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C4d Recomendations

This document outlines the recommendations for C4d staining in diagnostic renal transplant biopsies. It specifies criteria for C4d positivity using both cryostat sections with monoclonal antibodies and paraffin sections with polyclonal antibodies, including necessary controls and staining characteristics. Key points include the requirement for widespread, strong, and linear circumferential peritubular capillary staining, excluding necrotic areas, and the importance of reporting the percentage of positive PTC area and intensity. This standardized approach ensures accurate assessment in renal transplant pathology.

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C4d Recomendations

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  1. C4d Recomendations • C4d staining should be done on all diagnostic renal transplant biopsies.

  2. Criteria for C4d Positivity • 1. Cryostat section, Monoclonal Ab, immunofluorescence. • Widespread, strong, linear, circumferential, • peritubular capillary staining in either cortex or medulla • Excluding scarred or necrotic areas • Concurrent positive control (essential, if neg being • reported) • Reports should include the % of area of positive PTC and intensity.

  3. Criteria for C4d Positivity • 2. Paraffin, Polyclonal Ab, immunohistochemistry • Same as frozen tissue, but • strong staining not required* • *The type of pretreatment influences the intensity. GBM/mesangial staining in the sample cannot be used as a positive control, but membranous GN is satisfactory.

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