								}
							}
							ELEMENT[at0125] occurrences matches {0..1} matches {	-- Details of podocytes
								value matches {
									DV_TEXT matches {*}
								}
							}
							ELEMENT[at0089] occurrences matches {0..1} matches {	-- Hypertrophy
								value matches {
									DV_CODED_TEXT matches {
										defining_code matches {
											[local::
											at0091, 	-- Absent
											at0092, 	-- Slight
											at0093, 	-- Moderate
											at0094, 	-- Severe
											at0113, 	-- Equivocal
											at0114]	-- Indeterminate
										}
									}
									DV_TEXT matches {*}
									DV_BOOLEAN matches {
										value matches {True, False}
									}
								}
							}
							ELEMENT[at0096] occurrences matches {0..1} matches {	-- Bi- or multinucleated podocytes
								value matches {
									DV_CODED_TEXT matches {
										defining_code matches {
											[local::
											at0097, 	-- Absent
											at0098, 	-- Present
											at0100, 	-- Equivocal
											at0099; 	-- Indeterminate
											at0097]	-- assumed value
										}
									}
								}
							}
							ELEMENT[at0101] occurrences matches {0..1} matches {	-- Resorption droplets
								value matches {
									DV_CODED_TEXT matches {
										defining_code matches {
											[local::
											at0102, 	-- Absent
											at0103, 	-- Singular cells
											at0104, 	-- Numerous cells
											at0106, 	-- Equivocal
											at0105]	-- Indeterminate
										}
									}
								}
							}
							ELEMENT[at0107] occurrences matches {0..1} matches {	-- Pseudocysts
								value matches {
									DV_CODED_TEXT matches {
										defining_code matches {
											[local::
											at0108, 	-- Absent
											at0109, 	-- Singular
											at0110, 	-- Numerous
											at0111, 	-- Equivocal 
											at0112]	-- Indeterminate
										}
									}
								}
							}
						}
					}
					allow_archetype CLUSTER[at0028] occurrences matches {0..*} matches {	-- Details of specific  glomerular changes
						include
							archetype_id/value matches {/.*/}
					}
					ELEMENT[at0026] occurrences matches {0..1} matches {	-- Description of glomeruli
						value matches {
							DV_TEXT matches {*}
						}
					}
				}
			}
			CLUSTER[at0029] occurrences matches {0..1} matches {	-- Tubules
				items cardinality matches {1..*; unordered} matches {
					ELEMENT[at0209] occurrences matches {0..1} matches {	-- No abnormality detected
						value matches {
							DV_BOOLEAN matches {
								value matches {True, False}
							}
						}
					}
					ELEMENT[at0202] occurrences matches {0..*} matches {	-- Tubular epithelial cell changes
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0203, 	-- Hyaline droplet change
									at0204, 	-- Fine vacuolization
									at0205, 	-- Coarse vacuolization
									at0206, 	-- Fatty change
									at0207]	-- Giant mitochondria
								}
							}
						}
					}
					ELEMENT[at0080] occurrences matches {0..*} matches {	-- Casts in tubules
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0032, 	-- Tamm Horsfall protein
									at0033, 	-- Hyaline casts
									at0034, 	-- Granular casts
									at0035, 	-- Detached cells
									at0036, 	-- Red blood cells
									at0037, 	-- Granulocytes
									at0081, 	-- Mixed casts
									at0082, 	-- Pigmented casts
									at0031, 	-- Myeloma casts
									at0038]	-- Crystals
								}
							}
						}
					}
					CLUSTER[at0030] occurrences matches {0..1} matches {	-- Tubular casts
						items cardinality matches {1..*; unordered} matches {
							ELEMENT[at0032] occurrences matches {0..1} matches {	-- Tamm Horsfall protein
								value matches {
									DV_BOOLEAN matches {
										value matches {True, False}
									}
								}
							}
							ELEMENT[at0033] occurrences matches {0..1} matches {	-- Hyaline casts
								value matches {
									DV_BOOLEAN matches {
										value matches {True, False}
									}
								}
							}
							ELEMENT[at0034] occurrences matches {0..1} matches {	-- Granular casts
								value matches {
									DV_BOOLEAN matches {
										value matches {True, False}
									}
								}
							}
							ELEMENT[at0035] occurrences matches {0..1} matches {	-- Detached cells
								value matches {
									DV_BOOLEAN matches {
										value matches {True, False}
									}
								}
							}
							ELEMENT[at0036] occurrences matches {0..1} matches {	-- Red blood cells
								value matches {
									DV_BOOLEAN matches {
										value matches {True, False}
									}
								}
							}
							ELEMENT[at0037] occurrences matches {0..1} matches {	-- Granulocytes
								value matches {
									DV_BOOLEAN matches {
										value matches {True, False}
									}
								}
							}
							ELEMENT[at0081] occurrences matches {0..1} matches {	-- Mixed casts
								value matches {
									DV_BOOLEAN matches {
										value matches {True, False}
