L-selectin配体在输卵管妊娠中母胎界面的表达

目的:探讨L-selectin配体(HECA-452和MECA-79)与输卵管妊娠的关系.方法:运用免疫组化和实时荧光定量PCR的方法,检测16例输卵管妊娠患者的胚囊种植部位标本(A组)、16例胚囊种植旁部位标本(B组)和4例正常假孕输卵管标本中的HECA-452和MECA-79的表达情况.结果:免疫组化结果显示HECA-452在A组中染色强阳性、中度阳性和弱阳性分别为56.25%、31.25和12.5%,而在B组中仅为31.25%的弱阳性,而阴性占68.75%,A组中的HECA-452的染色阳性率和阳性程度明显高于B组.MECA-79染色在A组中弱阳性(25%),B组中均为阴性(100%).HECA-452和MECA-79在C组中均阴性.HECA-452 mRNA在A组中的表达明显高于B组,两者有统计学差异(P＜0.001).结论:L-selectin配体HECA-452和MECA-79在输卵管妊娠的母胎界面上有表达,L-selectin系统可能参与榆卵管妊娠的发生.     

肾活检组织免疫荧光染色

免疫荧光技术由 Coons等于五十年代创立 ,目前已广泛应用于临床检验。在人类肾脏疾病中 ,不同类型的肾小球肾炎有不同的免疫反应特点。我科自一九八四年至今 ,对住院患者的肾活检组织进行免疫荧光染色 ,共检测 395 3例 ,在实际应用中收到了很好的效果。现介绍如下 :1.材料1.1　标本来源 :肾组织均系我院肾病科肾活检标本 ,经恒温冷冻切片机 3～ 5 μm切片 ,4℃备用。1.2　试剂配制 :抗人荧光抗体 Ig G、Ig A、Ig M、C3、C4、Cq、F为 DAKo公司产品 ,由北京医科大学病理学系提供。1.3　染色步骤 :1肾组织冷冻切片凉至室温编号入湿盒。2…     

原发性子宫颈恶性黑色素瘤1例并文献复习

目的 探讨1例原发性子宫颈恶性黑色素瘤（primary malignant melanoma of the cervix, PMMC）的临床病理学特征、鉴别诊断、治疗及预后。方法 应用HE染色、免疫组织化学染色对武汉市中心医院收治的1例PMMC的临床病理特点及免疫表型进行分析,并进行相关的国内外文献复习。结果 大体标本呈乳头状,色暗红,局灶灰黑,大小4 cm×4 cm;镜下见不规则巢团样排列的肿瘤细胞弥漫浸润子宫颈壁,肿瘤细胞主呈上皮样,胞质较丰富,核多形较明显,少数细胞可见清晰核仁,未见明显色素颗粒;免疫组织化学表型：S-100、SOX-10、melan-A、MiTF弥漫强阳性,p16、vimentin阳性,CD34、D2-40示脉管,Ki-67增殖指数约50%,HMB-45、PCK、p40阴性。结论 PMMC是一种恶性程度极高、临床上罕见的肿瘤,术前诊断主要依赖临床表现、病理活检及免疫组织化学染色结果。手术治疗为主,术后结合辅助治疗,预后差。     

免疫组化染色阳性对照的设立、制作与应用

目的探讨如何设立免疫组化染色的阳性对照,使操作更简单、结果可靠和方法实用。方法选取阑尾、乳腺和扁桃体等不同类型的组织,通过HE切片观察,选取合适相应抗原表达的区域,将组织切成0.3cm*0.3cm大小,重新作石蜡包埋,连续切片厚4μm,贴在待检查组织旁边作为对照,进行CK、CK19、SMA、CD20、CD3、ER、PR、等36种抗体的免疫组化染色,并观察组织中抗原的表达是否正确,筛选出适合作为免疫组化染色阳性对照的组织。结果乳腺皮肤和扁桃体组织仅部分抗体染色阳性,而阑尾组织中有多种抗原表达,34种抗体染色均呈阳性,染色阳性的其他相对区域的组织细胞呈阴性染色。结论阑尾组织可作为大多抗体染色的阳性对照和阴性对照。方法简单,操作方便,节省抗体,适用于临床批量工作,对免疫组化的染色过程起到很好的质控作用。但对于某些抗体染色,如ER、PR等抗体的阳性对照,则应选用相应的组织如含正常导管上皮乳腺导管癌组织作对照。     

