Prediction of renal outcome in Henoch-Schonlein nephritis based on biopsy findings

Background In Henoch-Schonlein nephritis (HSN), a risk factor for unfavorable outcome is prolonged proteinuria, but the value of renal biopsies in prognosis assessment is debatable. Methods We evaluated serial renal biopsies from 26 HSN patients. Follow-up biopsy occurred at median 2.1 years after diagnostic biopsy. Patients formed two groups at the follow-up biopsy: patients without proteinuria (group I; n = 11) and with proteinuria (group II; n = 15). Biopsies underwent evaluation according to three classifications: International Study of Kidney Disease in Children (ISKDC), Oxford (MEST-C), and semiquantitative classification (SQC) including an activity and chronicity score. Analysis also included expression of pro-fibrotic (alpha-smooth muscle actin and vimentin) and inflammatory (P-selectin glycoprotein ligand-1) molecules in the diagnostic biopsy specimens. Definition of unfavorable outcome was active renal disease or reduced renal function at last follow-up. Results Between the biopsies, SQC chronicity score increased in 22 (85%) patients, whereas activity score and ISKDC grade decreased in 21 (81%) and 17 (65%), respectively. Of the MEST-C parameters, endocapillary proliferation (from 83 to 13%; p <0.001) and crescents (from 63 to 25%; p = 0.022) showed significant reduction, and segmental glomerulosclerosis (from 38 to 79%; p = 0.006) significant increment. These changes occurred similarly in groups I and II. Expression of the pro-fibrotic and inflammatory molecules showed no clinically significant differences between groups I and II. None in group I and five (33%) patients in group II had unfavorable outcome (p = 0.053). Conclusions Our results suggest that follow-up biopsies provide limited additional information to clinical symptoms in HSN outcome prediction.Peer reviewe

FOXP3(+) T cells are present in kidney biopsy samples in children with tubulointerstitial nephritis and uveitis syndrome

Tubulointerstitial nephritis (TIN) is an inflammatory disease of unknown pathogenesis. To evaluate a possible role of regulatory T cells (Tregs) in the pathophysiology of TIN with (TINU) and without uveitis, we investigated the presence and quantity of FOXP3(+) T regulatory lymphocytes in diagnostic kidney biopsies from pediatric patients. A total of 33 patients (14 TIN and 19 TINU) were enrolled. The quantity of CD4(+), FOXP3(+) and double-positive T cells in formalin-fixed kidney biopsies was determined using double label immunohistochemistry with anti-human CD4 and FOXP3 antibodies. FOXP3 staining was successful in all 33 patients. In patients with chronic uveitis, the density of FOXP3(+) cells was significantly lower (p = 0.046) than in TIN patients without uveitis or with uveitis lasting <3 months. CD4(+) staining was successful in 23 patients. The density of all lymphocytes (CD4(+), CD4(+)FOXP3(+) and FOXP3(+) cells) was significantly lower (p = 0.023) in patients with chronic uveitis than in other patients. FOXP3(+) T cells are present in kidney biopsy samples from TIN and TINU patients. In patients with chronic uveitis, the density of FOXP3(+) T cells is significantly lower than in other patients, suggesting a different pathomechanism for these clinical conditions.Peer reviewe

The ISKDC classification and a new semiquantitative classification for predicting outcomes of Henoch-Schonlein purpura nephritis

Histological findings from primary kidney biopsies were correlated with patient outcomes in a national cohort of paediatric Henoch-Schonlein nephritis (HSN) patients. Primary kidney biopsies from 53 HSN patients were re-evaluated using the ISKDC (International Study of Kidney Disease in Children) classification and a modified semiquantitative classification (SQC) that scores renal findings and also takes into account activity, chronicity and tubulointerstitial indices. The ISKDC and SQC classifications were evaluated comparatively in four outcome groups: no signs of renal disease (outcome A, n = 27), minor urinary abnormalities (outcome B, n = 18), active renal disease (outcome C, n = 3) and renal insufficiency, end-stage renal disease or succumbed due to HSN (outcome D, n = 5). For the receiver operating characteristic and logistic regression analyses, outcomes A and B were considered to be favourable and outcomes C and D to be unfavourable. The median follow-up time was 7.3 years. The patients with an unfavourable outcome (C and D), considered together due to low patient numbers, had significantly higher total biopsy SQC scores and activity indices than those who had a favourable one (groups A and B). The chronicity and tubulointerstitial indices differed significantly only between group C + D and group A. The difference in areas under the curve between the total biopsy SQC scores and ISKDC findings was 0.15 [p = 0.04, normal-based 95% confidence interval (CI) 0.007-0.29, bias-controlled 95% CI -0.004 to 0.28]. Our results suggest that the modified SQC is more sensitive than ISKDC classification for predicting the outcome in HSN cases.Peer reviewe

