Research Article

Diagnostic Accuracy of Direct Immunofluorescence Test on Paraffin-Embedded Blocks in Comparison with Frozen Section Blocks in Renal Biopsies

Table 11

Studies using the technique of immunofluorescence on enzyme digested paraffin-embedded tissue in the literature since 2015.

Ref.YearCasesEnzyme usedIF panel appliedSignificant result

Nidia Messias [4]2015304 (207 cases as salvage and 97 cases for antigen unmasking)Proteinase K (Dako, product no. S302080-2)IgG, IgA, IgM, C3, C4, C1q, fibrinogen, κ- and λ-light chainsParaffin immunofluorescence was necessary or had a significant contribution to diagnosis in > 1/3 of the cases and prevention of misdiagnosis due to masked immune complex-type deposits

Nada [21]201675 renal biopsies and 43 autopsies (LN, MGN, IgA, complement-mediated dense deposit disease, monoclonal diseases, amyloidosis, cast nephropathy)Proteinase-K, (Amresco, OH 44139 USA, Cat 0706)Immunoglobulins (IgG, IgA, IgM), complements (C3, C1q), light chains (kappa, lambda), and fibrinogen (Cako, Carpinteria, CA, USA)Formalin-fixed, paraffin-embedded tissue (recent and archival) can be used to demonstrate immunoglobulin and complement deposits using a proteinase-K enzyme treatment

Geetika Singh [13]2016246 (MN, MPGN, LN, PIGN, and chronic glomerulonephritis)Proteinase K (Sigma–Aldrich, United States)IgA, IgG, IgM, C3, C1q, kappa, and lambdaImmunofluorescence on formalin-fixed, paraffin-embedded tissue is a useful “salvage” technique in the case of nonavailability of representative fresh frozen tissue; however, it is not without pitfalls

Akira Yabuki [22]201712 (Differentiate between ICGN and non-ICGN)Combination of trypsin for 30 min (Try-30) and microwaveIgG, IgA, IgM, and C3IF-FFPE with trypsin and microwave pretreatment is a valuable technique for the diagnosis of renal diseases

Ranjana Solanki [11]201950 (LN, MGN, FSGS, MCD, HSP, IgMN)Proteinase-K (1.25 mg/mL) for 25–30 minIgG, IgA, IgM, complements C3c, C1q, and kappa and lambda light chainsIF-P can serve as a salvage technique and has significant diagnostic utility

Nasar Yousuf Alwahaibi [23]2020101 (FSGS, MN, MPGN, IgAN, MesPGN, acute tubular injury)Proteinase K (ready to use, code no. S3020; Dako, CA, USA)IgA, IgG, and IgM immune depositsIF-P is a specific method for the evaluation of immune deposits in the renal tissue biopsies

LN: Lupus nephritis; MN: Membranous nephropathy; FSGS: Focal segmental glomerulosclerosis; MCD: Minimal change disease; IgAN: IgA nephropathy; IgMN: IgM nephropathy; MPGN: Membranoproliferative glomerulonephritis; MesPGN: Mesangioproliferative glomerulonephritis; PIGN: Postinfectious glomerulonephritis; ICGN: Immune complex-mediated glomerulonephritis; HSP : Henoch-Schonlein purpura.