Immunofluorescence -- Renal Insufficiency

IMMUNOFLUORESCENCE

INTERPRETATION:

Findings indicate deposition of material containing polyclonal IgG and complement within the capiliary walls and mesangium as well as tubular basement membranes. The nonlinear pattern, nongranular staining with the enumerated staining profile suggests fibrillary/immunotactoid glomerulopathy.

RESULTS:

The tissue examined for immunofluorescence contained 12 glomeruli, of which 6 were sclerotic, 1 artery and 2 arterioles. Direct immunofluorescence was performed using a panel of ten anti-sera.

.	IgG	IgM	IgA	C1q	C3	C4	Fib	A1b	KAP	LAM
Glomeruli: Linear Diffuse	.	.	.	.	.	.	.	3+	.	.
Focal	*4+	^TR	.	.	.	.	.	.	.	*4+
Other**	3+	.	.	1-2+	1+	TR-1+	.	.	3+	2+
Tubules: Epithelial Cells	.	.	.	.	1+ (focal)	.	2+	3+	.	.
Basement Membrane	3+	.	.	1-2+	1+	TR-1+	.	3+	3+	2+
Casts	+	+	+	.	+	+	+	+	+	+
Interstitium: Connective Tissue	.	.	.	.	.	.	2+	.	.	.
Cells	.	1+ (focal)	2+ (focal)	.	.	.	.	.	.	.
Vessels: Arterioles	.	.	.	.	2+	.	.	.	.	.
Capillary	2+	1+	.	.	.	.	2+	.	.	.
Veins	.	.	.	.	.	.	.	.	.	.

Abbreviations:

Fib - Fibrinogen, Alb - Albumin, KAP - Kappa, LAM - Lambda, TR - Trace

Note:

* Focal segmental accentuation of staining.

** Ribbon-like/smudgy staining pattern--mesangial and peripheral capillary loop.

^ Non specific staining (? areas of scarring).

Focal staining of Bowman's capsule is noted with IgG and albumin.

Thioflavin-T (fluorescent stain for amyloid) shows weak, probably nonspecific, glomerular staining.

ELECTRON MICROSCOPY

FINAL DIAGNOSIS