Differential expression of basement membrane collagen in membranous nephropathy.

Membranous nephropathy (MN) is characterized by subepithelial immune complex formation and progressive thickening of the glomerular basement membrane (GBM). Kidney tissues from 21 patients stratified according to morphology (stage I: 5 patients; stage II: 5 patients, stage III: 11 patients) were studied by immunohistochemical techniques using antibody probes to matrix components of recently described (novel) chains of type IV collagen [alpha 3(IV)NC, alpha 4(IV)NC, Alport antigen] and of traditional type IV collagen [alpha 1(IV)NC, alpha 2(IV)NC, 7S(IV), triple helix]; as well as laminin B2, nidogen and fibronectin. In Stage I, there were no detectable changes when compared with normal tissue. In Stage II and early Stage III, the subepithelial projections of GBM (spikes) and the thickened GBM consisted predominantly of the novel type IV collagen chains as well as laminin B2 and nidogen, with no detectable changes in traditional type IV collagen. In late Stage III, an increase in the latter was observed in the subendothelial region of the thickened GBM with narrowing of the capillary lumen. At this stage, there was close apposition of novel and traditional type IV collagen molecules. The expression of these two groups of molecules is spatially and temporally distinct during the evolution of MN. It is hypothesized that immune complex formation in the subepithelial region of the GBM leads to increased formation of the novel type IV collagen network by visceral epithelial cells resulting in the formation of spikes and thickening of GBM between and surrounding immune deposits. These changes precede and are distinct from detectable alterations in traditional type IV collagen. With progression and time, the deposits become embedded in the novel collagen network and increased subendothelial formation of traditional type IV collagen molecules occurs with narrowing of the capillary lumen.