Background: Post-infectious glomerulonephritis (PIGN) (immune complex-mediated glo-merulonephritis) and C3 glomerulopathy are sub-types of glomerulonephritis (GN) with hypercellularity. Both have overlapping clinical and morphologic features on a kidney biopsy, however, the treatment and prognosis of these diseases are quite different making their distinction of utmost importance. Immune complex-mediated glomerulonephritis arises from glomerular deposition of immune-complexes (Igs) and C3 as a result of activation of classical (CP) and lectin pathways (LP). C4d is produced as a result of activation of the CP/ LP. On the other hand, C3 glomerulopathy results from activation of alternative pathway of complement. Aim: To distinguish between PIGN and C3 glomerulopathy with the help of C4d IHC stain. Materials and Methods: We studied 28 biopsies reported as GN with hypercellularity from January 2015 to January 2020. Clinical information, histological features and immuno-fluorescence patterns were analyzed. C4d IHC was performed on all the biopsies. Six known cases of immune complex-mediated GN were selected to act as a positive control for C4d staining. Results: Amongst 28 cases originally reported as GN with hypercellularity, 18 were labeled as post-infectious GN and 10 as C3 glomerulopathy based on clinical information and serological findings. 13 of 18 (72.2%) cases of PIGN had mild to moderate (1–2+) C4d staining, 2 (11.1%) had strong (3+) staining and 3 (16.7%) cases were negative for C4d staining. In the 10 biopsies of C3 glomerulopathy, mild (1+) C4d staining was noted only in 3 (30%) biopsies. C4d had moderate to strong (2–3+) staining in the control group. Conclusion: C4d IHC stain can be helpful in distinguishing PIGN from C3 glomerulopathy.
CITATION STYLE
Bashir, S., Hussain, M., Afzal, A., Hassan, U., Hameed, M., & Mushtaq, S. (2021). C4d at crossroads between post-infectious glomerulonephritis and c3 glomerulopathy. International Journal of Nephrology and Renovascular Disease, 14, 87–95. https://doi.org/10.2147/IJNRD.S285302
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