C4d immunohistochemical staining is a sensitive method to confirm immunoreactant deposition in formalin-fixed paraffin-embedded tissue in membranous glomerulonephritis
C4d immunohistochemical staining is a sensitive method to confirm immunoreactant deposition in formalin-fixed paraffin-embedded tissue in membranous glomerulonephritis
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DOI：
10.14670/hh-26.1391
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发表时间：
2011-11-01
影响因子：
2
通讯作者：
Arias, Manuel
中科院分区：
文献类型：
--
作者：
Fernando Val-Bernal, J.;Francisca Garijo, M.;Arias, Manuel
虽然常规的福尔马林固定石蜡包埋组织学可怀疑膜性肾小球肾炎(MGN)的诊断，但必须使用新鲜冰冻组织通过直接免疫荧光(IF)来显示该过程的免疫学性质。石蜡切片免疫荧光或免疫过氧化物酶(IP)检测免疫球蛋白和补体C3的效率存在争议。这项研究旨在评估在福尔马林固定的石蜡包埋组织中使用IP方法的肾小球C4D沉积是否可能是MGN的有用标记物。31例(100%)特发性肾小球肾炎(MGN)和5例(100%)单纯V类膜性狼疮性肾炎(5例)肾小球颗粒基底膜C4D沉积，常规IF检查阳性。对照组均为阴性。19例不同肾小球疾病，包括IgA肾病、原发性I型膜增生性肾小球肾炎、局灶节段性肾小球硬化症和微小病变病，C4D沉积模式多样，无固有背景。我们的结果表明，福尔马林固定的石蜡包埋组织的C4D染色可以用于确认MGN中颗粒基底膜免疫反应物的沉积。这被证明是一种可靠的方法，在肾冰冻切片中没有肾小球的病例中，或者当石蜡切片上的其他辅助IF或IP方法为阴性时，可以潜在地消除重新活检的需要。C4D免疫组织化学染色可作为MGN活检诊断的一种辅助方法。
Although the diagnosis of membranous glomerulonephritis (MGN) may be suspected on routine histology of formalin-fixed paraffin-embedded tissue, fresh-frozen tissue must be used to show the immunologic nature of the process by direct immunofluorescence (IF). The efficiency of IF or immunoperoxidase (IP) detection of IgG and C3 using paraffin sections is controversial. This study was designed to evaluate whether glomerular C4d deposition using an IP method in formalin-fixed paraffin-embedded tissue may be a useful marker for MGN. We showed characteristic glomerular, granular basement membrane deposition of C4d in 31 (100%) cases of idiopathic MGN and in 5 cases (100%) of pure class V membranous lupus nephritis, in which we had a positive diagnosis of the lesions for conventional IF study. Control cases were negative. Nineteen cases of different glomerulopathies, including IgA nephropathy, primary type I membranoproliferative glomerulonephritis, focal segmental glomerulosclerosis and minimal change disease showed diverse reproducible patterns of C4d deposition, without intrinsic background. Our results indicate that staining of formalin-fixed paraffin-embedded tissue for C4d can be used for confirmation of granular basement membrane immunoreactant deposition in cases of MGN. This proved to be a reliable method that could potentially obviate the need for rebiopsy in cases with absence of glomeruli in renal frozen sections or when other adjunct IF or IP methods on paraffin sections are negative. C4d immunostaining, using an IP method, deserves a place as an adjunct method in the biopsy diagnosis of MGN.