									}
								}
							}
							ELEMENT[at0082] occurrences matches {0..1} matches {	-- Pigmented casts
								value matches {
									DV_BOOLEAN matches {
										value matches {True, False}
									}
								}
							}
							ELEMENT[at0031] occurrences matches {0..1} matches {	-- Myeloma casts
								value matches {
									DV_BOOLEAN matches {
										value matches {True, False}
									}
								}
							}
							ELEMENT[at0038] occurrences matches {0..1} matches {	-- Crystals
								value matches {
									DV_BOOLEAN matches {
										value matches {True, False}
									}
								}
							}
						}
					}
					CLUSTER[at0041] occurrences matches {0..1} matches {	-- Tubular atrophy
						items cardinality matches {1..*; unordered} matches {
							ELEMENT[at0042] occurrences matches {0..1} matches {	-- Tubular atrophy semiquantitative
								value matches {
									DV_CODED_TEXT matches {
										defining_code matches {
											[local::
											at0043, 	-- Absent
											at0044, 	-- Slight
											at0045, 	-- Moderate
											at0046, 	-- Severe
											at0047]	-- Indeterminate
										}
									}
								}
							}
						}
					}
					ELEMENT[at0048] occurrences matches {0..1} matches {	-- Tubules description
						value matches {
							DV_TEXT matches {*}
						}
					}
				}
			}
			CLUSTER[at0049] occurrences matches {0..1} matches {	-- Interstitium
				items cardinality matches {1..*; unordered} matches {
					ELEMENT[at0210] occurrences matches {0..1} matches {	-- No abnormality detected
						value matches {
							DV_BOOLEAN matches {
								value matches {True, False}
							}
						}
					}
					CLUSTER[at0050] occurrences matches {0..1} matches {	-- Quantification of interstitial fibrosis
						items cardinality matches {1..*; unordered} matches {
							allow_archetype CLUSTER[at0051] occurrences matches {0..*} matches {	-- Image analysis details
								include
									archetype_id/value matches {/.*/}
							}
							ELEMENT[at0052] occurrences matches {0..1} matches {	-- Technique
								value matches {
									DV_CODED_TEXT matches {
										defining_code matches {
											[local::
											at0053, 	-- Sirius red unpolarized
											at0054, 	-- Sirius red polarized
											at0055]	-- Collagen III immunohistochemistry
										}
									}
									DV_TEXT matches {*}
								}
							}
							ELEMENT[at0056] occurrences matches {0..1} matches {	-- Percentage interstitial fibrosis
								value matches {
									C_DV_QUANTITY <
										property = <[openehr::507]>
										list = <
											["1"] = <
												units = <"%">
											>
										>
									>
								}
							}
							ELEMENT[at0079] occurrences matches {0..1} matches {	-- Multimedia representation of image analysis
								value matches {
									DV_MULTIMEDIA matches {
										media_type matches {[openEHR::]}
									}
								}
							}
						}
					}
					ELEMENT[at0057] occurrences matches {0..1} matches {	-- Cortical area with fibrosis estimated
						value matches {
							C_DV_QUANTITY <
								property = <[openehr::507]>
								list = <
									["1"] = <
										units = <"%">
										magnitude = <|<=0.0|>
										precision = <|0|>
									>
								>
							>
						}
					}
					ELEMENT[at0058] occurrences matches {0..1} matches {	-- Fibrous tissue estimated
						value matches {
							C_DV_QUANTITY <
								property = <[openehr::507]>
								list = <
									["1"] = <
										units = <"%">
										precision = <|0|>
									>
								>
							>
						}
					}
					ELEMENT[at0059] occurrences matches {0..1} matches {	-- Interstitium description
						value matches {
							DV_TEXT matches {*}
						}
					}
				}
			}
			CLUSTER[at0060] occurrences matches {0..1} matches {	-- Vasculature
				items cardinality matches {1..*; unordered} matches {
					ELEMENT[at0211] occurrences matches {0..1} matches {	-- No abnormality detected
						value matches {
							DV_BOOLEAN matches {
								value matches {True, False}
							}
						}
					}
					ELEMENT[at0061] occurrences matches {0..1} matches {	-- Number of arteries
						value matches {
							DV_COUNT matches {*}
						}
					}
					ELEMENT[at0062] occurrences matches {0..1} matches {	-- Arteriosclerosis
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0063, 	-- Not present/minimal
									at0064, 	-- Mild
									at0065, 	-- Moderate
									at0066]	-- Severe
								}
							}
							DV_TEXT matches {*}
						}
					}
					ELEMENT[at0067] occurrences matches {0..1} matches {	-- Arteriolosclerosis
						value matches {
							DV_TEXT matches {*}
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0068, 	-- Absent
									at0069, 	-- Present - nodular
									at0070]	-- Present - circumferential
								}
							}
						}
					}
					ELEMENT[at0071] occurrences matches {0..1} matches {	-- Vasculature description
						value matches {
							DV_TEXT matches {*}