萧山地区524例健康献血者血清中乙肝前S1蛋白调查分析

目的了解健康献血者（指表面抗原阴性、丙肝抗体阴性、艾滋抗体阴性、梅毒抗体阴性、ALT小于25赖氏单位）血清中乙肝前S1蛋白的阳性状况。方法采用ELISA法对萧山地区524例健康献血者作前S1蛋白调查检测,同时对前S1蛋白阳性标本采用放免法,作乙肝三系检测。结果有12例前S1蛋白阳性,阳性率为2．3％,其中有1例乙肝三系核心抗体IgG阳性,其余11例乙肝三系各项指标全阴性。对12例阳性者作跟踪调查,1年后,在12例阳性者中,有4例前S1蛋白仍保持阳性,对4例阳性标本再作乙肝三系检测,除1例1年前核心抗体IgG阳性外,其余3例乙肝三系各项指标仍保持阴性。     

唇腺活检、自身抗体在干燥综合征诊断中的意义

目的:探讨干燥综合征(ss)患者的唇腺活检病理表现、自身抗体及其在诊断中的意义。方法:收集85例干燥综合征患者的临床体征、唇腺活检以及其他相关辅助检查,对其唇腺活检病理标本及相关检查进行分析。结果:根据唇腺病理结果,单纯唇腺活检的阳性率为68.2%;单纯血清抗SSA/SSB抗体检出阳性率为78.8%;联合唇腺活检、抗SSA/SSB抗体疾病检出率达94.1%,与单纯唇腺活检或抗SSA/SSB抗体单项阳性的疾病检出率有统计学意义(P0.05);并且唇腺活检阳性患者较阴性患者口干或眼干持续时间长(P0.05);但腮腺ECT异常、关节肿痛、肺脏损害均较唇腺活检阴性组患者累及率高,但差异无统计学意义(P0.05)。结论:唇腺活检、自身抗体是诊断干燥综合征的必要检查,而其联合应用更具有举足轻重的意义。     

高表达C3aR的肥大细胞在糖尿病肾病患者肾组织中的分布及病理意义分析

选取糖尿病肾病(diabetic nephropathy,DN)早期、中期、晚期以及正常移植供肾各15例,分别作为DN早期组、中期组、晚期组和正常对照组,利用各个病例的肾穿刺组织标本进行C3aR免疫组化染色,分析各组中高表达C3aR浸润细胞的数量和分布特点,及其与DN发生、发展的关系,利用连续切片、免疫荧光双套色染色、免疫电镜、及甲苯胺蓝染色等方法对DN患者肾组织中高表达C3aR的浸润细胞进行细胞类型鉴定.结果表明:a.光镜和免疫电镜的形态学分析显示DN患者肾组织中高表达C3aR的浸润细胞在形态上具有肥大细胞的特点,免疫荧光双套色染色的分析显示,C3aR浸润细胞CD45阴性、CD68和类胰蛋白酶阳性,与肥大细胞的情况一致,甲苯胺蓝特殊染色进一步证实这是一种肥大细胞.b.正常移植供肾组织中虽有肥大细胞分布,但数量很少;从DN早期组到DN中期组,再到DN晚期组,肾组织中肥大细胞的数量有一种不断增加的趋势;DN患者肾组织肥大细胞的数量与24 h尿蛋白和血肌酐水平均具有很好的线性相关性.上述工作不仅揭示了在DN发生发展过程中肥大细胞在DN患者肾组织中的数量及分布情况,提示肥大细胞很可能参与了DN的发生发展过程,同时,DN患者肾组织肥大细胞高表达过敏毒素C3a受体C3aR的发现,提示C3a/C3aR通路很可能在DN患者肥大细胞的招募和激活过程中有重要作用.     

