Minimal change disease immunohistology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]
Overview
A kidney biopsy is not routinely performed as soon as nephrotic syndrome is found during lab work-up. According to the National Kidney Foundation (NKF) Kidney Disease – Improve Global Outcomes (KDIGO) guidelines in 2012, an initial attempt using corticosteroids should be performed before a renal biopsy is performed. A renal biopsy of minimal change disease shows no or minimal abnormalities on light microscopy. Lipid-laden cells may be seen in proximal tubular epithelium. Renal biopsy is often unremarkable under immunofluorescence, with the exception of few cases that stain positively for IgM antibodies and C3.The hallmark of minimal change disease is absence of visible alterations on light microscopy and absence of effacement of foot processes by electron microscopy.
Immunohistology
Light Microscopy
- A renal biopsy of minimal change disease shows no or nearly normal with abnormalities on light microscopy.[1][2][3]
- Mesangial proliferation is seen on light microscopy.
- Lipid-laden cells may be seen in proximal tubular epithelium.
- Additional features of focal segmental glomerulosclerosis, such as mesangial prominence, interstitial fibrosis, and tubular atrophy, or glomerular tip lesions of focal segmental glomerulosclerosis, may be seen in patients who have complicated disease.[4]
- Those with acute renal injury may have histological features of focal flattening of the proximal tubular epithelium.[4]
Immunofluorescence
- Renal biopsy is often unremarkable under immunofluorescence, with the exception of few cases that stain positively for IgM antibodies and C3.[4]
References
- ↑ Beck L, Bomback AS, Choi MJ, Holzman LB, Langford C, Mariani LH; et al. (2013). "KDOQI US commentary on the 2012 KDIGO clinical practice guideline for glomerulonephritis". Am J Kidney Dis. 62 (3): 403–41. doi:10.1053/j.ajkd.2013.06.002. PMID 23871408.
- ↑ Vivarelli, Marina; Massella, Laura; Ruggiero, Barbara; Emma, Francesco (2017). "Minimal Change Disease". Clinical Journal of the American Society of Nephrology. 12 (2): 332–345. doi:10.2215/CJN.05000516. ISSN 1555-9041.
- ↑ Vivarelli M, Massella L, Ruggiero B, Emma F (February 2017). "Minimal Change Disease". Clin J Am Soc Nephrol. 12 (2): 332–345. doi:10.2215/CJN.05000516. PMC 5293332. PMID 27940460.
- ↑ 4.0 4.1 4.2 D'Agati V (2003). "Pathologic classification of focal segmental glomerulosclerosis". Semin Nephrol. 23 (2): 117–34. doi:10.1053/snep.2003.50012. PMID 12704572.