						}
					}
				}
			}
			CLUSTER[at0072] occurrences matches {0..1} matches {	-- Amyloid
				items cardinality matches {1..*; unordered} matches {
					ELEMENT[at0212] occurrences matches {0..1} matches {	-- Amyloid not detected
						value matches {
							DV_BOOLEAN matches {
								value matches {True, False}
							}
						}
					}
					allow_archetype CLUSTER[at0076] occurrences matches {0..*} matches {	-- Details of amyloid deposition 
						include
							archetype_id/value matches {/.*/}
					}
				}
			}
			allow_archetype CLUSTER[at0077] occurrences matches {0..*} matches {	-- Specific clinical situations
				include
					archetype_id/value matches {/.*/}
			}
			ELEMENT[at0078] occurrences matches {0..1} matches {	-- Multimedia representation
				value matches {
					DV_MULTIMEDIA matches {
						media_type matches {[openEHR::]}
					}
				}
			}
		}
	}



ontology
	term_definitions = <
		["en"] = <
			items = <
				["at0000"] = <
					text = <"Microscopy renal biopsy non neoplastic">
					description = <"Microscopic findings related to a non-neoplastic renal biopsy">
				>
				["at0001"] = <
					text = <"Renal biopsy overall description">
					description = <"Describes tissue types  in the renal biopsy specimen.">
				>
				["at0003"] = <
					text = <"Cortex">
					description = <"Cortical tissue present, alternatively core length with cortical tissue, alternatively proportion of cortical tissue in relation to the core with renal tissue.">
				>
				["at0004"] = <
					text = <"Present">
					description = <"Cortical tissue present.">
				>
				["at0005"] = <
					text = <"Absent">
					description = <"Cortical tissue absent.">
				>
				["at0006"] = <
					text = <"Indeterminate">
					description = <"Presence of cortical tissue has not been determined.">
				>
				["at0007"] = <
					text = <"Medulla">
					description = <"Medullary tissue present, alternatively core length with medullary tissue, alternatively proportion of medullary tissue in relation to the core with renal tissue.">
				>
				["at0008"] = <
					text = <"Present">
					description = <"Medullary tissue present.">
				>
				["at0009"] = <
					text = <"Absent">
					description = <"Medullary tissue absent.">
				>
				["at0010"] = <
					text = <"Indeterminate">
					description = <"Presence of medullary tissue has not been determined.">
				>
				["at0011"] = <
					text = <"Renale capsule">
					description = <"A statement whether the renal capsule is present.">
				>
				["at0012"] = <
					text = <"Other tissue elements">
					description = <"Description of other tissue elements, e.g. muscle tissue.">
				>
				["at0013"] = <
					text = <"Sceletal muscle and/or fat tissue and/or connective tissue">
					description = <"Sceletal muscle and/or fat tissue and/or connective tissue present.">
				>
				["at0014"] = <
					text = <"Renal pelvis mucosa">
					description = <"Renal pelvis mucosa present.">
				>
				["at0015"] = <
					text = <"Glomeruli">
					description = <"Description of glomerular changes.">
				>
				["at0016"] = <
					text = <"Glomeruli">
					description = <"The maximum number of glomeruli  irrespective of size present in one section; structures consisting of Bowman's capsule with empty Bowman's space are excluded.">
				>
				["at0017"] = <
					text = <"Scorable glomeruli">
					description = <"The number of glomeruli judged as adequate for scoring by the reporting pathologist.">
				>
				["at0019"] = <
					text = <"Glomeruli solely with necrosis">
					description = <"The number of glomeruli showing fibrinoid necrosis without crescent formation.">
				>
				["at0020"] = <
					text = <"Glomeruli with crescents">
					description = <"The number of glomeruli showing cellular or fibrocellular crescents.">
				>
				["at0021"] = <
					text = <"Glomeruli with ischemic changes">
					description = <"The number of glomeruli showing some degree of tuft retraction and wrinkling of capillary walls. Chronic ischemic changes  might show fibrosis of Bowman's capsule.">
				>
				["at0022"] = <
					text = <"Glomeruli with segmental sclerosis">
					description = <"The number of glomeruli showing obliteration of capillary lumen by extracellular matrix in a portion of the tuft area with or without adhesions to the Bowman capsule, hyaline lesions, foam cells.">
				>
				["at0023"] = <
					text = <"Glomeruli with global sclerosis">
					description = <"The number of glomeruli showing scarring with obliteration of capillary lumen by extracellular matrix in the entire or nearly entire glomerular tuft. ">
				>
				["at0024"] = <
					text = <"Normal glomeruli">
					description = <"The number of glomeruli which appear normal without major changes.">
				>
				["at0026"] = <
					text = <"Description of glomeruli">
					description = <"A narrative description of glomerular findings, e.g. mesangial and endocapillary cellularity, capillary wall changes, podocytes, Bowman's space.
