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Published on: August 19, 2020
Is CD44 in glomerular parietal epithelial cells a pathological marker of renal function deterioration in primary
Brunna Pinto Froes1, Stanley de Almeida Araújo2, Eduardo Alves Bambirra2
1Department of Pediatrics, Pediatric Nephrourology Unit, Faculty of Medicine, Federal University of Minas Gerais, Avenida Alfredo Balena 190/sala 331, Belo Horizonte, Minas Gerais, 30130-100, Brazil.
Insights
CD44 staining in parietal epithelial cells (PECs) may indicate worsening kidney function in children with focal segmental glomerulosclerosis (FSGS). This finding could help predict prognosis and guide treatment for pediatric FSGS patients.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Immunohistochemistry
Background:
- Identifying risk factors for chronic kidney disease (CKD) in pediatric focal segmental glomerulosclerosis (FSGS) is crucial for prognosis and treatment.
- This study explored CD44 immunostaining in glomerular parietal epithelial cells (PECs) as a potential prognostic marker in pediatric FSGS.
Purpose of the Study:
- To investigate the potential of CD44 immunostaining in PECs as a prognostic marker for renal function decline in pediatric FSGS.
- To determine if CD44 positivity in PECs is associated with poorer renal outcomes in children with FSGS.
Main Methods:
- A retrospective analysis of 26 pediatric FSGS patients biopsied between 1985 and 2010.
- Immunohistochemistry was used to assess CD44 expression in PECs.
- Patients were categorized as CD44-positive or CD44-negative in PECs, with a primary outcome of a 50% or greater decline in estimated glomerular filtration rate (eGFR).
Main Results:
- CD44-positive PECs were associated with lower baseline eGFR and a significant decline in eGFR compared to CD44-negative PECs.
- Renal survival was significantly reduced in patients with CD44-positive PECs (3.8 years vs. 14.6 years).
- CD44 staining in PECs was significantly linked to a 50% or greater decline in baseline eGFR.
Conclusions:
- CD44 positivity in PECs appears to be a novel pathological marker for renal function deterioration in pediatric FSGS.
- These preliminary findings suggest CD44 staining could aid in predicting disease progression and informing clinical management in pediatric FSGS.
Background:
The search for risk factors for chronic kidney disease in children with focal segmental glomerulosclerosis (FSGS) is important in defining prognosis and individualized treatment. This study preliminarily investigated whether CD44 immunostaining in glomerular parietal epithelial cells (PECs) is a prognostic marker in pediatric FSGS.
Methods:
In this retrospective study, 26 patients with FSGS, biopsied from 1985 to 2010, were evaluated. Immunohistochemistry for CD44 was performed in all cases. For analysis purposes, patients were grouped according to whether or not they were positive for CD44 in PECs. The primary outcome was a decline in baseline estimated glomerular filtration rate (eGFR) of 50% or more.
Results:
Median follow-up was 6.9 years. Median renal survival was 14.5 years and probability of a 50% decline of eGRF was 30% in 10 years. Nine children exhibited the primary outcome and 7 developed end-stage renal disease (ESRD). In comparison with PEC CD44-negative patients (n = 18), PEC CD44-positive patients (n = 8) presented lower baseline eGFR (99 ± 41 versus 141 ± 44 ml/min/1.73 m2, p = 0.035) and a significant decline in eGFR (-38.6 ± 39.5 versus -5.6 ± 25.3 ml/min/1.73 m2/year, p = 0.018). No difference was observed in FSGS subtypes or other glomerular features. Presence of CD44 staining in PECs was significantly associated with the decline in baseline eGFR of 50% or more. Renal survival was significantly reduced in PEC CD44-positive patients (3.8 vs 14.6 years in C4d-negative, p < 0.05).
Conclusion:
Our preliminary findings indicate, for the first time, that positivity for CD44 in PECs seems to be a pathological marker of renal function deterioration in pediatric patients with FSGS.
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