Serial Studies On C4d By Immunohistochemical Staining Ⅲ

【Objective】1. The deposition of C4d and other complements and immunoglobulin in FSGS of different types, and the relationship between these factors were investigated to explore the contribution of complement and immunoglobulin in the development of FSGS.2. To observe the deposition of C4d in Early FSGS and investigate the value of C4d in early diagnosis and differential diagnosis of FSGS.3. To observe the expression features of C4d in ABO-incompatible liver transplantation and investigate the diagnostic criteria in humoral rejection of liver transplantation.【Methods】1. The paraffin specimen of 260 patients diagnosed as primary FSGS by HE, immunohistochemical and electron microscope staining were collected, including 153 cases of FSGS, 33 cases of Early FSGS, 23 cases of Suspected FSGS, 21 cases of Glomerular minor lesion and 30 cases of minimal change disease. Every specimen was staining by HE, PAS, PASM and immunohistochemical staining of IgG, IgM, IgA, C3c, C4c, C4d, C1q and Fib. 20 cases of specimen that none pathological changes nephridial tissue exsected because of umour were collected as control group by C4d immunohistochemical staining.2. Routine uranium- plumbum double stain of electron microscope was carried out in biopsies above all for ultrastructure observesion.3. The deposition of all kinds of immunoglobulin and complements were observed in 2 cases of ABO-incompatible liver transplantation by immunohistochemical and HE staining.【Results】1. In FSGS, the main deposition was IgM and C4d, especially C4d (90.8%), which was the highest rate and always accompanied by C1q.2. The average scores of C4d positive deposition intensity in LD group was higher than NLD group (P<0.01). The rate of hormone resistance and hypertension in LD group was higher than NLD group.3. In the cellular variant and collapsing variant, the rates of C4d posititve were both 100%, which were higher than other groups, and the rate of IgM was significantly higher than classical type of FSGS(P<0.01). In collapsing variant, the positive rate (87.5%) and the positive intensity of C1q were higher than other group(P<0.01). Comparing with other groups, collapsing type has shorter course, higher hypertension rate, more 24h Urine protein and renal inadequacy rate and lower plasma albumin level.4. In E-FSGS, the strong deposition of C4d was presented with shape of line in basal membrane and granulo-form in mesangium, and located in sclerotive area of glomerular.5. In the 2 cases of liver transplantation, filiform or particles of IgG, IgM, IgA, C4c, C4d and C1q were deposited in hepatic sinusoidal endothelial cells.【Conclusion】1. In FSGS,the strong expression of C4d in sclerotive glomerulus indicated the activation of classical pathway of complement. In FSGS, there are two types expression of C4d, Linear deposition in basal membrane and granulo-form or bolus-form deposition in mesangium. Linear deposition of C4d are present the higher activation of classical pathway of complement, and indicate the poor prognosis and hormone resistance.2. The intension and form of C4d deposition are the indication for treatment and prognosis of FSGS.3. The focal segmental strong expression of C4d is an important morphological index of immunopathogenesis, which is also important for diagnose and differential diagnosis of FSGS.For early diagnosis of FSGS, Linear deposition of C4d in basal membrane is an earlier morphological appearance than Bowman's capsule adhering.4. It may be regard as the evidence of humoral rejection in transplant hepatic tissue that immunoglobulins IgG accompany with C4d and other complements diffusely deposited in hepatic sinusoidal endothelial cells.