Clinicopathological spectrum of two common conditions encountered in renal biopsies: acute diffuse proliferative glomerulonephritis and lupus nephritis

Abstract Objectives This study aims to determine the prevalence and localization of complement factor C4d in renal biopsies of lupus nephritis (LN) patients, as well as its association with the clinico-pathological features of the disease. Especially, the correlation between arteriolar C4d deposition and renal microvascular lesions (RVL) was further analyzed. Methods A total of 325 biopsy-proven lupus nephritis patients were enrolled and their clinico-pathological data were collected. C4d staining in renal biopsies was performed by immunohistochemistry. The association between C4d deposition and the clinico-pathological features was further analyzed. Results C4d deposition was present in most of renal specimens (98.8%) in our cohort. They were localized in the glomeruli (98.2%), tubular basement membrane (TBM) (43.7%), arterioles (31.4%) and peritubular capillary (33.8%), respectively. TBM C4d staining was closely related to the disease activity (SLEDAI) and NIH pathological activity and chronicity indices (P < 0.01). Patients with arteriolar C4d deposition were more likely to develop RVL (91.2%) in comparison to those negative (78.0%; P = 0.004), especially with two or more types of RVL (P < 0.001). During an average follow-up of 55.8 months, the presence of arteriolar C4d was related to worse renal outcomes (HR: 2.074, 95% CI 1.056–4.075, P = 0.034). Co-deposition of arteriolar C4d and C3c was an independent risk factor (HR: 2.539, 95% CI 1.130–5.705, P = 0.024) for predicting renal outcomes by the multivariate stepwise Cox hazard analysis Conclusions C4d deposition was common in renal tissues of lupus nephritis patients. TBM C4d deposition was related to the disease activity and arteriolar C4d deposition was associated with RVL and worse renal outcomes.

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Deposition of the lectin pathway of complement in renal biopsies of lupus nephritis patients

Human Immunology ◽

10.1016/j.humimm.2013.04.030 ◽

2013 ◽

Vol 74 (8) ◽

pp. 907-910 ◽

Cited By ~ 24

Author(s):

Renato M. Nisihara ◽

Fernanda Magrini ◽

Valmir Mocelin ◽

Iara J. Messias-Reason

Keyword(s):

Lupus Nephritis ◽

Lectin Pathway ◽

Renal Biopsies

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III. Lupus Erythmatosus Supqiementary : A Study on Lupus Nephritis. Serial Renal Biopsies Especially in the Patients with Non-Renal SLE

Japanese Journal of Medicine ◽

10.2169/internalmedicine1962.19.251 ◽

1980 ◽

Vol 19 (3) ◽

pp. 251-252

Author(s):

Fuyuhiko HIGASHI ◽

Ippei FUJIMORI

Keyword(s):

Lupus Nephritis ◽

Renal Biopsies

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Long term outcome of treatment of diffuse proliferative glomerulonephritis with pulse steroids and short course pulse cyclophosphamide

Reumatismo ◽

10.4081/reumatismo.2010.215 ◽

2011 ◽

Vol 62 (3) ◽

Author(s):

C. Tani ◽

M. Mosca ◽

A. D'Ascanio ◽

R. Neri ◽

A. Tavoni ◽

...

Keyword(s):

Proliferative Glomerulonephritis ◽

Term Outcome ◽

Long Term Outcome ◽

Pulse Cyclophosphamide ◽

Short Course ◽

Diffuse Proliferative Glomerulonephritis ◽

Pulse Steroids

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Urinary T cells in active lupus nephritis show an effector memory phenotype

Annals of the Rheumatic Diseases ◽

10.1136/ard.2009.124636 ◽

2010 ◽

Vol 69 (11) ◽

pp. 2034-2041 ◽

Cited By ~ 27

Author(s):

Sebastian Dolff ◽

Wayel H Abdulahad ◽

Marcory C R F van Dijk ◽

Pieter C Limburg ◽

Cees G M Kallenberg ◽

...

Keyword(s):

T Cells ◽

Lupus Nephritis ◽

Renal Disease ◽

Memory T Cells ◽

Effector Memory ◽

Healthy Controls ◽

Effector Memory T Cells ◽

Renal Biopsies ◽

Active Lupus Nephritis ◽

Active Lupus

BackgroundSystemic lupus erythematosus (SLE) is accompanied by alterations in T cell homeostasis including an increased effector response. Migrated effector memory T cells (CD45RO+CCR7–; TEM) appear to be involved in tissue injury. The objective of this study was to investigate the distribution and phenotype of effector memory T cells in the peripheral blood (PB), and their presence in renal biopsies and urine of patients with SLE. The hypothesis that these TEM cells migrate to the kidney during active disease was tested.MethodsA total of 43 patients with SLE and 20 healthy controls were enrolled. CD4+TEM cells and CD8+TEM cells were analysed in PB and urine using flow cytometric analysis. In 10 patients with active lupus nephritis a parallel analysis was performed on the presence of TEM cells in kidney biopsies.ResultsThe percentage of circulating CD8+TEM cells in patients with SLE was significantly decreased versus healthy controls (33.9±18.3% vs 42.9±11.0%, p=0.008). In patients with active renal involvement (n=12) this percentage was further decreased to 30.4±15.9%, p=0.01. Analysis of the urinary sediment in active renal disease showed increased numbers of CD4+T cells (134±71 cells/ml) and CD8+T cells (287±220 cells/ml), respectively, while in healthy controls and patients without active renal disease almost no T cells were present. In all, 73.6±8.3% of urinary CD4+T cells and 69.3±26.0% of urinary CD8+T cells expressed the TEM phenotype. CD8+ cells were also found in renal biopsies.ConclusionsThe data presented are compatible with the hypothesis that CD8+ effector memory cells migrate from the PB to the kidney and appear in the urine during active renal disease in patients with SLE. These cells could serve as an additional marker of renal activity in patients with SLE.

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