DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20175459

Immunologic glomerulopathies-diagnostic role of immunofluorescence study of renal biopsies

Kaushlendra K. Pandey, Anjali Tiwari, Asha Agarwal

Abstract


Background: The kidney is a structurally complex organ that has evolved to subserve a number of important functions: excretion of the waste products of metabolism, regulation of body water and salt, maintenance of appropriate acid balance, and secretion of a variety of hormones and autacoids. Some clinical disorders affect more than one structure. In addition, the anatomic interdependence of structures in the kidney implies that damage to one almost always secondarily affects the others. Thus, severe glomerular damage impairs the flow through the peritubular vascular system, conversely, tubular destruction, by increasing interglomerular pressure, may induce glomerular atrophy. Thus, whatever the origin, there is a tendency for all forms of chronic renal disease ultimately to destroy all four components of the kidney, culminating in chronic renal failure and what has been called end-stage contracted kidneys. The functional reserve of the kidney is large, and much damage may occur before functional impairment is evident. The circulating immune complexes play a very major role in various types of glomerular nephropathies.

Methods: The present study was conducted on renal biopsies referred to Pathology Department of G.S.V.M. Medical College, Kanpur and Regency Hospital Ltd., Kanpur. Frozen section of renal biopsy was taken for IF studies. Renal biopsy tissue was received in IF fluid containing Ammonium sulphate, N-ethyl malcimide, Magnesium sulphate.

Results: The lgG class of immunoglobulins was found to be most fatal to the G13M, the 1gM and IgA were also found to cause glomerular damage. This mechanism was seen responsible for most cases of ICGN. In the present study, fluorescent study of renal biopsy tissue was also done using Hollande’s fixative and it was observed that a better diagnosis could be done when used with routine H & E and immunofluorescent studies.

Conclusions: The immunofluorescence microscopy proved to be very useful and essential, for proper diagnosis and therapy of a renal disease. IFM comes out to be a very good indicator of the deposition site and class of immunoglobulin involved in the Immune-complex deposit.

Keywords


Glomerulopathies, Immunoglobulins, Immune complexes, Kidney, Membranous glomerulonephritis

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References


Molne J, Breimer ME, Svalander C. Immunoperoxidase versus immunofluorescence in the assessment of human renal biopsies. Am J Kidney Dis. 2005;45:674-83.

Das RK, Saleh AF, Kabir AN, Talukder SI, Kamal M. Immunofluorescence studies of renal biopsies. Dinajpur Med Col J. 2008;1(1):8-13.

Satoskar AA, Calomeni E, Bott C, Nadasdy GM, Nadasdy T. Focal glomerular immune complex deposition: possible role of periglomerular fibrosis/atubular glomeruli. Arch Pathol Lab Med. 2009;133(2):283-8.

Abbas K, Mubarak M, Kazi JI, Muzaffar R. Pattern of morphology in renal biopsies of nephrotic syndrome patients. Correlation with immunoglobulin and complement deposition and serology. JPMA. 2009;59:540-2.

Walker PD. The renal biopsy. Arch Pathol Lab Med. 2009;133:181-8.

Uppin MS, Prayaga AK, Srinivas BH, Rapur R, Desai M, Dakshina Murthy KV. Light chain immunofluorescence in various nephropathies. Indian J Pathol Microbiol. 2011;54:55-8.

Bomback AS, Appel GB. Pathogenesis of the C3 glomerulopathies and reclassification of MPGN. Nat Rev Nephrol. 2012;8:634-42.

Fatima H, Siew ED, Dwyer JP, Paueksakon P. Membranous glomerulopathy with superimposed pauci-immune necrotizing crescentic glomerulonephritis. Nephrol Dia Transplant Plus. 2012;5(6):587-90.

Messias NC, Walker PD, Larsen CP. Paraffin immunofluorescence in the renal pathology laboratory: more than a salvage technique. Modern Pathology. 2015 Jun 1;28(6):854-60.

Buch AC, Sood SK, Bamanikar SA, Chandanwale SS, Kumar H, Swapnil K. Role of direct immunofluorescence in the diagnosis of glomerulonephritis. Med J DY Patil Univ. 2015;8:452-7.

Minz RW, Chhabra S, Joshi K, Khirwadkar N, Sakhuja V, Pasricha N, et al. Direct immunoflorescence of renal biopsy: Perspective of an Immunologist. J Postgraduate Med. Edu Res. 2015;49(1):10-17.

Larsen CP, Boils CL. Clinicopathologic features of membranous-like glomerulopathy with masked IgG Kappa deposits. Kidney Int Reports. 2016;1(4):299-305.