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Published on: February 8, 2019
CD68 and MCP-1/CCR2 expression of initial biopsies reflect the outcomes of membranous nephropathy
Keiichi Yoshimoto1, Takashi Wada, Kengo Furuichi
1Department of Gastroenterology and Nephrology and Division of Blood Purification, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan. dialysis@medf.m.kanazawa-u.ac.jp
Background:
A considerable diversity of prognosis is seen with idiopathic membranous nephropathy (IMN). The initial factors affecting long-term outcome remain unclear.
Methods:
We studied retrospectively 30 patients with IMN who had been followed up for at least 5 years, or until end-stage renal failure (ESRF). We analyzed the prognostic factors of ESRF in the first renal biopsies; these factors included presence of tubulointerstitial lesions and foam cells, as well as expression of CD68, monocyte chemoattractant protein-1 (MCP-1), its cognate receptor chemokine receptor 2 (CCR2) and alpha-smooth muscle actin.
Results:
The patients who developed ESRF showed higher percentages of glomerular segmental sclerosis, interstitial MCP-1 expression, CCR2- or CD68-positive monocyte/macrophages and foam cells in the interstitium, and these proved on multivariate analysis to be independent risk factors for ESRF. Finally, ESRF was characterized by the presence of ten interstitial CD68-positive cells per visual field at 200x magnification (hazard ratio 4.096, CI 1.271-15.029, p < 0.001).
Conclusions:
Our results suggested that an interstitial infiltration of CD68-positive cells accompanied by MCP-1/CCR2 expression is the most significant indicator of ESRF in IMN.
Insights
Interstitial CD68-positive cells and MCP-1/CCR2 expression indicate a higher risk of end-stage renal failure (ESRF) in idiopathic membranous nephropathy (IMN) patients. This finding aids in predicting long-term outcomes for IMN.
Area of Science:
- Nephrology
- Pathology
- Immunology
Background:
- Idiopathic membranous nephropathy (IMN) presents a variable prognosis.
- Predictive factors for long-term outcomes in IMN are not well-defined.
Purpose of the Study:
- To identify prognostic factors for end-stage renal failure (ESRF) in idiopathic membranous nephropathy (IMN).
- To analyze initial renal biopsy findings associated with long-term outcomes in IMN patients.
Main Methods:
- Retrospective study of 30 IMN patients followed for at least 5 years or until ESRF.
- Analysis of renal biopsies for tubulointerstitial lesions, foam cells, CD68, MCP-1, CCR2, and alpha-smooth muscle actin expression.
Main Results:
- Patients developing ESRF showed increased glomerular segmental sclerosis, interstitial MCP-1, CCR2/CD68-positive cells, and foam cells.
- Interstitial CD68-positive cells (≥10/field) were an independent risk factor for ESRF (HR 4.096, p < 0.001).
Conclusions:
- Interstitial infiltration of CD68-positive cells and MCP-1/CCR2 expression are significant indicators of ESRF in IMN.
- These markers can help predict the long-term prognosis of IMN.
