The presence of both LKM and GPC antibodies together can cause a great deal of confusion. Their combined distribution is similar to that of anti-mitochondrial antibodies except for the absence of staining in the distal renal tubules and the presence of smooth homogenous fluorescence in the liver indicating the presence of LKM. This anomaly would have to be investigated further with an alternative method. The example below demonstrates this point clearly.
Liver & kidney
Strong cytoplasmic staining of hepatocytes (negative nuclei) is seen with LKM but in the kidney, only the proximal renal tubules are positive.
Another image showing positive proximal renal tubules with negative glomerulus.
Liver & stomach
LKM & GPC staining of gastric parietal cell and liver is common for anti-mitochondrial antibody and often causes confusion.
Image: lack of staining in the distal renal tubules, which contrasts with mitochondrial antibody.
This is one of the features which distinguishes between LKM and mitochondrial antibody. Note the additional presence of gastric parietal cell antibody.