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Tubular and interstitial lesions and mononuclear cell infiltration in primary forms of glomerulonephritis
1Department of Nephrology, Faculty of Medicine, Skopje, Macedonia.
Abstract:
In the present study of 246 patients with primary forms of glomerulonephritis (GN) we investigated their tubular and interstitial changes, especially mononuclear cell infiltration and optical microscopy, and compared this finding with the outcome of the disease (5-year survival rate). Only first biopsies were analyzed in order to detect early tubulointerstitial changes which occur together with the glomerular changes. Different degrees of the lesions of tubules and interstitium were present in different forms of GN. Mononuclear cell infiltration was present in 100% of the patients with crescentic, in 90.9% in focal sclerosing, in 89% in membranoproliferative, and in 76.4% of patients with chronic diffuse GN. Less than 50% of the other patients showed infiltration. Using monoclonal antibodies it was demonstrated that mononuclear cell infiltrates mainly consisted of T and T4 cells. Interstitial edema was expressed in the same forms of GN and in similar proportions. Interstitial fibrosis was found only in patients with: focal sclerosing GN (13.7%), IgA GN (4.1%), membranoproliferative GN (31.4%), chronic diffuse GN (23%), and crescentic GN (27.7%). Tubular atrophic changes were again dominantly present in: crescentic GN (94.2%), focal sclerosing GN (77.8%), chronic diffuse GN (76.4%), and membranoproliferative GN (68.4%). Patients with severe tubulointerstitial changes together with the glomerular changes had a low 5-year survival rate of renal function.
Insights
Tubulointerstitial changes, including mononuclear cell infiltration, are common in primary glomerulonephritis (GN). Severe changes correlate with a poor 5-year renal survival rate.
Area of Science:
- Nephrology
- Pathology
- Immunology
Background:
- Primary glomerulonephritis (GN) encompasses diverse kidney diseases.
- Tubulointerstitial damage often accompanies glomerular pathology in GN.
- Early detection of tubulointerstitial changes is crucial for prognosis.
Purpose of the Study:
- To investigate tubular and interstitial changes in primary GN.
- To correlate these changes with the 5-year survival rate.
- To analyze early tubulointerstitial alterations using initial biopsies.
Main Methods:
- Analysis of initial kidney biopsies from 246 patients with primary GN.
- Evaluation of tubular and interstitial changes via optical microscopy.
- Assessment of mononuclear cell infiltration using monoclonal antibodies (T and T4 cells).
Main Results:
- Mononuclear cell infiltration was prevalent in crescentic (100%), focal sclerosing (90.9%), membranoproliferative (89%), and chronic diffuse GN (76.4%).
- Interstitial edema and fibrosis, along with tubular atrophy, were observed in various GN subtypes.
- Severe tubulointerstitial changes were associated with a significantly lower 5-year renal function survival rate.
Conclusions:
- Tubulointerstitial pathology, particularly mononuclear cell infiltration, is a significant feature across primary GN types.
- The severity of tubulointerstitial lesions is a critical predictor of long-term renal outcome in GN patients.
- Early identification of these changes aids in predicting disease progression and patient survival.