 For structured description of specific renal diseases use appropriate cluster (IgA nephropathy, lupus nephritis).">
				>
				["at0028"] = <
					text = <"Details of specific  glomerular changes">
					description = <"Slot for detailed description of specific glomerular changes.
Include:
openEHR-EHR-CLUSTER.glomerulus_segmental_glomerulosclerosis_classification.v1.">
				>
				["at0029"] = <
					text = <"Tubules">
					description = <"Description of tubular changes.">
				>
				["at0030"] = <
					text = <"Tubular casts">
					description = <"Structured report of kind of tubular casts present.">
				>
				["at0031"] = <
					text = <"Myeloma casts">
					description = <"Characteristic myeloma casts, often surrounded by reactive tubular epithelial cells. or multinucleated cells, present in tubular lumen.">
				>
				["at0032"] = <
					text = <"Tamm Horsfall protein">
					description = <"Presence of intratubular Tamm Horsfall protein.">
				>
				["at0033"] = <
					text = <"Hyaline casts">
					description = <"Presence of hyalin casts in tubular lumen.">
				>
				["at0034"] = <
					text = <"Granular casts">
					description = <"Presence of granular casts in tubular lumen.">
				>
				["at0035"] = <
					text = <"Detached cells">
					description = <"Detached cells, commonly epithelial cells,  present in the tubular lumen.">
				>
				["at0036"] = <
					text = <"Red blood cells">
					description = <"Collections of red blood cells or red blood cell casts present in tubular lumen.">
				>
				["at0037"] = <
					text = <"Granulocytes">
					description = <"Presence of neutrophil granulocytes in tubular lumen.">
				>
				["at0038"] = <
					text = <"Crystals">
					description = <"Crystals present in tubular lumen.">
				>
				["at0041"] = <
					text = <"Tubular atrophy">
					description = <"Semiquantitative or quantitative assessment of tubular atrophy.">
				>
				["at0042"] = <
					text = <"Tubular atrophy semiquantitative">
					description = <"Semiquantitative visual assessment of tubular atrophy.">
				>
				["at0043"] = <
					text = <"Absent">
					description = <"Tubular atrophy is not present or minimal (few transsections).">
				>
				["at0044"] = <
					text = <"Slight">
					description = <"Tubular atrophy in up to 25 % of the area of cortical tubules.">
				>
				["at0045"] = <
					text = <"Moderate">
					description = <"Tubular atrophy involving 25 - 50% of the area of cortical tubules.">
				>
				["at0046"] = <
					text = <"Severe">
					description = <"Tubular atrophy present in more than 50% of the area of cortical tubules.">
				>
				["at0047"] = <
					text = <"Indeterminate">
					description = <"Tubular atrophy could not be assessed, e.g. due to bad sections.">
				>
				["at0048"] = <
					text = <"Tubules description">
					description = <"Desription of tubular changes, e.g. hyalin droplet change, acute epithelial damage, cytoplasmic vacuolation, sloughing of cells, loss of brush border.">
				>
				["at0049"] = <
					text = <"Interstitium">
					description = <"Interstitial changes, especially semiquantitative or quantitative assessment of interstitial fibrosis.">
				>
				["at0050"] = <
					text = <"Quantification of interstitial fibrosis">
					description = <"Quantification of interstitial fibrosis by image analysis methods.">
				>
				["at0051"] = <
					text = <"Image analysis details">
					description = <"To record details of the image analysis, e.g. software, algorithm.">
				>
				["at0052"] = <
					text = <"Technique">
					description = <"Technique used to quantify fibrosis.">
				>
				["at0053"] = <
					text = <"Sirius red unpolarized">
					description = <"Sirius red stain unpolarized used for fibrosis quantification by image analysis">
				>
				["at0054"] = <
					text = <"Sirius red polarized">
					description = <"Sirius red stain polarized used for fibrosis quantification by image analysis">
				>
				["at0055"] = <
					text = <"Collagen III immunohistochemistry">
					description = <"Collagen III immunohistochemical stain used for fibrosis quantification by image analysis">
				>
				["at0056"] = <
					text = <"Percentage interstitial fibrosis">
					description = <"Percentage of the renal cortical tissue involved by fibrosis.">
				>
				["at0057"] = <
					text = <"Cortical area with fibrosis estimated">
					description = <"Visual quantification of interstitial fibrosis; The fibrosis percentage is the percentage of abnormal cortical  tissue with fibrosis.">
				>
				["at0058"] = <
					text = <"Fibrous tissue estimated">
					description = <"Visual quantification of interstitial fibrosis; The fibrosis percentage is the percentage of all cortical  tissue (excluding tubules and glomeruli) occupied by fibrous tissue.">
