Al Aly Ziyad, Yalamanchili Praveen, Cortese Cherise, Salinas-Madrigal Luis, Bastani Bahar
Division of Nephrology, Saint Louis University, St Louis, MO 63110, USA.
Transpl Int. 2005 Jul;18(7):800-5. doi: 10.1111/j.1432-2277.2005.00130.x.
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.
在伴有慢性移植肾肾病（CAN）和移植肾小球病（TGP）的活检标本中，肾小管周围毛细血管C4d染色阳性的真实发生率仍存在争议。我们回顾性分析了2002年6月至2004年5月在圣路易斯大学医院进行的所有移植肾活检。我们检查了具有或不具有TGP特征的单纯CAN活检标本中肾小管周围毛细血管C4d染色阳性的发生率。我们在43例患者中确定了54例显示CAN的活检标本。平均年龄为46±13岁。活检时的平均肌酐水平为308±211微摩尔/升（3.5±2.4毫克/分升）。20例（37%）活检标本表现出与TGP一致的特征。只有两例活检标本的肾小管周围毛细血管C4d染色呈阳性。C4d阳性的活检标本来自两名不同的患者；一名患者在活检时具有针对HLA Ⅰ类的供体特异性抗体（DSA），另一名患者未检测到DSA。所有TGP活检标本均未显示肾小管周围C4d染色。在具有和不具有TGP特征的单纯CAN患者中，肾小管周围毛细血管C4d染色似乎很少见。
