55 J I M D C   2 0 1 7  55 

Address of Correspondence:  
Prof Saeed Alam 
Email: drsaeed_alam@hotmail.com 

 
 

Pathologist-Clinician Collaboration and Patient Care 

Saeed Alam 

Professor of Histopathology, Islamabad Medical and Dental College, Islamabad 

In this era of personalized medicine Pathology plays a 

pivotal role and pathologists are at the forefront of 

establishing a correct diagnosis, on the basis of which 

further management of any disease is carried out.  Infect 

the glorification of modern medicine and understanding of 

human body owes a lot to advances in pathology.  A 

practicing physician or a surgeon is stranded without the 

help of a diagnostic pathology laboratory and guidelines 

from pathologist. Clinician suspects a disease and 

advises a battery of laboratory tests encompassing all the 

differential diagnosis and quite often, the confirmation 

requires a microscopic examination or more sophisticated 

tests involving molecular or genetic studies.   It is believed 

that 70% of clinical decisions are based upon laboratory 

tests. 

Collaboration between the pathologist and clinician has 

been found to be indispensable in improving the quality of 

patient care especially in, but not limited to, the areas of 

cancer management and care.1 Knowledge about the 

sample collection, the right container used and proper 

documentation can minimize the pre-analytic errors. 

Laboratory request form is the first contact between the 

patient and laboratory and inadequately completed 

laboratory request forms or illegible clinical information 

provided limits pathologists advice to clinician and may 

contribute to medical errors. Majority of laboratory errors 

occur in pre-analytic phase of laboratory workflow and 

inadequately completed forms have been described as a 

contributory pre-analytic error.2   Awareness about the 

limitations and interpretation of different test results is an 

essential component of patient care. 

Despite all precautionary measures “Zero lab error” is a 

Utopian target for any lab however only 15% of errors 

occur in Analytic phase. 3 Availability of relevant clinical 

history, imaging results, supportive laboratory results and 

procedural details contribute a lot towards establishing a 

correct cytological or histopathological diagnosis. In a 

study titled as “Clinicians are from Mars and pathologists 

are from Venus” it is highlighted that a  communication 

gap exists between pathologists and surgeons and 

surgeons misunderstood pathologists report 30% of the 

time.4  The practice of deliberately hiding the relevant 

clinical details from pathologist can lead to detrimental 

consequences for the patient. 

Seeking advice of microbiologist is of immense value in 

selecting the best arsenal to combat infectious diseases 

and to minimize hospital acquired infections by utilizing 

guidelines of hospital infection control committee. 

Similarly, a hematologist can provide the best advice in 

conditions like DIC and other life threatening 

hematological disorders. When to transfuse and which 

component of blood is required for the particular patient 

falls under the domain of Blood Transfusion specialist or a 

hematologist and a coordinated effort is of utmost benefit 

for the patient.    

To shorten the communication gap between the 

pathologist and clinician, various strategies have been 

suggested. Most convenient is to share the patient’s 

clinical details on telephone or a junior doctor can visit the 

laboratory in a hospital setting and exchange clinical 

details. Interdepartmental meetings and clinico-

pathological conferences are quite useful in this regard. 

Multidisciplinary teams involving a pathologist, radiologist 

and other clinical specialties also add quality to diagnosis 

and best patient management decisions. 

 

E D I T O R I A L S  



 

                           56 J I M D C   2 0 1 7  56 

Address of Correspondence:  
Dr.Rafiq Ahmad 
Email: rafiqahmad2012@gmail.com 

R e f e r e n c e s  
1. Suleiman DE. Pathologist clinician collaboration: a 

marriage of necessity toward improving the quality of 
patient care. Ann Nigerian Med. 2015; 9(1):1-3. 

2. Osega ID, Afolabi O, Onyenekwu CP. The effectiveness of 
clinical education on the adequate completion of laboratory 

test request forms at a tertiary hospital. Ann Med Health 
Sci Res. 2016; 6(2):90-4. 

3. Association of clinical pathologists of Nepal. Right test 
cycle. J Pathol. 2013; 3(2):1. 

4. Powsner SM, Costa J, Homer RJ. Clinicians are from Mars 
and pathologists are from Venus: clinical interpretation of 
pathology reports. Arch Pathol Lab Med. 2000; 124:1040-
6.

 
 

Microalbuminuria: A Urinary Biomarker of Diabetic  
Kidney Disease 

Rafiq Ahmad 

Assistant Professor, Department of Pathology, Islamabad Medical & Dental College Islamabad 

 

Diabetes Mellitus is a chronic metabolic disorder 

characterized by persistent hyperglycemia and disorders 

of carbohydrate, protein and lipid metabolism.1 It is 

expected that by the year 2030, about 552 million people 

globally will be affected from diabetes mellitus.2 If not well 

controlled, diabetes mellitus leads to both microvascular 

and macrovascular complications.2 Diabetic mellitus is the 

most common cause of diabetes nephropathy that has a 

momentous impact on quality of life and survival of the 

patient.1 It is estimated that about 40 % of type I and type 

II diabetes mellitus develop diabetic kidney disease.2 If 

not timely diagnosed and properly treated, diabetic 

nephropathy eventually leads to End stage renal disease 

that requires dialysis or renal transplantation. Multiple 

serum and urinary biomarkers are used to diagnose 

diabetic nephropathy before it is clinically evident.2 

Urinary microalbumin has been used as a clinical 

biomarker of diabetic kidney disease since 1982.4 It is 

used to screen both type I and type II diabetes mellitus.5 

Microalbuminuria results when albumin crosses 

glomerular filtration barrier due to ultrastructural changes 

in endothelial glycocalyx.6 Microalbuminuria also 

represents a marker of systemic endothelial dysfunction 

with increased risk of cardiovascular and cerebral insults 

in patients with diabetes mellitus.7 

In addition to glomerular injury, newer biomarkers of 

tubular, vascular, inflammation, podocytes and oxidative 

stress have been verified in some patients that detect 

diabetic nephropathy much earlier than 

microalbuminuria.3 Usefulness of these biomarkers is still 

debatable in research due to limited studies performed 

and requires further validation.3 Microalbuminuria even 

disputed as biomarker of early diabetic nephropathy, is 

still considered as an important screening test to detect 

glomerular and tubular injury in diabetic population.3 

American Diabetes Association guidelines recommend 

initial assessment of urinary albumin excretion in type I 

diabetes mellitus who have had diabetes for at least five 

years and in all patients with type II diabetes mellitus at 

the time of presentation and during pregnancy.8 All 

diabetic patients with negative screening test for 

microalbuminuria should be assessed for kidney functions 

on annual basis.9 

Microalbuminuria (although a misnomer term) is detection 

of small quantity of albumin (and not small-size albumin) 

in the urine i.e. 30-300 mg/24 hours or 20 to 200 µg/min 

in the absence of clinical proteinurea as measured by 

standard analytical methods.7 More appropriate term for 

microalbuminuria is paucialbuminuria or albumin excretion 

rate.10 

Normal urinary albumin excretion is less than 30 mg/24 

hours (20ug/min). This small amount is not detectable by