Immunofluorescence Microscopy

Typical diabetic glomerulosclerosis usually can be diagnosed with reasonable accuracy from the immunofluorescence microscopy findings alone. The characteristic feature is linear staining of GBMs with antisera specific for immunoglobulin G (IgG) and other plasma proteins, although the staining for IgG is usually brightest (Fig. 12.8). Kappa light chain staining usually is brighter than lambda light chain staining. Immunofluorescence microscopy is useful for ruling out other glomerular diseases that can mimic diabetic glomerulosclerosis by light microscopy, such as monoclonal immunoglobulin deposition disease, membranoproliferative glomerulone-phritis, fibrillary glomerulonephritis, and amyloidosis. Bowman's capsule and TBMs also often show linear staining.

In addition to the linear staining for IgG, the background fluorescence often allows identification of the typical nodular sclerosis because the mesangial nodules may also stain for IgG and other determinants.

The overall histology, not to mention the clinical features, usually preclude any confusion with anti-GBM disease as a result of the linear GBM staining for IgG.

Figure 12.8. Glomerulus from patient with diabetic glomerulosclerosis showing linear staining of glomerular basement membranes (GBMs) by immunofluores-cence microscopy for immunoglobulin G (IgG). Note also the tubular basement membrane (TBM) staining on the left.

Figure 12.9. Electron microscopy of a glomerulus from patient with diabetic glomerulosclerosis showing marked increase in mesangial matrix (lower right quadrant), thickening of the GBM (especially at the top of the image), and a capsular drop of electron-dense insudative material (upper left quadrant).

Figure 12.9. Electron microscopy of a glomerulus from patient with diabetic glomerulosclerosis showing marked increase in mesangial matrix (lower right quadrant), thickening of the GBM (especially at the top of the image), and a capsular drop of electron-dense insudative material (upper left quadrant).

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

Get My Free Ebook


Post a comment