EBER原位杂交结合CK免疫组织化学双染在诊断鼻咽癌中的应用价值

目的探讨全自动免疫组织化学仪行EB病毒早期RNA(Epstein-Barr virus early RNA,EBER)与细胞角蛋白(cytokeratin,CK)双染在鼻咽癌诊断中的应用价值。方法收集我院2018年1月至2019年12月鼻咽活检组织60例,根据诊断结果进行分组,A组为鼻咽非角化型未分化性癌30例,B组为上皮性病变30例。在VENTANA全自动免疫组织化学仪平台上分别对这两组病变进行CK免疫组织化学染色、EBER原位杂交、EBER原位杂交结合CK免疫组织化学(EBERCK)双染标记,其中双染再分为是否复染苏木素,比较染色情况。结果免疫组织化学CK单染A、B组均可见阳性细胞;原位杂交EBER单染A组鼻咽癌细胞阳性,B组表达呈阴性;EBER-CK双染A组鼻咽癌细胞呈双阳性,B组病变细胞呈CK阳性、EBER呈阴性,未见双阳性表达;EBER-CK双染复染苏木素后的表达与未复染苏木素的表达相同,但对比差,不易观察。结论全自动免疫组织化学仪行EBER-CK双染有助于鼻咽癌组织学诊断,不复染苏木素效果更佳,值得推广。     

ELISA法检测流行性腮腺炎病毒感染特异性IgM抗体的研究

用流行性腮腺炎(流腮)病毒Enders株接种鸡胚尿囊腔培养,尿囊液经聚乙二醇6000处理制备流腮病毒抗原,用ELISA法检测流腮患者血清中特异性IgM抗体,其敏感性,特异性、重复性和稳定性都很高。 79份流腮患者血清,检出特异性IgM72份,阳性率为91％,32例非流腮患者IgM全部阴性、两者有极显著差异(P<0.01)。 10份血清作血清倍比稀释至1∶3200测IgM仍全部阳性,1∶6400稀释仅1例阴性,1∶12800稀释5例中仍有2例阳性。 10份血清作流腮抗原特异性抗体阻断试验,光密度抑制率均大于50％,平均为87％,10份标本作2-ME和SPA阻断后检测IgM抗体,结果2-ME阻断标本全部阴转,而SPA阻断标本仍阳性,证实所检测为流腮特异性抗体。 24份标本2次重复检测流腮IgM,其阴、阳性结果一致,这期间抗原放4℃ 1个月,提示抗原的稳定性和方法的重复性都很好。本方法敏感性明显高于血凝抑制试验,其阳性率分别为91％和61％,两者有显著差异。而且所用试剂简单经济,操作简便,快速,适用于临床早期诊断,易于广泛推广应用。     

抗HLJ1单克隆抗体的制备及抗原检测方法的建立

为制备抗人肝脏DnaJ-like蛋白(Human liver DnaJ-like protein, HLJ1)的单克隆抗体, 并建立免疫组化和双抗体夹心ELISA检测HLJ1的方法。采用淋巴细胞杂交瘤技术, 获得两株能稳定分泌抗HLJ1单克隆抗体的杂交瘤细胞株A4C7和 C4C8。经鉴定, 两株单抗的亚类均为IgG1, 并且效价高、特异性好。以单抗A4C7和C4C8作为一抗, 对人胎肝组织石蜡切片进行免疫组化染色, 结果表明, 两株单抗均为阳性染色, 且HLJ1主要定位于胎肝细胞的胞浆。选取A4C7进行HRP酶标记, 并以HRP- A4C7作为酶标抗体, 以C4C8作为包被抗体, 建立双抗体夹心ELISA方法, 并进行棋盘滴定确定抗体的最佳工作浓度。该检测方法的线性范围是15~750 ng/mL, 灵敏度下限达15 ng/mL, 特异性良好。所建立的免疫组化和双抗体夹心ELISA 法可用于快速、灵敏地检测组织及血清中的HLJ1蛋白, 为HLJ1的肿瘤相关性研究提供了有力的工具。     

