Clinicopathologic significance of “full-house” immunofluorescent staining in glomerular diseases: a 50-case analysis

Objective The “full house” immunofluorescent staining is characterized by positive staining of IgG, IgA, IgM, C 3 as well as C 1q in the glomerualr mesangium and along the glomerular basement membrane, which is one of the features of lupus nephritis (LN). There are few reports discussing the significance of the “full house” immunofluorescent staining in various glomerular diseases. The authors aimed to analyze case by case the clinical manifestations and renal biopsy specimens and interpret the clinicopathologic correlations of the “full house” immunofluorescent staining in glomerular diseases. Methods There were 50 out of 450 renal biopsies described as having “full house” immunofluorescent staining in renal specimens from 1984 to 1999. The clinical data of the 50 cases with “full house” immunofluorescent staining were retrospectively analyzed and investigated. Results Totally 10.1% (50/450)renal specimens presented “full house” immunofluorescent staining. Among the 50 cases as “full house” immunofluorescent staining, the renal pathology showed various lesions. (1)Twenty one of 50 cases with “full house” immunofluorescent staining were LN including 4 cases with Class II LN, 5 cases with Class III, 9 cases with Class IV and 3 cases with Class V. (2)Thirteen of 50 cases were hepatitis B virus related glomerulonephritis (HBV GN) including 4 cases with mild mesangioproliferative glomerulonephritis, 7 with membranous nephropathy and 2 with membranoproliferative glomerulonephritis. (3) Nine of 50 cases were purpura nephritis and presented clinically with nephrotic syndrome. (4) Six of 50 cases were IgA nephropathy. (5)There was only 1 case of 50 diagnosed as rapidly progressive glomerulonephritis with positive anti neutrophil cytoplasmic autoantibody (ANCA) staining. Conclusion The “full house” immunofluorescent staining is a common manifestation of renal pathology for LN, which is not only demonstrated in LN. HBV GN might present with “full house”, because hepatitis B virus would cause various sizes of immune complex deposits within the glomeruli. Occasionally the “full house” could be found in the cases of purpura nephritis and IgA nephropathy. In the cases of non lupus nephritis with “full house” immunofluorescent staining, a long term follow up is suggested in order to rule out some possible cases with delayed appearance of autoimmune antibodies and/or delayed onset of systemic lupus erythematosus.