A comparative study of human glomerular basement membrane thickness using direct measurement and orthogonal intercept methods

Introduction Here we report estimates of glomerular basement membrane (GBM) thickness in the Brazilian population performed using direct (DM) and orthogonal interception methods (OIM), and comment on potential sources of variation among estimates made by different laboratories. Methodology A total of 38 patients, ranging from 3 to 78 years of age, 26 (68%) males and 12 (32%) females, were submitted to kidney biopsy procedures for renal disease diagnosis. Glomeruli were diagnosed with minor histological changes by conventional, immunofluorescence and electron microscopy. GBM thickness was estimated using both DM and OIM methods. Results Estimates of GBM thickness obtained using DM were higher than those obtained by OIM. However, the application of a correction for non-perpendicular membrane sectioning to DM estimates yielded similar results to those obtained under OIM. The estimated GMB thickness using DM after correction was 289 + 44 nm, versus 287 + 48 nm by OIM. No statistically significant differences were detected in GMB thickness, nor with respect to patient age or sex. Conclusions GBM thickness in the studied Brazilian population measured approximately 290 nm. The application of criteria for estimating the shortest distance between the endothelial and podocyte cell membranes with correction for non-perpendicular membrane sectioning can increase the accuracy of GBM thickness estimates using DM and OIM.

Lupus Nephritis Correlates with B-Cell Interferon-β, Anti-Smith, and Anti-DNA: A Retrospective Study

Background: In systemic lupus erythematosus (SLE), detection of interferon-β (IFNβ)in B cells was found to be most prominent in patients with high anti-Smith (Sm) and renal disease, but a mechanistic connection was not clear. The objective of the present study is to determine the association of IFNβ in peripheral blood naïve B cells with the histopathological features of lupus nephritis (LN).Methods: The percentage of IFNβ+ cells in IgD+CD27− naïve CD19+ B cells (B-cell IFNβ) among peripheral blood mononuclear cells (PBMCs) from 80 SLE patients were analyzed using flow cytometry. Serological and clinical data were collected. The correlations of B-cell IFNβ with LN classification and with histopathological findings (light, electron and immunofluorescence [IF] microscopic analyses for deposition of IgM, IgG, IgA, C1q, and C3) were determined in 23 available biopsy specimens.Results: B-cell IFNβ is positively associated with anti-Sm (p = 0.001), anti-DNA (p = 0.010), and LN (p = 0.001), but was negatively associated with oral/nasal ulcer (p = 0.003) and photosensitivity (p = 0.045). B-cell IFNβ positively correlated with immune complex (IC) deposit in the glomerular basement membrane (GBM) (p = 0.002) but not in the mesangial (p = 0.107) or tubular region (p = 0.313). Patients with high B-cell IFNβ had statistically increased development of the proliferative LN (Classes III, IV and/or V), compared to patients with low B-cell IFNβ (p < 0.0001). Histopathological features positively associated with increased B-cell IFNβ included active glomerular lesions as determined by fibrocellular crescents (p = 0.023), chronic glomerular lesions indicated by segmental sclerosis (p = 0.033), and a membranous pattern of renal damage indicated by spike/holes (p = 0.015).Conclusion: B-cell IFNβ correlates with severe LN, glomerular basement membrane (GBM) IC deposition, and anatomical features of both active and chronic glomerular lesions.

Myeloproliferative neoplasm related nephropathy

Primary Myelofibrosis associated Nephropathy is a recently described entity. Primary Myelofibrosis (PMF) is a Myeloproliferative Neoplasm (MPN) where the marrow space shows fibrosis with megakaryocyte dysplasia. We present a case of a 32 year old patient who was detected to have proteinuria, renal dysfunction and anemia ,on a routine health check up. Primary Myelofibrosis was confirmed by positive Jak 2 expression. Kidney biopsy showed focal segmental glomerulosclerosis along with thickened glomerular basement membrane. The histomorphological features of renal and bonemarrow biopsies are analysed and a detailed review of the literature is done.

Anti-glomerular basement membrane disease in children: a brief overview

Anti-glomerular basement membrane disease (Anti-GBM), previously known as Goodpasture syndrome, is an extremely rare cause of rapidly progressive glomerulonephritis and chronic kidney disease stage 5 (CKD5) in children. It is associated with acute pulmonary haemorrhage and it has a poor prognosis. It is classified as an autoimmune, small-vessel vasculitis caused by autoantibody formation against the alpha-3 chain in type IV collagen found in the glomerular basement membrane. Evidence of anti-GBM antibodies in serum or histologically are required for diagnosis. Treatment in children is based on very limited adult data and often involves the use of acute apheresis to rapidly remove circulating factors coupled with intensive immunosuppression such as cyclophosphamide and intravenous corticosteroids. There is also an emerging role for the use of biologic agents such as B cell depletion. The evidence base in children with anti-GBM disease is extremely limited. Multi-centre international collaboration is required to provide insight into this disease, better describe its prognosis and work towards improving outcomes. This review article summarises the key features of this disease in children, highlights treatment options and considers areas of unmet need.

