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Peritubular capillary basement membrane changes in chronic renal allograft rejection

Comparison of light microscopic and ultrastructural observations

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Abstract

Marked peritubular capillary basement membrane (PTCBM) multilayering, the ultrastructural feature of chronic antibody-mediated rejection (ABMR) of kidney allografts, was found to correspond histologically to PTCs with thickened BMs; such PTCs have been suggested as a novel histological marker of chronic rejection. We investigated whether scoring of PTCBM thickening can substitute the ultrastructural search for PTCBM multilayering. The thickening was graded in PAS- and Jones-stained sections in 110 biopsies from recipients with a late dysfunction, all examined ultrastructurally for transplant capillaropathy (≥3 PTCs with ≥5 BM layers). Grade 0 indicated no thickening. Grade 1 and grade 2 were assigned when the PTCBMs were as thick as or thicker than those of the non-atrophic tubules, and duplication/chain-like lamination of the PTCBM was noted in ≤3 or ≥4 high-power fields, respectively. The series was enrolled in subgroups of those with and those without histopathological lesions of chronic rejection. Fifty-six biopsies displayed lesions of chronic ABMR. Transplant capillaropathy was demonstrated in 40 biopsies. Grade 2 thickening furnished a substantial interobserver concordance rate (κ = 0.803) and correlated with the transplant capillaropathy. Jones staining performed somewhat better in scoring than PAS staining. Grade 2 thickening was verified in 35 biopsies involving chronic ABMR, and in one control biopsy (sensitivity 61.4%, specificity 0.98). Grade 1 thickening was not suggestive of chronic ABMR at all. In conclusion, grade 2 thickening can be regarded as the histopathological lesion of chronic ABMR; however, electron microscopy remains the gold standard in the assessment of PTCBM changes.

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Acknowledgement

This study was supported in part by a grant to B.I. (TÁMOP-4.2.1/B-09/1/KONV-2010-0005, Budapest, Hungary). The authors appreciate the highly constructive comments of Reviewer 2.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Pathology, University of Szeged, Allomas u. 2, 6720, Szeged, Hungary

    Bela Ivanyi, Eva Kemeny & Peter Rago

  2. Transplantation and Surgical Clinic, Semmelweis University, Budapest, Hungary

    Norbert Lazar

  3. Department of Medical Informatics, University of Szeged, Szeged, Hungary

    Krisztina Boda

  4. Department of Radiology, University of Szeged, Szeged, Hungary

    Zita Morvay

  5. Renal Transplantation Unit of the Surgical Clinic, University of Szeged, Szeged, Hungary

    Pal Szenohradszky & Edit Szederkenyi

Authors
  1. Bela Ivanyi
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  2. Eva Kemeny
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  3. Peter Rago
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  4. Norbert Lazar
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  5. Krisztina Boda
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  6. Zita Morvay
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  7. Pal Szenohradszky
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  8. Edit Szederkenyi
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Correspondence to Bela Ivanyi.

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Ivanyi, B., Kemeny, E., Rago, P. et al. Peritubular capillary basement membrane changes in chronic renal allograft rejection. Virchows Arch 459, 321–330 (2011). https://doi.org/10.1007/s00428-011-1114-x

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  • DOI: https://doi.org/10.1007/s00428-011-1114-x

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