Digital pathology evaluation of complement C4d component deposition in the kidney allograft biopsies is a useful tool to improve reproducibility of the scoring

Complement C4d component deposition in kidney allograft biopsies is an established marker of antibody-mediated rejection. In the Banff 07 classification of renal allograft pathology, semi-quantitative evaluation of the proportion of C4d-positive peritubular capilaries (PTC) is used. We aimed to explore the potential of digital pathology tools to obtain quantitative and reproducible measure of C4d deposition in the renal allograft tissue.34 routine kidney allograft biopsies immunohistochemically stained for C4d were included in the study and were evaluated by a qualified pathologist twice, recording an approximate percentage of positive PTC and glomerular area. The same slides were scanned by Aperio ScanScope scanner. Two layers of annotations were created: layer of glomeruli and the remaining non-glomerular area. Image analysis was performed with Aperio Positive Pixel Count algorithm to quantify the proportion of C4d-positive pixels in the area analysed. The percentage of positive (defined as 2+ and 3+) pixels in glomeruli and non-glomerular area was obtained and compared to the percentage of C4d-positive PTC and C4d-positive area of glomeruli recorded by the pathologist. The correlation of digital and manual C4d-positive area scoring in glomeruli was very high (r= 0.89, p<0.0001), while the correlation for non-glomerular (digital) and PTC (manual) area was moderate (r=0.60, p<0.001). The correlation between digital and manual evaluation of C4d in non-glomerular area after exclusion of C4d-positive arterioles from analysis did not improve substantially (r = 0.59, p < 0.001). Reproducibility of digital and manual results was evaluated. For C4d deposition in PTC, agreement between the first and the second digital C4d evaluation (after re-drawing annotations) was perfect (κ=0.96, CI 0.91÷1.00) while agreement between two subsequent manual C4d scorings was substantial (κ = 0.67, CI 0.47 ÷ 0.88). Similarly, for C4d deposition in the glomeruli, agreement of digital evaluation was perfect (κ=1) while for manual scorings it was substantial (κ = 0.76, CI 0.64 ÷ 0.88). Digital evaluation of C4d deposition in allograft kidney correlates with pathologist's scoring and exceeds the latter in reproducibilty. Therefore, it provides a useful tool to control for intraobserver and interobserver variability and may serve as quality assurance measure for allograft pathology diagnosis and research.     

Poly[ADP-Ribose] Polymerase-1 Expression Is Related To Cold Ischemia,Acute Tubular Necrosis,and Delayed Renal Function In Kidney Transplantation

Cold ischemia time especially impacts on outcomes of expanded-criteria donor (ECD) transplantation. Ischemia-reperfusion (IR) injury produces excessive poly[ADP-Ribose] Polymerase-1 (PARP-1) activation. The present study explored the hypothesis that increased tubular expression of PARP-1 contributes to delayed renal function in suboptimal ECD kidney allografts and in non-ECD allografts that develop posttransplant acute tubular necrosis (ATN).

Materials and Methods

Nuclear PARP-1 immunohistochemical expression was studied in 326 paraffin-embedded renal allograft biopsies (193 with different degrees of ATN and 133 controls) and in murine Parp-1 knockout model of IR injury.

Results

PARP-1 expression showed a significant relationship with cold ischemia time (r coefficient = 0.603), time to effective diuresis (r = 0.770), serum creatinine levels at biopsy (r = 0.649), and degree of ATN (r = 0.810) (p = 0.001, Pearson test). In the murine IR model, western blot showed an increase in PARP-1 that was blocked by Parp-1 inhibitor. Immunohistochemical study of PARP-1 in kidney allograft biopsies would allow early detection of possible delayed renal function, and the administration of PARP-1 inhibitors may offer a therapeutic option to reduce damage from IR in donor kidneys by preventing or minimizing ATN. In summary, these results suggest a pivotal role for PARP-1 in the ATN of renal transplantation. We propose the immunohistochemical assessment of PARP-1 in kidney allograft biopsies for early detection of a possible delayed renal function.     

