Department of Nephrology, Toho University Graduate School of Medicine, Tokyo, Japan.
Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan.
Nephron. 2020;144 Suppl 1(Suppl 1):71-78. doi: 10.1159/000512136. Epub 2020 Dec 1.
Low-vacuum scanning electron microscopy (LVSEM) has been reported to aid in diagnosis of renal biopsy. This study evaluated early transplant glomerulopathy in kidney transplant recipients using LVSEM.
We selected 4 biopsies of cg0, 5 biopsies of cg1a, 5 biopsies of cg1b, and 4 biopsies of cg2 lesions that had been evaluated by light microscopy (LM) and transmission electron microscopy from recipients with acute/active or chronic, active antibody-mediated rejection (AABMR or CAABMR). Renal allograft paraffin sections (1 µm thickness) were stained with periodic acid-methenamine silver and observed using LVSEM. The cg score was based on the Banff classification. The parameter "percentage of duplicated capillary number" was calculated as follows: in 1 glomerulus with glomerular basement membrane (GBM) duplication, the total duplicated capillary number/the total number of capillaries ×100.
In all 4 biopsy specimens with AABMR showing cg0, LVSEM revealed GBM duplication not identified by LM. The average percentage of duplicated capillary number per glomerulus with GBM duplication was higher when observed by LVSEM than when observed by LM in all cg1b and cg2 biopsy specimens.
LVSEM revealed early GBM duplication in AABMR. Early GBM duplication might progress in the very early phase of AABMR. GBM duplication was more frequently detected by LVSEM than by LM in biopsy specimens with early chronic, active antibody mediated rejection. Thus, LVSEM may be useful in diagnosis of early transplant glomerulopathy.
低真空扫描电子显微镜（LVSEM）已被报道有助于肾活检的诊断。本研究使用 LVSEM 评估了肾移植受者的早期移植肾小球病。
我们从急性/活跃或慢性、活跃抗体介导的排斥反应（AABMR 或 CAABMR）受者的光镜（LM）和透射电镜评估中选择了 4 例 cg0 活检、5 例 cg1a 活检、5 例 cg1b 活检和 4 例 cg2 病变。肾移植石蜡切片（1 µm 厚）用过碘酸-美蓝染色，并用 LVSEM 观察。cg 评分基于 Banff 分类。“重复毛细血管数量的百分比”参数的计算方法如下：在 1 个具有肾小球基底膜（GBM）重复的肾小球中，总重复毛细血管数量/总毛细血管数量×100。
在所有 4 例 AABMR 显示 cg0 的活检标本中，LVSEM 显示了 LM 未识别的 GBM 重复。在所有 cg1b 和 cg2 活检标本中，用 LVSEM 观察时，每个具有 GBM 重复的肾小球的平均重复毛细血管数量百分比均高于用 LM 观察时。
LVSEM 显示了 AABMR 中的早期 GBM 重复。早期 GBM 重复可能在 AABMR 的极早期阶段进展。在具有早期慢性、活跃抗体介导排斥反应的活检标本中，LVSEM 比 LM 更频繁地检测到 GBM 重复。因此，LVSEM 可能有助于早期移植肾小球病的诊断。
