Vol. 8, No 1, 2001 pp. 19 - 25
UC 612.12
PROGNOSIS MARKERS OF TUBULOINTERSTITIAL
INJURY
IN PRIMARY TYPE I MESANGIOCAPILLARY GLOMERULONEPHRITIS
Ligia Petrica1, Raica Marius2, Adalbert Schiller1,
Silvia Velciov1, Gheorghe Gluhovschi1,
Virginia Trandafirescu1, Bozdog Gheorghe1,
Cristina Gluhovschi1, Flaviu Bob1
University of Medicine and Pharmacy, Timişoara, Romania
1 Dpt. of Nephrology, 2 Dpt. of Histology, County
Hospital, Timişoara, Romania
Summary. Renal fibrosis is the common pathway that leads to end-stage
renal insufficiency in almost all renal diseases. Tubulointerstitial lesions
are the basic parameter of progression in chronic glomerulonephritis. Tubular
cells, as well as interstitial cells infiltrates, are of particular interest.
A group of 32 patients (p) with primary type I mesangiocapillary glomerulonephritis
(MCGN) was assessed concerning the relationship between the severity of
the tubulointerstitial (Ti) lesions and blood pressure (BP), proteinuria
and serum creatinine (SC). All p underwent kidney biopsies which were processed
in light microscopy (LM-hematoxylin-eosin, Masson's trichrome, PAS), immunoflu-ores-cen-ce,
immunohistochemical (IH) procedures with monoclonal antibodies [performed
with the EPOS-system, DAKO: -anti-smooth muscle cell actin (alpha-SMA);
- anti-desmin (D), anti-cytokeratin (CK), anti-proliferating cell nuclear
antigen (PCNA)]. The evaluation of the Ti lesions in LM revealed in 23
p (71.88%) severe Ti injury, which correlated significantly with the IH
data: - the extent of the ?-SMA positive cells (myofibroblasts) infiltrates
(P<0.001), PCNA (P<0.01), D (proximal tubular necroses) (P<0.01),
CK (distal tubular necroses) (P<0.001). Proteinuria correlated with
?-SMA (P<0.001), PCNA (P<0.01), D (P<0.001), CK (P<0.001);
SC correlated with alpha-SMA (P<0.001), PCNA (P<0.001), D (P<0.001),
CK (P<0.01); BP did not correlate with these parameters.
Ti lesions recorded in type I MCGN imply important myofibroblasts infiltrates
and severe proximal and distal tubular involvement. These changes are consistent
with the level of proteinuria and the rate of decline of renal function.
Key words: Mesangiocapillary glomerulonephritis, myofibro-blasts,
proteinuria, renal fibrosis, tubular cells, tubulointerstitium
PROGNOSTIČKI MARKERI TUBULOINTERSTICIJSKOG
OŠTEĆENJA
U PRIMARNOM MEZANGIOKAPILARNOM GLOMERULONEFRITISU
TIP I
Kratak sadržaj: Fibroza bubrega je čest proces koji vodi u terminalnu
uremiju u većine bubrežnih bolesti. Tubulointersticijsko oštećenje je osnovni
parametar u progresiji hroničnog glomerulonefritisa. Od posebnog interesa
su tubulske ćelije i intersticijski infiltrati ćelija. Ispitivana je grupa
od 32 bolesnika sa mezangiokapilarnim glomerulonefritisom tip I (MCGN)
i ispitivan odnos između težine tubulointersticijskih promena sa krvnim
pritiskom, proteinurijom i serumskim kreatininom. U 23 bolesnika (71,88%)
nađeno je teško tubulointersticijsko oštećenje koje je koreliralo značajno
sa stepenom infiltracije alfa-SMA pozitivnih ćelija (miofibroblasta) (P<0,001),
PCNA (P<0,01), anti-desminom (nekroza proksimalnih tubula) (P<0,01),
anticitokeratinom (nekroza distalnih tubula) (P<0,001). Proteinurija
je korelirala sa alfa-SMA (P<0,001), PCNA (P<0,001), anti-desminom
(P<0,001), anti-citokeratinom (P<0,01). Krvni pritisak nije korelirao
sa ovim parametrima.
U zaključku, oštećenja nađena u MCGN ukazuju na značajnu infiltraciju
miofibroblasta i teška oštećenja proksimalnih i distalnih tubula. Ove promene
odgovaraju stepenu proteinurije i stepenu smanjenja bubrežne funkcije.
Ključne reči: Mezangiokapilarni glomerulonefritis, miofibroblasti,
fibroza bubrega, tubulske ćelije, intersticijum bubrega