Machine scoring of Her2/neu immunohistochemical stains

OBJECTIVE: To establish the feasibility of a machine scoring method for her2/neu immunohistochemistry in samples of breast carcinoma. STUDY DESIGN: A total of 65 consecutive cases of breast carcinoma with immunohistochemical stainingfor her2/neu by the Herceptest (Dako Corp., Carpinteria, California, U.S.A.) method (DAB chromogen with hematoxylin counterstain) were analyzed using an Extended Slide Wizard (Tripath Imaging, Inc., Burlington, North Carolina, U.S.A.) workstation running prototype software. Representative fields of view from the positive control, negative control and up to 10 fields from the stained tumor sample were captured interactively with a phased alternating line 3 CCD color camera. To determine the amount of specific membrane staining, chromogen separation of nuclear counterstain and membrane-positive stain was performed based on their respective absorption coefficients in the three color channels. The amount of specific membrane staining was scored based on a training set covering the rangefrom 0 to 3 + staining scores according to Dako. Manual scores of 2 + were tested for amplification by fluorescence in situ hybridization. RESULTS: The automated scoring results correlated highly with the manual scores obtained per the Herceptest (Dako) instructions (R2>.92). The results were obtained in real time in the interactive mode. CONCLUSION: Machine scoring of immunohistochemical stains is practical, rapid and inherently reproducible, especially for samples with 1+ and 2+ manual scores.     

Prolonged renal allograft survival by donor interleukin-6 deficiency: association with decreased alloantibodies and increased intragraft T regulatory cells

Both humoral and cellular immune responses are involved in renal allograft rejection. Interleukin (IL)-6 is a regulatory cytokine for both B and Foxp3 (forkhead box P3)-expressing regulatory T (Treg) cells. This study was designed to investigate the impact of donor IL-6 production on renal allograft survival. Donor kidneys from IL-6 knockout (KO) vs. wild-type (WT) C57BL/6 mice (H-2(b)) were orthotopically transplanted to nephrotomized BALB/c mice (H-2(d)). Alloantibodies and Treg cells were examined by fluorescence-activated cell sorting analysis. Graft survival was determined by the time to graft failure. Here, we showed that a deficiency in IL-6 expression in donor kidneys significantly prolonged renal allograft survival compared with WT controls. IL-6 protein was upregulated in renal tubules and endothelium of renal allografts following rejection, which correlated with an increase in serum IL-6 compared with that in those receiving KO grafts or naive controls. The absence of graft-producing IL-6 or lower levels of serum IL-6 in the recipients receiving IL-6 KO allografts was associated with decreased circulating anti-graft alloantibodies and increased the percentage of intragraft CD4(+)CD25(+)Foxp3(+) Treg cells compared with those with WT allografts. In conclusion, the lack of graft-producing IL-6 significantly prolongs renal allograft survival, which is associated with reduced alloantibody production and/or increased intragraft Treg cell population, implying that targeting donor IL-6 may effectively prevent both humoral and cellular rejection of kidney transplants.     

Immunophenotyping of acute lymphoblastic leukemia using immunohistochemistry in bone marrow biopsy specimens

