Peritubular capillary C4d deposition in lupus nephritis different from antibody-mediated renal rejection
Abstract
C4d deposition in peritubular capillaries (PTC) has been used as a marker of antibody-mediated rejection (AMR). However, PTC C4d deposition is not described in patients with lupus nephritis (LN). C4d deposition in PTC was detected in 455 patients with biopsy proven LN in the present study. Renal tissues from 21 cases of acute AMR served as controls. C4d deposition in PTC was found in 31 patients (6.81%) with LN. Patients with PTC C4d positive showed higher SLEDAI score and higher frequency of hypocomplementemia as compared to C4d negative. The prevalence of ANA, anti-dsDNA, anti-Sm and ACA were higher in C4d positive group, and most of these patients showed the diffuse proliferative glomerular lesion. In contrast with acute AMR, the staining pattern of C4d was granular deposition and the detection of C4d along PTC was accompanied by deposition of IgG and C1q or C3. Electron dense deposition on PTC was observed in most of LN patients. In conclusion, C4d deposition in PTC could be found in a small part of patients with LN. Our study suggested for the first time that C4d positive deposition were close relation with the higher disease activity of LN, and that immune complex formation might be involved in PTC C4d deposition in LN patients, Such PTC C4d deposition is distinct from that of AMR. Lupus (2007) 16, 875—880.
Get full access to this article
View all access and purchase options for this article.
References
Tang S., Lui SL, Lai KN Pathogenesis of lupus nephritis: an update. Nephrology (Carlton) 2005; 10: 174—179.
Manzi S., Ahearn JM, Salmon J. New insights into complement: a mediator of injury and marker of disease activity in systemic lupus erythematosus. Lupus 2004 ; 13: 298—303.
Manzi S., Rairie JE, Carpenter AB et al. Sensitivity and specificity of plasma and urine complement split products as indicators of lupus disease activity. Arthritis Rheum 1996; 39: 1178—1188.
Liu CC, Manzi S., Kao AH, Navratil JS, Ruffing MJ, Ahearn JM Reticulocytes bearing C4d as biomarkers of disease activity for systemic lupus erythematosus. Arthritis Rheum 2005; 52: 3087—3099.
Collins AB, Schneeberger EE, Pascual MA et al. Complement activation in acute humoral renal allograft rejection: diagnostic significance of C4d deposits in peritubular capillaries. J Am Soc Nephrol 1999; 10: 2208—2214.
Nickeleit V., Zeiler M., Gudat F., Thiel G., Mihatsch MJ Detection of the complement degradation product C4d in renal allografts: diagnostic and therapeutic implications. J Am Soc Nephrol 2002; 13: 242—251.
Racusen LC, Colvin RB, Solez K. et al. Antibody-mediated rejection criteria - an addition to the Banff 97 classification of renal allograft rejection. Am J Transplant 2003; 3: 708—714.
Herzenberg AM, Gill JS, Djurdjew O., Magil AB C4d deposition in acute rejection: an independent long-term prognostic factor. J Am Soc Nephrol 2002; 13: 234—241.
Sun Q., Liu ZH, Cheng Z. et al. Treatment of early mixed cellular and humoral renal allograft rejection with tacrolimus and mycophenolate mofetil. Kidney Int 2007; 71: 24—30.
Lerut E., Kuypers D., Van Damme B. C4d deposition in the peritubular capillaries of native renal biopsies. Histopathology 2005; 47: 430—432 (letter).
Sun Q., Liu ZH, Yin G. et al. Tacrolimus combined with mycophenolate mofetil can effectively reverse C4d-positive steroid-resistant acute rejection in Chinese renal allograft recipients. Nephrol Dial Transplant 2006; 21: 510—517.
Weening JJ, D'Agati VD, Schwartz MM et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited. J Am Soc Nephrol 2004; 15: 241—250.
Racusen LC, Philip F. Halloran PF, Solez K. Banff 2003 Meeting Report: New Diagnostic Insights and Standards. Am J Transplant 2004; 4: 1562—1566.
Brentjens JR, Sepulveda M., Baliah T. et al. Interstitial immune complex nephritis in patients with systemic lupus erythematosus. Kidney Int 1975; 7: 342—350.
Hayakawa S., Nakabayashi K., Karube M. et al. Tubulointerstitial immune complex nephritis in a patient with systemic lupus erythematosus: role of peritubular capillaritis with immune complex deposits in the pathogenesis of the tubulointerstitial nephritis. Clin Exp Nephrol 2006; 10: 146—151.
Liptak P., Kemeny E., Morvay Z. et al. Peritubular capillary damage in acute humoral rejection: an ultrastructural study on human renal allografts. Am J Transplant 2005; 5: 2870—2876.
Cite article
Cite article
Cite article
OR
Download to reference manager
If you have citation software installed, you can download article citation data to the citation manager of your choice
Information, rights and permissions
Information
Published In
Article first published: November 2007
Issue published: November 2007
Keywords
PubMed: 17971360
Authors
Metrics and citations
Metrics
Article usage*
Total views and downloads: 88
*Article usage tracking started in December 2016
Altmetric
See the impact this article is making through the number of times it’s been read, and the Altmetric Score.
Learn more about the Altmetric Scores
Articles citing this one
Receive email alerts when this article is cited
Web of Science: 27 view articles Opens in new tab
Crossref: 26
- Utility of C4d Immunohistochemistry as an Adjunct Stain in Diagnostic ...
- Complement C4d as a biomarker for systemic lupus erythematosus and lup...
- Renal C4d is a potential biomarker of disease activity and severity in...
- C4d as a Screening Tool and an Independent Predictor of Clinical Outco...
- Effect of sera from lupus patients on the glomerular endothelial fibri...
- Renal thrombotic microangiopathy associated to worse renal prognosis i...
- The Spectrum of C4d Deposition in Renal Biopsies of Lupus Nephritis Pa...
- Alternative complement pathway activation in thrombotic microangiopath...
- A novel glomerular C4d scoring system: A tool to prognosticate prolife...
- Antibody‐mediated rejection with the presence of glomerular crescents ...
- Lupus nephritis: correlation of immunohistochemical expression of C4d,...
- Clinical significance of C4d deposition in renal tissues from patients...
- Epidemiology and Pathophysiology of Glomerular C4d Staining in Native ...
- Thrombotic Microangiopathies with Rheumatologic Involvement
- Therapy of scleroderma renal crisis: State of the art
- Complement activation and effect of eculizumab in scleroderma renal cr...
- Kidney Transplantation
- Clinicopathological relevance of granular C4d deposition in peritubula...
- Biomarkers and Updates on Pediatrics Lupus Nephritis
- The spectrum of renal thrombotic microangiopathy in lupus nephritis
- Prospective assessment of C4d deposits on circulating cells and renal ...
- Clinicopathologic correlations of renal microthrombosis and inflammato...
- Significance of Peritubular Capillary, Glomerular, and Arteriolar C4d ...
- Deposition of Complement Product C4d in Anti–Glomerular Basement Membr...
- Renal biopsy findings predicting outcome in scleroderma renal crisis
- Current World Literature
Figures and tables
Figures & Media
Tables
View Options
Get access
Access options
If you have access to journal content via a personal subscription, university, library, employer or society, select from the options below:
loading institutional access options
Alternatively, view purchase options below:
Purchase 24 hour online access to view and download content.
Access journal content via a DeepDyve subscription or find out more about this option.