				>
				["at0059"] = <
					text = <"Interstitium description">
					description = <"Description of interstitial changes, e.g. edema, inflammatory cells, deposits.">
				>
				["at0060"] = <
					text = <"Vasculature">
					description = <"Changes affecting arteries, arterioles, venes and peritubular capillaries.">
				>
				["at0061"] = <
					text = <"Number of arteries">
					description = <"Number of arteries in a renal biopsy.">
				>
				["at0062"] = <
					text = <"Arteriosclerosis">
					description = <"Amount of arteriosclerosis in the most affected vessel.">
				>
				["at0063"] = <
					text = <"Not present/minimal">
					description = <"There is no intimal sclerosis or intimal sclerosis is minimal.">
				>
				["at0064"] = <
					text = <"Mild">
					description = <"There is < 25% lumen narrowing by intimal fibrosis.">
				>
				["at0065"] = <
					text = <"Moderate">
					description = <"There is 25% - 50% lumen narrowing by intimal fibrosis.">
				>
				["at0066"] = <
					text = <"Severe">
					description = <"There is > 50% lumen narrowing by intimal fibrosis.">
				>
				["at0067"] = <
					text = <"Arteriolosclerosis">
					description = <"Amount of arteriolosclerosis in the most affected vessel.">
				>
				["at0068"] = <
					text = <"Absent">
					description = <"Arteriolosclerosis not present.">
				>
				["at0069"] = <
					text = <"Present - nodular">
					description = <"Nodular arteriolosclerosis is present.">
				>
				["at0070"] = <
					text = <"Present - circumferential">
					description = <"Circumferential arteriolosclerosis is present.">
				>
				["at0071"] = <
					text = <"Vasculature description">
					description = <"Description of vascular changes, e.g. vasculitis, venulitis. For description of severity of arteriosclerosis and arteriolosclerosis use coded text.">
				>
				["at0072"] = <
					text = <"Amyloid">
					description = <"Findings related to amyloid deposition.">
				>
				["at0076"] = <
					text = <"Details of amyloid deposition ">
					description = <"Slot for detailed description of specific glomerular changes.
Include:
openEHR-EHR-CLUSTER.amyloid_deposition.v1">
				>
				["at0077"] = <
					text = <"Specific clinical situations">
					description = <"Detailed structured description for specific clinical situations, e.g. biopsy of renal transplant, lupus nephritis, IgA nephropathy.">
				>
				["at0078"] = <
					text = <"Multimedia representation">
					description = <"Images from lesions could be attached here.">
				>
				["at0079"] = <
					text = <"Multimedia representation of image analysis">
					description = <"Images, graphs and tables from automatic image analysis of  interstitial fibrosis.">
				>
				["at0080"] = <
					text = <"Casts in tubules">
					description = <"Choose the type of casts present in tubuli. Multiple choices possible.">
				>
				["at0081"] = <
					text = <"Mixed casts">
					description = <"Casts consisting of more than one component.">
				>
				["at0082"] = <
					text = <"Pigmented casts">
					description = <"Discolorated casts e.g. due to hemoglobin, myoglobin, drug pigments, bilirubin, melanin.">
				>
				["at0088"] = <
					text = <"Podocytes">
					description = <"Description of podocyte changes.">
				>
				["at0089"] = <
					text = <"Hypertrophy">
					description = <"Enlarged podocytes often with amphophil cytoplasm.">
				>
				["at0091"] = <
					text = <"Absent">
					description = <"Podocyte size is normal.">
				>
				["at0092"] = <
					text = <"Slight">
					description = <"Podocytes are slightly enlarged.">
				>
				["at0093"] = <
					text = <"Moderate">
					description = <"Podocytes are moderately enlarged.">
				>
				["at0094"] = <
					text = <"Severe">
					description = <"Podocytes are severely enlarged.">
				>
				["at0096"] = <
					text = <"Bi- or multinucleated podocytes">
					description = <"Podocytes with 2 or more nuclei.">
				>
				["at0097"] = <
					text = <"Absent">
					description = <"Bi- or multinucleated podocytes are not seen.">
				>
				["at0098"] = <
					text = <"Present">
					description = <"Bi- or multinucleated podocytes are seen.">
				>
				["at0099"] = <
					text = <"Indeterminate">
					description = <"Presence of bi- or mulitnucleated podocytes has not been determined.">
				>
				["at0100"] = <
					text = <"Equivocal">
					description = <"Presence of bi- or mulitnucleated podocytes is equivocal.">
				>
				["at0101"] = <
					text = <"Resorption droplets">
					description = <"Podocytes with PAS positive resorption droplets.">
				>
				["at0102"] = <
					text = <"Absent">
					description = <"Podocytes with resorption droplets are not present.">
				>
				["at0103"] = <
					text = <"Singular cells">
