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dc.contributor.authorDrachenberg, C.B.
dc.contributor.authorPapadimitriou, J.C.
dc.contributor.authorChandra, P.
dc.contributor.authorHaririan, A.
dc.contributor.authorMendley, S.
dc.contributor.authorWeir, M.R.
dc.contributor.authorRubin, M.F.
dc.date.accessioned2019-10-03T14:14:47Z
dc.date.available2019-10-03T14:14:47Z
dc.date.issued2019
dc.identifier.urihttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85072596652&doi=10.1016%2fj.ekir.2019.07.015&partnerID=40&md5=e66a534637b92a1b21bc98094539e117
dc.identifier.urihttp://hdl.handle.net/10713/11048
dc.description.abstractIntroduction: Routine C4d staining in renal transplantation has stimulated its use in kidney biopsies with glomerulonephritis (GN). Methodical description on staining patterns in the native kidney is not available. Methods: We retrospectively evaluated C4d staining in formalin-fixed paraffin-embedded sections from 519 native kidney biopsies (bx) with and without glomerular disease. Results: Strong C4d staining was consistently present in immune-complex GN, including lupus nephritis (LN) (n = 68), membranous GN (n = 24), membranoproliferative glomerulonephritis (MPGN) pattern (n = 22), fibrillary GN (n = 3), and proliferative GN with monoclonal IgG (n = 3). C4d stained all cases of postinfectious GN (n = 7) amyloidosis (n = 20) and C1q GN (n = 3). In contrast, IgA nephropathy (IgAN) (n = 34), was negative in 62% of bx, with the rest staining variably. The E1 Oxford classification score correlated with capillary wall C4d staining (P = 0.05). C4d marked the glomerular and arteriolar lesions in thrombotic microangiopathy (TMA; n = 16), the glomerular sclerotic segments in focal segmental glomerulosclerosis (FSGS; n = 77), and marked areas of necrosis in crescentic GN (n = 21). In diabetic glomerulopathy (n = 70), C4d marked advanced insudative lesions but was negative otherwise. C4d weakly stained the mesangium, or was negative in normal biopsies (n = 13), minimal change disease (MCD; n = 21), thin basement membrane disease (n = 20), Alport (n = 3), IgM nephropathy (n = 2), C3 glomerulopathy (n = 5), acute interstitial nephritis (n = 12), acute tubular necrosis (n = 22), ischemic glomerulopathy/nephrosclerosis (n = 23), and other miscellaneous processes (n = 14). Staining in tubular basement membranes and peritubular capillaries was most common in lupus. Conclusion: Based on reliable staining in lupus and membranous GN, C4d staining is potentially useful as a screening and diagnostic tool, if only paraffin-embedded tissue is available. Knowledge of C4d staining patterns in normal and pathological tissues enhances its diagnostic value.en_US
dc.description.urihttps://doi.org/10.1016/j.ekir.2019.07.015en_US
dc.language.isoen-USen_US
dc.publisherElsevier Incen_US
dc.relation.ispartofKidney International Reports
dc.subjectcomplement depositionen_US
dc.subjectdiabetes mellitusen_US
dc.subjectglomerulonephritisen_US
dc.subjectIgA nephropathyen_US
dc.subjectimmune depositsen_US
dc.subjectlupus nephritisen_US
dc.subjectmembranous glomerulopathyen_US
dc.titleEpidemiology and Pathophysiology of Glomerular C4d Staining in Native Kidney Biopsiesen_US
dc.typeArticleen_US
dc.identifier.doi10.1016/j.ekir.2019.07.015


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