Abstract
BackgroundPathologic diagnosis of stage I idiopathic membranous nephropathy (MN-I) requires electron microscopy or immunohistochemistry that shows a glomerular capillary staining pattern of IgG and C3. However, it is not uncommon that renal biopsy did not obtain sufficient material for electron microscopy and that IgG and C3 staining in glomeruli largely lost at biopsy due to corticosteroid treatment. Since C3d is one of the final degradation products of C3 that is more stable in vivo, we determine if C3d staining could be used as a novel immunohistochemical marker for MN-I.Methods and results74 MN-I patients with electron microscopy proven MN-I were examined by immunoperoxidase staining of C3d. Intensive C3d staining was present in glomerular capillary like the staining pattern of IgG and C3 in MN-I. Importantly, in 40 MN-I patients who underwent corticosteroid treatment at biopsy the intensity and glomerular capillary pattern of C3d staining remained largely intact while the staining for IgG had substantially reduced and the pattern of glomerular capillary staining became unrecognizable.ConclusionsC3d glomerular capillary staining may be a novel marker for pathologic diagnosis of MN-I that is continuously present at biopsy in patient who has received corticosteroid treatment.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2120780075734479
Highlights
Pathologic diagnosis of stage I idiopathic membranous nephropathy (MN-I) requires electron microscopy or immunohistochemistry that shows a glomerular capillary staining pattern of immunoglobulin G (IgG) and complement 3 (C3)
C3d glomerular capillary staining may be a novel marker for pathologic diagnosis of Stage I idiopathic membranous nephropathy (MN-I) that is continuously present at biopsy in patient who has received corticosteroid treatment
Since our preliminary examination showed the presence of capillary C3d immunostaining like C3 and IgG in glomeruli of MN-I, we further examined if C3d could be used as an immune deposit marker for MN-I even after patients have been treated for a period with corticosteroid
Summary
Pathologic diagnosis of stage I idiopathic membranous nephropathy (MN-I) requires electron microscopy or immunohistochemistry that shows a glomerular capillary staining pattern of IgG and C3. It is not uncommon that renal biopsy did not obtain sufficient material for electron microscopy and that IgG and C3 staining in glomeruli largely lost at biopsy due to corticosteroid treatment. Pathologic diagnosis of stage I idiopathic membranous nephropathy (MN-I) requires electron microscopy since the disease exhibits minimal glomerular change under optical microscopy. Since our preliminary examination showed the presence of capillary C3d immunostaining like C3 and IgG in glomeruli of MN-I, we further examined if C3d could be used as an immune deposit marker for MN-I even after patients have been treated for a period with corticosteroid
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