The Immunohistology of IgA Nephropathy

免疫染色 肾小球肾炎 肾病 医学 病理 免疫球蛋白A 免疫学 免疫组织化学 系膜增生性肾小球肾炎 免疫病理学 狼疮性肾炎 抗体 免疫球蛋白G 内科学 内分泌学 疾病 糖尿病
作者
J. Charles Jennette
出处
期刊:American Journal of Kidney Diseases [Elsevier BV]
卷期号:12 (5): 348-352 被引量:147
标识
DOI:10.1016/s0272-6386(88)80022-2
摘要

The glomerular immunohistologic characteristics of 180 patients with IgA nephropathy (IgAN), defined by 2 + or greater (out of 0 to 4 +) mesangial IgA-dominant or codominant immunostaining and no evidence for systemic lupus erythematosus, were compared with those of 84 patients with proliferative lupus glomerulonephritis and 254 patients with other forms of proliferative glomerulonephritis. The IgAN population increased in number by only 5% if the IgA immunostaining criterion was lowered to 1+, and it decreased by only 2% if IgA codominant staining was disallowed. A distinctive immunohistologic feature of IgAN in comparison with other immune complex-mediated glomerulopathies, in addition to the predominance of IgA immunostaining, was a high frequency (67%) of patients with greater λ- than Κ-immunoglobulin light chain immunostaining. There was no correlation between the absolute or relative intensities or frequencies of IgA, IgG, or IgM immunostaining and the severity of glomerular disease; however, the presence of capillary wall immune deposits correlated with more severe disease. Terminal complement components were consistently present and were more conspicuous in more severely injured glomeruli. Immunostaining for the early classical complement activation pathway component C1q was absent or scanty in IgAN. This finding was particularly useful in the immunohistologic differentiation of IgAN from proliferative lupus glomerulonephritis, which was the form of glomerulonephritis with the greatest overlap with IgAN with respect to IgA immunostaining. When the diagnostic criteria for IgAN were 2 + or greater, dominant or codominant mesangial IgA immunostaining and less than 2 + C1 q immunostaining, an immunohistologic diagnosis of IgAN was made with 98% accuracy. The glomerular immunohistologic characteristics of 180 patients with IgA nephropathy (IgAN), defined by 2 + or greater (out of 0 to 4 +) mesangial IgA-dominant or codominant immunostaining and no evidence for systemic lupus erythematosus, were compared with those of 84 patients with proliferative lupus glomerulonephritis and 254 patients with other forms of proliferative glomerulonephritis. The IgAN population increased in number by only 5% if the IgA immunostaining criterion was lowered to 1+, and it decreased by only 2% if IgA codominant staining was disallowed. A distinctive immunohistologic feature of IgAN in comparison with other immune complex-mediated glomerulopathies, in addition to the predominance of IgA immunostaining, was a high frequency (67%) of patients with greater λ- than Κ-immunoglobulin light chain immunostaining. There was no correlation between the absolute or relative intensities or frequencies of IgA, IgG, or IgM immunostaining and the severity of glomerular disease; however, the presence of capillary wall immune deposits correlated with more severe disease. Terminal complement components were consistently present and were more conspicuous in more severely injured glomeruli. Immunostaining for the early classical complement activation pathway component C1q was absent or scanty in IgAN. This finding was particularly useful in the immunohistologic differentiation of IgAN from proliferative lupus glomerulonephritis, which was the form of glomerulonephritis with the greatest overlap with IgAN with respect to IgA immunostaining. When the diagnostic criteria for IgAN were 2 + or greater, dominant or codominant mesangial IgA immunostaining and less than 2 + C1 q immunostaining, an immunohistologic diagnosis of IgAN was made with 98% accuracy.
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