Uppin Megha S, Prayaga Aruna K, Srinivas B H, Rapur Ram, Desai Madhav, Dakshina Murthy K V
Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad 500 082, Andhra Pradesh, India.
Indian J Pathol Microbiol. 2011 Jan-Mar;54(1):55-8. doi: 10.4103/0377-4929.77325.
Light chain immunofluoresence (IF) in renal biopsy is routinely used in the diagnosis of light chain deposition disease (LCDD), amyloidosis and cast nephropathy. Light chain predominance has also been reported in certain glomerulopathies like IgA nephropathy. However, pathogenesis of this pattern of deposition in various glomerulopathies is uncertain.
To discuss the pathogenesis and utility of light chain IF in nephropathies.
Retrospective study.
The pattern of light chain IF and light microscopic diagnosis in 306 cases of various nephropathies was reviewed. Direct IF was done in all these cases with commercial fluorescence (Fluoresciene Isothiocynate ) conjugated polyclonal rabbit anti-human antisera against IgM, IgG, IgA, C3, C1q, kappa and lambda light chains.
Light chain deposits were seen in 240 (78.43%) cases. In IgA nephropathy, lupus nephritis and post-infectious glomerulonephritis (PIGN), lambda positivity was more as compared to kappa. Light chain deposits in LCDD and membranous nephropathy were more kappa type. The IF pattern in amyloidosis was not consistent.
The pathogenesis of light chain predominance in glomerulopathies is not clear and it depends on isoelectric point and size of the immune complex. Light chain IF should be performed routinely in all the renal biopsies.
肾活检中的轻链免疫荧光法（IF）常用于诊断轻链沉积病（LCDD）、淀粉样变性和管型肾病。在某些肾小球疾病如IgA肾病中也有轻链优势的报道。然而，这种沉积模式在各种肾小球疾病中的发病机制尚不清楚。
探讨轻链免疫荧光法在肾病中的发病机制及应用。
回顾性研究。
回顾了306例各种肾病的轻链免疫荧光模式及光镜诊断结果。所有这些病例均采用商业荧光（异硫氰酸荧光素）偶联的兔抗人多克隆抗血清对IgM、IgG、IgA、C3、C1q、κ和λ轻链进行直接免疫荧光检测。
240例（78.43%）出现轻链沉积。在IgA肾病、狼疮性肾炎和感染后肾小球肾炎（PIGN）中，λ阳性比κ更多。LCDD和膜性肾病中的轻链沉积多为κ型。淀粉样变性的免疫荧光模式不一致。
肾小球疾病中轻链优势的发病机制尚不清楚，这取决于免疫复合物的等电点和大小。所有肾活检均应常规进行轻链免疫荧光检测。