An Investigation of the Antigenic Characteristics of the Renal Glomerulus in the Rat

<p>The finding of a granular deposition of immunoglobulin in the kidney in experimental animal models of glomerulonephritis has been been interpreted as resulting from the random deposition of immune complexes in the glomeruli. Recent data suggests that although immune complex deposition may be an important factor in some forms of glomerulonephritis, the in situ formation of immune complexes between circulating anti-kidney antibodies and fixed glomerular capillary wall antigens may also be a significant factor in the pathogenesis of some animal models of glomerulonephritis. To examine the characteristics of discontinuously represented glomerular capillary wall antigens in the rat, monoclonal antibodies were generated against a glomerular plasma membrane fraction, depleted of glomerular basement membrane, prepared from isolated Lewis rat glomeruli. A total of 17 hybridomas, generated from the fusion of splenocytes obtained from mice immunised with the glomerular membrane fraction produced monoclonal antibodies which reacted with discontinuously represented antigens in the glomerulus and renal tubules. One further hybridoma secreted a monoclonal antibody which reacted with an antigen present on glomerular and tubular nuclear membranes. No hybridomas were produced which secreted a monoclonal antibody which reacted with linearly arrayed glomerular basement membrane antigens. Two of these monoclonal antibodies, both of the IgM subclass and code-named PH7 and SC5, produced a heavy granular glomerular staining pattern when examined by indirect immunofluorescence microscopy. Neither monoclonal antibody was kidney specific, with reactivity being demonstrated with a number of non-renal tissues. When administered intravenously to normal Lewis rats both SC5 and PH7 induced a mild proteinuric lesion. The proteinuria was not associated with histopathological changes at the light or electron microscope level. Immunoblotting experiments revealed that SC5 reacted predominantly with a protein band of 96 kDa present in detergent extracts of isolated glomeruli and glomerular plasma membranes. PH7 was shown to react with three low molecular weight proteins of 14, 13 and 11 kDa The findings of this study demonstrate the potential for a nephritogenic response to occur following the in situ formation of immune complexes between circulating anti-kidney antibodies and discontinuously arrayed non-glomerular, basement membrane glomerular capillary wall antigens characterised by granular immunofluorescence patterns,in animal models of glomerulonephritis.</p>

An Investigation of the Antigenic Characteristics of the Renal Glomerulus in the Rat

<p>The finding of a granular deposition of immunoglobulin in the kidney in experimental animal models of glomerulonephritis has been been interpreted as resulting from the random deposition of immune complexes in the glomeruli. Recent data suggests that although immune complex deposition may be an important factor in some forms of glomerulonephritis, the in situ formation of immune complexes between circulating anti-kidney antibodies and fixed glomerular capillary wall antigens may also be a significant factor in the pathogenesis of some animal models of glomerulonephritis. To examine the characteristics of discontinuously represented glomerular capillary wall antigens in the rat, monoclonal antibodies were generated against a glomerular plasma membrane fraction, depleted of glomerular basement membrane, prepared from isolated Lewis rat glomeruli. A total of 17 hybridomas, generated from the fusion of splenocytes obtained from mice immunised with the glomerular membrane fraction produced monoclonal antibodies which reacted with discontinuously represented antigens in the glomerulus and renal tubules. One further hybridoma secreted a monoclonal antibody which reacted with an antigen present on glomerular and tubular nuclear membranes. No hybridomas were produced which secreted a monoclonal antibody which reacted with linearly arrayed glomerular basement membrane antigens. Two of these monoclonal antibodies, both of the IgM subclass and code-named PH7 and SC5, produced a heavy granular glomerular staining pattern when examined by indirect immunofluorescence microscopy. Neither monoclonal antibody was kidney specific, with reactivity being demonstrated with a number of non-renal tissues. When administered intravenously to normal Lewis rats both SC5 and PH7 induced a mild proteinuric lesion. The proteinuria was not associated with histopathological changes at the light or electron microscope level. Immunoblotting experiments revealed that SC5 reacted predominantly with a protein band of 96 kDa present in detergent extracts of isolated glomeruli and glomerular plasma membranes. PH7 was shown to react with three low molecular weight proteins of 14, 13 and 11 kDa The findings of this study demonstrate the potential for a nephritogenic response to occur following the in situ formation of immune complexes between circulating anti-kidney antibodies and discontinuously arrayed non-glomerular, basement membrane glomerular capillary wall antigens characterised by granular immunofluorescence patterns,in animal models of glomerulonephritis.</p>

Evaluation of ultrastructural alterations of glomerular basement membrane and podocytes in glomeruli by low-vacuum scanning electron microscopy

Background Low-vacuum scanning electron microscopy (LV-SEM) is applied to diagnostic renal pathology. Methods To demonstrate the usefulness of LV-SEM and to clarify the optimal conditions of pathology samples, we investigated the alterations of glomerular basement membrane (GBM) and podocytes in control and experimental active Heymann nephritis (AHN) rats by LV-SEM. Results On week 15 following induction of AHN, spike formation on GBM with diffuse deposition of IgG and C3 developed. Using LV-SEM, diffuse crater-like protrusions were clearly noted three-dimensionally (3D) on surface of GBM in the same specimens of light microscopy (LM) and immunofluorescence (IF) studies only after removal coverslips or further adding periodic acid-silver methenamine (PAM) staining. These 3D ultrastructural findings of GBM surface could be detected in PAM-stained specimens by LV-SEM, although true GBM surface findings could not be obtained in acellular glomeruli, because some subepithelial deposits remained on surface of GBM. Adequate thickness was 1.5–5 μm for 10% formalin-fixed paraffin-embedded (FFPE) and 5–10 μm for the unfixed frozen sections. The foot processes and their effacement of podocytes could be observed by LV-SEM using 10%FFPE specimens with platinum blue (Pt-blue) staining or double staining of PAM and Pt-blue. These findings were obtained more large areas in 2.5% glutaraldehyde-fixed paraffin-embedded (2.5%GFPE) specimens. Conclusion Our findings suggest that LV-SEM is a useful assessment tool for evaluating the alterations of GBM and podocytes in renal pathology using routine LM and IF specimens, as well as 2.5%GFPE specimens.