Sis et al described the ABCD tetrad to describe patients with transplant glomerulopathy (TG) following renal transplant. The authors are from the University of Alberta in Edmonton, Canada.
Tetrad Element
Findings in the Transplanted Kidney and Patient's Serum
A
(A)ntidonor antibodies
B
capillary (B)asement membrane multilayering
C
(C)omplement C4d deposition in peritubular capillaries
D
(D)uplication of the glomerular basement membrane (GBD)
The presence of duplication of the glomerular basement membrane (component D) defines transplant glomerulopathy. The other elements may be present in different combinations, resulting in a number of phenotypes.
The antidonor antibodies are anti-HLA (Class II) antibodies.
The presence of A and/or C is evidence of alloantibody-mediated injury.
Tetrad Element
Frequency
A
71%
B
40%
C
89%
D
100% (defines state)
There are 8 possible combinations of the tetrad elements (ABCD, ABD, ACD, AD, BCD, CD, BD, D).
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