					description = <"One or few podocytes with resorption droplets are present.">
				>
				["at0104"] = <
					text = <"Numerous cells">
					description = <"Numerous podocytes with resorption droplets are present.">
				>
				["at0105"] = <
					text = <"Indeterminate">
					description = <"Presence of podocytes with resorption droplets could not be assessed, e.g. due tof bad morphology.">
				>
				["at0106"] = <
					text = <"Equivocal">
					description = <"It is uncertain whether podocytes with resorption droplets are present or not.">
				>
				["at0107"] = <
					text = <"Pseudocysts">
					description = <"Podocytes with pseudocysts.">
				>
				["at0108"] = <
					text = <"Absent">
					description = <"Podocytes with resorption droplets are not present.">
				>
				["at0109"] = <
					text = <"Singular">
					description = <"One of few podocytes with resorption droplets are present.">
				>
				["at0110"] = <
					text = <"Numerous">
					description = <"Numerous podocytes with resorption droplets are present.">
				>
				["at0111"] = <
					text = <"Equivocal ">
					description = <"It is uncertain whether podocytes with resorption droplets are present or not.">
				>
				["at0112"] = <
					text = <"Indeterminate">
					description = <"Presence of podocytes with resorption droplets could not be assessed, e.g. due to bad morphology.">
				>
				["at0113"] = <
					text = <"Equivocal">
					description = <"It is uncertain whether podocyte size is normal or enlarged.">
				>
				["at0114"] = <
					text = <"Indeterminate">
					description = <"Podocyte size could not be assessed, e.g. due to bad morphology.">
				>
				["at0115"] = <
					text = <"Mesangium">
					description = <"Description of mesangial changes.">
				>
				["at0116"] = <
					text = <"No abnormality detected">
					description = <"Statement that no abnormality was detected on examination of the mesangial areas.">
				>
				["at0117"] = <
					text = <"No abnormality detected">
					description = <"Statement that no abnormality was detected on examination of podocytes.">
				>
				["at0118"] = <
					text = <"Details of the mesangium">
					description = <"A narrative description of mesangial changes.">
				>
				["at0119"] = <
					text = <"Mesangial matrix increase">
					description = <"Visual assessment of the amount of mesangial matrix.">
				>
				["at0120"] = <
					text = <"Absent">
					description = <"Mesangial matrix is not increased.">
				>
				["at0121"] = <
					text = <"Slight">
					description = <"Mesangial matrix is slightly increased.">
				>
				["at0122"] = <
					text = <"Moderate">
					description = <"Mesangial matrix is moderately increased.">
				>
				["at0123"] = <
					text = <"Severe">
					description = <"Mesangial matrix is severely increased.">
				>
				["at0124"] = <
					text = <"Equivocal">
					description = <"It is uncertain, whether mesangial matrix is increased.">
				>
				["at0125"] = <
					text = <"Details of podocytes">
					description = <"A narrative description of podocyte changes.">
				>
				["at0126"] = <
					text = <"Indeterminate">
					description = <"Mesangial matrix increase could not be assessed. e.g. due to bad morphology.">
				>
				["at0128"] = <
					text = <"Mesangial hypercellularity">
					description = <"A visual assessment of the cellularity of the mesangium. Normally there are 1 - 3 cells per mesangial area. The score is based on the most cellular mesangial area. Mesangial areas adjacent to the vascular stalk should not be scored.">
					comment = <"Definitions based on Roberts et al, 2009.">
				>
				["at0129"] = <
					text = <"Absent">
					description = <"There is no increase in mesangial cells.">
				>
				["at0130"] = <
					text = <"Slight">
					description = <"There is a slight increase in mesangial cellularity, usually 4-5 cells per mesangial area.">
				>
				["at0131"] = <
					text = <"Moderate">
					description = <"There is a moderate increase in mesangial cellularity, usually 6-7 cells per mesangial area.">
				>
				["at0132"] = <
					text = <"Severe">
					description = <"There is a severe increase in mesangial cellularity, usually 8 or more cells per mesangial area.">
				>
				["at0133"] = <
					text = <"Equivocal">
					description = <"It is uncertain whether there is an increase in mesangial cellularity or not.">
				>
				["at0134"] = <
					text = <"Indeterminate">
					description = <"Mesangial cellularity could not be assessed, e.g. due to bad morphology or thick sections.">
				>
				["at0138"] = <
					text = <"Capillaries">
					description = <"Description of glomerular capillary changes.">
				>
				["at0139"] = <
					text = <"No abnormality detected">
					description = <"Statement that no abnormality was detected on examination of the glomerular capillaries.">