Flow cytometry is the preferred method of diagnosing and immunophenotyping acute lymphoblastic leukemia (ALL). However, there are situations in which immunohistochemical staining (IH) of bone marrow trephine biopsy specimens can be used to provide immunophenotypic information. To evaluate the use of IH and to confirm its value in diagnosing and typing of ALL, we studied 50 cases of denovo ALL that were previously classified into pre B, T and B by morphologic, cytochemical and FC methods. Paraffin embedded bone marrow trephine biopsies sections were stained using a panel of antibodies,namely, myeloperoxidase (MPO), terminal deoxynucleotidyl transferase (TdT), CD10, CD20, CD79a, CD3. The cases included 37 pre BALL, 10 T ALL and 3 mature BALL. TdT was the most commonly expressed antibody and was positive in 41 of 50 cases of ALL (82%) and in 95% of pre B ALL cases. CD79a and CD10 were positive in 68% and 65% of pre B ALL cases, respectively. CD79a showed similar positivity in B ALL cases (66%). CD 20 was positive in 66% of mature B ALL cases but less positive in pre B ALL (22%). CD3 was positive in 70% of T ALL cases and negative in other ALL subtypes. All of the cases were negative for MPO. Diagnosis and immunophenotyping of acute lymphoblastic leukemia is possible using immunohistochemical staining of bone marrow trephine biopsies.     

Differential Expression of Specific Dermatan Sulfate Domains in Renal Pathology

Dermatan sulfate (DS), also known as chondroitin sulfate (CS)-B, is a member of the linear polysaccharides called glycosaminoglycans (GAGs). The expression of CS/DS and DS proteoglycans is increased in several fibrotic renal diseases, including interstitial fibrosis, diabetic nephropathy, mesangial sclerosis and nephrosclerosis. Little, however, is known about structural alterations in DS in renal diseases. The aim of this study was to evaluate the renal expression of two different DS domains in renal transplant rejection and glomerular pathologies. DS expression was evaluated in normal renal tissue and in kidney biopsies obtained from patients with acute interstitial or vascular renal allograft rejection, patients with interstitial fibrosis and tubular atrophy (IF/TA), and from patients with focal segmental glomerulosclerosis (FSGS), membranous glomerulopathy (MGP) or systemic lupus erythematosus (SLE), using our unique specific anti-DS antibodies LKN1 and GD3A12. Expression of the 4/2,4-di-O-sulfated DS domain recognized by antibody LKN1 was decreased in the interstitium of transplant kidneys with IF/TA, which was accompanied by an increased expression of type I collagen, decorin and transforming growth factor beta (TGF-β), while its expression was increased in the interstitium in FSGS, MGP and SLE. Importantly, all patients showed glomerular LKN1 staining in contrast to the controls. Expression of the IdoA-Gal-NAc4SDS domain recognized by GD3A12 was similar in controls and patients. Our data suggest a role for the DS domain recognized by antibody LKN1 in renal diseases with early fibrosis. Further research is required to delineate the exact role of different DS domains in renal fibrosis.     

Acute Antibody-Mediated Rejection in Presence of MICA-DSA and Successful Renal Re-Transplant with Negative-MICA Virtual Crossmatch

The presence of donor-specific alloantibodies (DSAs) against the MICA antigen results in high risk for antibody-mediated rejection (AMR) of a transplanted kidney, especially in patients receiving a re-transplant. We describe the incidence of acute C4d+ AMR in a patient who had received a first kidney transplant with a zero HLA antigen mismatch. Retrospective analysis of post-transplant T and B cell crossmatches were negative, but a high level of MICA alloantibody was detected in sera collected both before and after transplant. The DSA against the first allograft mismatched MICA*018 was in the recipient. Flow cytometry and cytotoxicity tests with five samples of freshly isolated human umbilical vein endothelial cells demonstrated the alloantibody nature of patient’s MICA-DSA. Prior to the second transplant, a MICA virtual crossmatch and T and B cell crossmatches were used to identify a suitable donor. The patient received a second kidney transplant, and allograft was functioning well at one-year follow-up. Our study indicates that MICA virtual crossmatch is important in selection of a kidney donor if the recipient has been sensitized with MICA antigens.     

