title: C4d and C4bp deposition along the glomerular capillary walls in a patient with preeclampsia.
abstract: Complement (C) 4d and cofactor C4b binding protein (C4bp) are detected in the glomerular capillary walls of a patient with preeclampsia. A 32-year-old nullipara had proteinuria of 1.2 g/d and edema at the 33rd week of pregnancy. Gradually the urinary protein excretion increased, reaching 5.1 g/d at the 37th week. The patient also showed hypertension at this stage. After normal mature delivery, the level of the urinary protein excretion remained at 3 to 4 g/d. Renal biopsy performed by means of light and electron microscopy, 15 days after delivery, showed almost normal glomeruli and modest subendothelial widening. Immunohistochemistry indicated that immunoglobulin (Ig) A, IgG, C1q, C3c, and C4c were not deposited in the glomeruli, whereas weakly positive IgM and fibrin-related antigen (FRA) were observed. Conversely, C4d, C3d, and C4bp were strongly deposited. Protein S (PS) also was observed, with a similar distribution pattern to that of C4bp. Immunoelectron microscopy showed the deposition of C4d along the capillary walls and of C4bp in the subendothelium. These findings suggest that the C4 activation process as well as the regulation process of C system and of the inflammatory coagulation axis by C4bp and PS may play an important role in the pathophysiology of preeclampsia, so-called glomerular capillary endotheliosis (GCE).
authors.affiliation: Department of Nephrology, Saiseikai Nakatsu Hospital, Osaka, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Joyama
authors.forename: T
authors.initials: T
authors.lastname: Yoshida
authors.forename: M
authors.initials: M
authors.lastname: Koshikawa
authors.forename: K
authors.initials: K
authors.lastname: Sawai
authors.forename: H
authors.initials: H
authors.lastname: Yokoi
authors.forename: A
authors.initials: A
authors.lastname: Tanaka
authors.forename: M
authors.initials: M
authors.lastname: Gotoh
authors.forename: S
authors.initials: S
authors.lastname: Ueda
authors.forename: A
authors.initials: A
authors.lastname: Sugawara
authors.forename: T
authors.initials: T
authors.lastname: Kuwahara
mesh_terms: D000328:Adult; D001706:Biopsy; D002196:Capillaries / Q000648:ultrastructure*; D003167:Complement Activation; D003181:Complement C4 / Q000032:analysis*; D015935:Complement C4b; D050716:Complement C4b-Binding Protein; D005260:Female; D005455:Fluorescent Antibody Technique; D006649:Histocompatibility Antigens / Q000032:analysis*; D006801:Humans; D007124:Immunoenzyme Techniques; D007668:Kidney / Q000473:pathology*; D007678:Kidney Glomerulus / Q000098:blood supply / Q000473:pathology*; D010446:Peptide Fragments / Q000032:analysis*; D011225:Pre-Eclampsia / Q000473:pathology*; D011247:Pregnancy
chemical_list: C055609:C4BPA protein, human; C489165:C4BPB protein, human; D003181:Complement C4; D050716:Complement C4b-Binding Protein; D006649:Histocompatibility Antigens; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d