title: C4d peritubular capillary staining in chronic allograft nephropathy and transplant glomerulopathy: an uncommon finding.
abstract: The true incidence of positive C4d staining in the peritubular capillaries of biopsies with chronic allograft nephropathy (CAN) and transplant glomerulopathy (TGP) remains controversial. We retrospectively reviewed all transplant biopsies performed at Saint Louis University Hospital between June 2002 and May 2004. We examined the incidence of positive C4d staining in the peritubular capillaries of biopsy specimens with pure CAN with or without features of TGP. We identified 54 biopsies in 43 patients showing CAN. The average age was 46 +/- 13 years. The average creatinine at the time of biopsy was 308 +/- 211 micromol/l (3.5 +/- 2.4 mg/dl). Twenty (37%) biopsies exhibited features consistent with TGP. Only two biopsies had positive C4d staining in the peritubular capillaries. The C4d positive biopsies were from two different patients; one patient had donor specific antibodies (DSA) against HLA class 1 at the time of biopsy and the other patient had no detectable DSA. None of the TGP biopsies showed peritubular C4d staining. C4d staining of the peritubular capillaries appears to be rare in patients with pure CAN with and without TGP features.
authors.affiliation: Division of Nephrology, Saint Louis University, St Louis, MO 63110, USA. zalaly@slu.edu
authors.forename: Ziyad
authors.initials: Z
authors.lastname: Al Aly
authors.forename: Praveen
authors.initials: P
authors.lastname: Yalamanchili
authors.forename: Cherise
authors.initials: C
authors.lastname: Cortese
authors.forename: Luis
authors.initials: L
authors.lastname: Salinas-Madrigal
authors.forename: Bahar
authors.initials: B
authors.lastname: Bastani
mesh_terms: D000328:Adult; D000906:Antibodies / Q000097:blood; D001706:Biopsy; D002196:Capillaries / Q000378:metabolism*; D002908:Chronic Disease; D015935:Complement C4b / Q000378:metabolism*; D005260:Female; D015395:Histocompatibility Antigens Class I / Q000276:immunology; D006801:Humans; D007668:Kidney / Q000098:blood supply / Q000473:pathology; D007674:Kidney Diseases / Q000209:etiology* / Q000378:metabolism*; D007678:Kidney Glomerulus; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D008856:Microscopy, Fluorescence; D008875:Middle Aged; D010446:Peptide Fragments / Q000378:metabolism*; D012189:Retrospective Studies; D013194:Staining and Labeling; D014019:Tissue Donors; D014184:Transplantation, Homologous
chemical_list: D000906:Antibodies; D015395:Histocompatibility Antigens Class I; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d