In situ lymphoproliferation in renal transplant biopsies

A double immunohistochemical labelling procedure in paraffin-embedded renal tissue is reported in which CD3 was targeted as a T cell marker and Ki67 as a marker of cell proliferation. Proliferating and quiescent T cells were unequivocally identified in situ, and their precise location within the kidney was clarified by the use of periodic acid-Schiff counterstaining to outline the basement membranes. Proliferating tubular epithelial cells were also clearly identified. The results showed that T lymphocytes proliferate within the tubular compartment during acute renal allograft rejection. Preliminary evaluation of the method in routine transplant biopsies indicated significant correlations between histologically defined rejection grade and mean intratubular T lymphocytes per tubular cross section and between proliferation of tubular epithelial cells and of intratubular T lymphocytes. The associated tubular epithelial cell proliferation may be a response to local damage.     

Depression of Complement Regulatory Factors in Rat and Human Renal Grafts Is Associated with the Progress of Acute T-Cell Mediated Rejection

Background

The association of complement with the progression of acute T cell mediated rejection (ATCMR) is not well understood. We investigated the production of complement components and the expression of complement regulatory proteins (Cregs) in acute T-cell mediated rejection using rat and human renal allografts.

Methods

We prepared rat allograft and syngeneic graft models of renal transplantation. The expression of Complement components and Cregs was assessed in the rat grafts using quantitative real-time PCR (qRT-PCR) and immunofluorescent staining. We also administered anti-Crry and anti-CD59 antibodies to the rat allograft model. Further, we assessed the relationship between the expression of membrane cofactor protein (MCP) by immunohistochemical staining in human renal grafts and their clinical course.

Results

qRT-PCR results showed that the expression of Cregs, CD59 and rodent-specific complement regulator complement receptor 1-related gene/protein-y (Crry), was diminished in the rat allograft model especially on day 5 after transplantation in comparison with the syngeneic model. In contrast, the expression of complement components and receptors: C3, C3a receptor, C5a receptor, Factor B, C9, C1q, was increased, but not the expression of C4 and C5, indicating a possible activation of the alternative pathway. When anti-Crry and anti-CD59 mAbs were administered to the allograft, the survival period for each group was shortened. In the human ATCMR cases, the group with higher MCP expression in the grafts showed improved serum creatinine levels after the ATCMR treatment as well as a better 5-year graft survival rate.

Conclusions

We conclude that the expression of Cregs in allografts is connected with ATCMR. Our results suggest that controlling complement activation in renal grafts can be a new strategy for the treatment of ATCMR.     

Sarcoidosis in Native and Transplanted Kidneys: Incidence,Pathologic Findings,and Clinical Course

Renal involvement by sarcoidosis in native and transplanted kidneys classically presents as non caseating granulomatous interstitial nephritis. However, the incidence of sarcoidosis in native and transplant kidney biopsies, its frequency as a cause of end stage renal disease and its recurrence in renal allograft are not well defined, which prompted this study. The electronic medical records and the pathology findings in native and transplant kidney biopsies reviewed at the Johns Hopkins Hospital from 1/1/2000 to 6/30/2011 were searched. A total of 51 patients with a diagnosis of sarcoidosis and renal abnormalities requiring a native kidney biopsy were identified. Granulomatous interstitial nephritis, consistent with renal sarcoidosis was identified in kidney biopsies from 19 of these subjects (37%). This is equivalent to a frequency of 0.18% of this diagnosis in a total of 10,023 biopsies from native kidney reviewed at our institution. Follow-up information was available in 10 patients with biopsy-proven renal sarcoidosis: 6 responded to treatment with prednisone, one progressed to end stage renal disease. Renal sarcoidosis was the primary cause of end stage renal disease in only 2 out of 2,331 transplants performed. Only one biopsy-proven recurrence of sarcoidosis granulomatous interstitial nephritis was identified.

Conclusions

Renal involvement by sarcoidosis in the form of granulomatous interstitial nephritis was a rare finding in biopsies from native kidneys reviewed at our center, and was found to be a rare cause of end stage renal disease. However, our observations indicate that recurrence of sarcoid granulomatous inflammation may occur in the transplanted kidney of patients with sarcoidosis as the original kidney disease.