				>
				["at0140"] = <
					text = <"Capillary wall thickening">
					description = <"A visual assessment of the capillary wall thickness.">
				>
				["at0142"] = <
					text = <"Details of glomerular capillaries">
					description = <"A narrative description of glomerular capillary changes.">
				>
				["at0143"] = <
					text = <"Absent">
					description = <"Glomerular capillary walls are not thickened.">
				>
				["at0144"] = <
					text = <"Focal">
					description = <"Glomerular capillary walls are focally thickened.">
				>
				["at0145"] = <
					text = <"Diffuse">
					description = <"Glomerular capillary walls are diffusely thickened.">
				>
				["at0146"] = <
					text = <"Segmental">
					description = <"Glomerular capillary walls are segmentally thickened.">
				>
				["at0147"] = <
					text = <"Global">
					description = <"Glomerular capillary walls are globally thickened.">
				>
				["at0148"] = <
					text = <"Equivocal">
					description = <"It is uncertain whether glomerular capillary walls are thickened.">
				>
				["at0149"] = <
					text = <"Indeterminate">
					description = <"Glomerular capillary wall thickness could not be assessed, e.g. due to section thickness.">
				>
				["at0150"] = <
					text = <"Capillary wall duplication">
					description = <"A visual assessment of the presence of capillary wall duplication.">
				>
				["at0151"] = <
					text = <"Absent">
					description = <"Capillary wall duplication is not present.">
				>
				["at0152"] = <
					text = <"Focal">
					description = <"Capillary wall duplication is focally present.">
				>
				["at0153"] = <
					text = <"Diffuse">
					description = <"Capillary wall duplication is diffusely present.">
				>
				["at0154"] = <
					text = <"Segmental ">
					description = <"Capillary wall duplication is segmentally present.">
				>
				["at0155"] = <
					text = <"Global">
					description = <"Capillary wall duplication is globally present.">
				>
				["at0156"] = <
					text = <"Equivocal">
					description = <"It is unceratin whether capillary wall duplication is present.">
				>
				["at0157"] = <
					text = <"Indeterminate">
					description = <"Capillary wall thickening could not be assessed, e.g. due to bad morphology.">
				>
				["at0159"] = <
					text = <"Capillary lumen">
					description = <"Description of changes in the capillary lumens.">
				>
				["at0160"] = <
					text = <"Endocapillary hypercellularity">
					description = <"Visual assessment of endocapillary hypercellularity.">
				>
				["at0161"] = <
					text = <"Absent">
					description = <"Endocapillary hypercellularity is not present.">
				>
				["at0162"] = <
					text = <"Focal">
					description = <"Endocapillary hypercellularity is focally present.">
				>
				["at0163"] = <
					text = <"Diffuse">
					description = <"Endocapillary hypercellularity is diffusely present.">
				>
				["at0164"] = <
					text = <"Segmental">
					description = <"Endocapillary hypercellularity is segmentally present.">
				>
				["at0165"] = <
					text = <"Global">
					description = <"Endocapillary hypercellularity is globally present.">
				>
				["at0166"] = <
					text = <"Equivocal">
					description = <"It is uncertain whether there is endocapillary hypercellularity.">
				>
				["at0167"] = <
					text = <"Indeterminate">
					description = <"Endocapillary cellularity could not be assessed, e.g. due to bad morphology.">
				>
				["at0168"] = <
					text = <"Thrombi">
					description = <"Visual assessment of intracapillary thrombi.">
				>
				["at0169"] = <
					text = <"Absent">
					description = <"Intracapillary thrombi are absent.">
				>
				["at0170"] = <
					text = <"Endocapillary hypercellularity">
					description = <"Findings related to endocapillary cellularity.">
				>
				["at0171"] = <
					text = <"Cell type">
					description = <"Composition of intracapillary cells.">
				>
				["at0172"] = <
					text = <"Endothelial cells">
					description = <"Endothelial cells are part of the intracapillary infiltrate.">
				>
				["at0173"] = <
					text = <"Macrophages">
					description = <"Macrophages  are part of the intracapillary infiltrate.">
				>
				["at0174"] = <
					text = <"Neutrophil granulocytes">
					description = <"Neutrophil granulocytes are part of the intracapillary infiltrate.">
				>
				["at0175"] = <
					text = <"Lymphocytes">
					description = <"Lymphocytes  are part of the intracapillary infiltrate.">
				>
				["at0176"] = <
					text = <"Atypical cells">
					description = <"Atypical cells  are part of the intracapillary infiltrate.">
				>
				["at0178"] = <
					text = <"Focal">
