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Peritubular capillary basement membrane changes in chronic renal allograft rejection

Comparison of light microscopic and ultrastructural observations


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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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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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 (2011).

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  • Chronic antibody-mediated rejection
  • Electron microscopy
  • Histology
  • Kidney allograft
  • Peritubular capillary