Nasr S H, Galgano S J, Markowitz G S, Stokes M B, D'Agati V D
Department of Pathology, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA.
Kidney Int. 2006 Dec;70(12):2148-51. doi: 10.1038/sj.ki.5001990. Epub 2006 Oct 25.
Direct immunofluorescence (IF) on frozen tissue is the method of choice for the study of medical renal diseases. When no glomeruli are available, IF can be performed on the formalin-fixed paraffin-embedded tissue allocated for light microscopy after antigen retrieval with proteases. In this study, the results of IF on frozen tissue (IF-F) and on deparaffinized, pronase-treated tissue (IF-P) were compared in 71 renal biopsies representing 12 major renal diseases. Using IF-P, diagnostic findings were obtained in 100% of cases of lupus nephritis, acute post-infectious glomerulonephritis, cryoglobulinemic glomerulonephritis, fibrillary glomerulonephritis, primary amyloidosis, myeloma cast nephropathy, and light-chain Fanconi syndrome (LCFS), 88% of cases of immunoglobulin (Ig)A nephropathy, 80% of cases of light-chain deposition disease, 60% of cases of membranoproliferative glomerulonephritis type 1, 50% of cases of idiopathic membranous glomerulopathy (MGN) and 20% of cases of anti-glomerular basement membrane (GBM) disease. IF-P was less sensitive than IF-F for the detection of C3 in all disease categories and for the detection of IgG in cases of MGN and anti-GBM disease. The diagnostic kappa light-chain staining was demonstrated in 100% of cases of LCFS by IF-P versus 40% by IF-F. We conclude that IF-P is a valuable salvage immunohistochemical technique for renal biopsies lacking adequate cortical sampling for IF-F, and is superior to IF-F for the diagnosis of LCFS.
对冷冻组织进行直接免疫荧光（IF）检查是研究医学肾脏疾病的首选方法。当没有肾小球可用时，在使用蛋白酶进行抗原修复后，可对用于光学显微镜检查的福尔马林固定石蜡包埋组织进行IF检查。在本研究中，对代表12种主要肾脏疾病的71例肾活检组织的冷冻组织IF（IF-F）和脱蜡、经链霉蛋白酶处理组织的IF（IF-P）结果进行了比较。使用IF-P，在狼疮性肾炎、急性感染后肾小球肾炎、冷球蛋白血症性肾小球肾炎、纤维性肾小球肾炎、原发性淀粉样变性、骨髓瘤管型肾病和轻链范科尼综合征（LCFS）的所有病例中均获得了诊断结果；在免疫球蛋白（Ig）A肾病的88%病例、轻链沉积病的80%病例、1型膜增生性肾小球肾炎的60%病例、特发性膜性肾小球病（MGN）的50%病例和抗肾小球基底膜（GBM）病的20%病例中也获得了诊断结果。在所有疾病类别中，IF-P检测C3的敏感性低于IF-F，在MGN和抗GBM病病例中检测IgG的敏感性也低于IF-F。IF-P在100%的LCFS病例中显示出诊断性κ轻链染色，而IF-F仅为40%。我们得出结论，IF-P是一种有价值的挽救性免疫组织化学技术，适用于缺乏足够皮质样本进行IF-F检查的肾活检，并且在诊断LCFS方面优于IF-F。