					description = <"Intracapillary thrombi are  present in less than half of the glomeruli.">
				>
				["at0179"] = <
					text = <"Diffuse">
					description = <"Intracapillary thrombi are present in more than half of the glomeruli.">
				>
				["at0180"] = <
					text = <"Segmental">
					description = <"Intracapillary thrombi are present only in a part of the glomerular tuft.">
				>
				["at0181"] = <
					text = <"Global">
					description = <"Intracapillary thrombi are present in the whole glomerular tuft.">
				>
				["at0182"] = <
					text = <"Equivocal">
					description = <"It is uncertain whether intracapillary thrombi are present or not.">
				>
				["at0183"] = <
					text = <"Indeterminate">
					description = <"Presence of intracapillary thrombi could not be assessed, e.g. because of bad sections.">
				>
				["at0184"] = <
					text = <"Thrombi">
					description = <"Findings related to intracapillary thrombi.">
				>
				["at0185"] = <
					text = <"Thrombus type">
					description = <"Type of intracapillary thrombi.">
				>
				["at0186"] = <
					text = <"Hyalin">
					description = <"The intracapillary thrombi are mainly hyalinous.">
				>
				["at0187"] = <
					text = <"Fibrin">
					description = <"The intracapillary thrombi consist mainly of fibrin.">
				>
				["at0188"] = <
					text = <"Mesangial cell interposition">
					description = <"A visual assesment of the presence of interposed cells in the capillary periphery.">
				>
				["at0189"] = <
					text = <"Present">
					description = <"Mesangial interposition is present.">
				>
				["at0190"] = <
					text = <"Absent">
					description = <"Mesangial interposition is absent.">
				>
				["at0191"] = <
					text = <"Equivocal">
					description = <"It is uncertain whether mesangial interposition  is present.">
				>
				["at0192"] = <
					text = <"Indeterminate">
					description = <"Mesangial interposition could not be assessed, e.g. because of bad sections.">
				>
				["at0193"] = <
					text = <"Mesangial nodularity">
					description = <"A visual assessment of the presence of acellular PAS positive mesangial nodules.">
				>
				["at0194"] = <
					text = <"Absent">
					description = <"Mesangial nodules are absent.">
				>
				["at0195"] = <
					text = <"Present">
					description = <"Mesangial nodules are present.">
				>
				["at0196"] = <
					text = <"Equivocal">
					description = <"It is uncertain whether mesangial nodules are present.">
				>
				["at0197"] = <
					text = <"Indeterminate">
					description = <"Presence of mesangial nodules could not be assessed, e.g. because of bad sections.">
				>
				["at0202"] = <
					text = <"Tubular epithelial cell changes">
					description = <"Description of tubular epithelial cell changes. Multiple choices possible.">
				>
				["at0203"] = <
					text = <"Hyaline droplet change">
					description = <"PAS positive absorption droplets in the epithelium of proximal tubules, usually indicating glomerular proteinuria.">
				>
				["at0204"] = <
					text = <"Fine vacuolization">
					description = <"Fine, even vacuolization of the proximal tubular epithelium. Hydropic change is a synonym. If related to infusion of hypertonic solutions, the change is also described as osmotic nephrosis. If related to cyclosporin therapy, the change is called isometric vacuolization.">
				>
				["at0205"] = <
					text = <"Coarse vacuolization">
					description = <"Irregular and coarse vacuolization of the tubular epithelium. The change might be associated with hypokaliemia or tubulotoxicity.">
				>
				["at0206"] = <
					text = <"Fatty change">
					description = <"Fine vacuoles containing lipid, often at the base of the tubular epithelial cells. Fat can be demonstrated by lipid stains on frozen sections.">
				>
				["at0207"] = <
					text = <"Giant mitochondria">
					description = <"Enlarged mitochondria visuable as eosinophilic bodies in tubular epithelial cells.">
				>
				["at0208"] = <
					text = <"Glomeruli with adhesions">
					description = <"The number of glomeruli showing coneective tissue connections between the tuft and Bowman's capsule without overt sclerosis.">
				>
				["at0209"] = <
					text = <"No abnormality detected">
					description = <"A statement that no abnormality was detected in renal tubules.">
				>
				["at0210"] = <
					text = <"No abnormality detected">
					description = <"A statement that no abnormality was detected in the renal interstitium.">
				>
				["at0211"] = <
					text = <"No abnormality detected">
					description = <"A statement that no abnormality was detected in the renal vasculature.">
				>
				["at0212"] = <
					text = <"Amyloid not detected">
					description = <"A statement that no amyloid deposition was detected.">
				>
			>
		>
	>