No evidence for genotype/phenotype correlation in NPHS1 and NPHS2 mutations

Primary steroid-resistant nephrotic syndrome (SRNS) is characterized by childhood onset of proteinuria and progression to end-stage renal disease. In 26% of cases it is caused by recessive mutations in NPHS2 (podocin). Congenital nephrotic syndrome (CNS) is caused by mutations in NPHS1 (nephrin) or NPHS2 . In three families mutations in NPHS1 and NPHS2 had been reported to occur together, and these tri-allelic mutations were implicated in genotype/phenotype correlations. To further test the hypothesis of tri-allelism, we examined a group of 62 unrelated patients for NPHS1 mutations, who were previously shown to have NPHS2 mutations; 15 of 62 patients had CNS. In addition, 12 CNS patients without NPHS2 mutation were examined for NPHS1 mutations. Mutational analysis yielded three different groups. (1) In 48 patients with two recessive NPHS2 mutations (11 with CNS), no NPHS1 mutation was detected, except for 1 patient, who had one NPHS1 mutation only. This patient was indistinguishable clinically and did not have CNS. (2) In 14 patients with one NPHS2 mutation only (4 with CNS), we detected two additional recessive NPHS1 mutations in the 4 patients with CNS. They all carried the R229Q variant of NPHS2 . The CNS phenotype may be sufficiently explained by the presence of two NPHS1 mutations. (3) In 12 patients without NPHS2 mutation (all with CNS), we detected two recessive NPHS1 mutations in 11 patients, explaining their CNS phenotype. We report ten novel mutations in the nephrin gene. Our data do not suggest any genotype/phenotype correlation in the 5 patients with mutations in both the NPHS1 and the NPHS2 genes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47823/1/467_2004_Article_1629.pd

Влияние фосфатных связующих на физико-механические свойства периклазохромитовых огнеупоров

У данній статті наведено та порівняно фізико-механічні властивості периклазо-хромітових матеріалів в залежності від різних типів фосфатних зв’язуючих та введення різних домішок. Визначено, що найбільш раціональним є введення триполіфосфату натрію.In given clause are resulted and the physycal-mechanical properties periclase-cgromite of materials are compared depending on different of types phosphate binding and introduction of the various additives. Is determined, that most rational is the introduction treepolyphosphate sodume

Carbonic anhydrase III: a new histochemical marker for myoepithelial cells.

Carbonic anhydrase III, a major protein of red skeletal muscle, was localized immunohistochemically in smooth muscle cells of human uterus and in myoepithelial cells of mammary and prostate glands. The presence of this antigen in myoepithelial cells could be used to detect these not easily recognizable cells in paraffin-embedded tissue sections. Some epithelial cells of larger mammary ducts revealed occasional strongly positive cells. These cells may represent a new epithelial cell type transitional between myoepithelium and ductal epithelium. </jats:p

Scanning electron microscopic study of normal human glomerulogenesis and of fetal glomeruli in congenital nephrotic syndrome of the Finnish type

Although the normal morphogenesis of the developing glomerulus has been thoroughly investigated by light and transmission electron microscopy [1–5], the three-dimensional structure of glomeruli and the visceral epithelial cells covering their capillaries are best studied by scanning electron microscopy (SEM). A few studies have been performed on adult normal and nephrotic human glomeruli and those of experimental animals [6–12]. The SEM stereoscopic view of the epithelial cells has provided new insight into the foot process changes in massive proteinuria as compared with the picture derived from transmission electron microscopic studies [7, 11, 12]. The foot process loss in the most mature glomeruli in the fetal kidneys of congenital nephrotic syndrome of the Finnish type (CNF) has been thought to be due to heavy fetal proteinuria [13].Glomerulogenesis in normal human fetuses has not been studied with SEM. Also, transmission electron microscopic studies on fetuses have not provided information of the development of podocytes in congenital nephrotic syndrome. We report the normal development of human glomeruli as seen by SEM and the changes caused by fetal nephrosis. Special emphasis was paid to the possible effect of fetal nephrosis prior to the final maturation of the podocytes

Distribution of the extracellular matrix proteins tenascin, fibronectin, and vitronectin in fetal, infant, and adult human spleens.

Using immunohistochemistry, we investigated the distribution of the extracellular matrix (ECM) glycoproteins tenascin, fibronectin, and vitronectin in fetal [16-24 gestational weeks (GW)], infant (40 GW), and adult human spleens to clarify the presence of these proteins during different phases of maturation. In the red and white pulp, tenascin and fibronectin were constant components of the reticular fibers from the age of 18 GW onwards, whereas vitronectin was seen only in adult spleens. The immunohistochemical staining patterns of tenascin and fibronectin remained unchanged at different fetal ages. Ring fibers, which are modified basement membranes around venous sinuses, became visible relatively late, and in adult spleens they contained both tenascin and vitronectin but lacked fibronectin. The composition of the ring fibers is therefore clearly different from that of ordinary basement membranes, which have not been reported to contain tenascin or vitronectin. The rapidly increasing number of reticular fibers in the spleen at the age of approximately 18 GW corresponds with the beginning of lymphatic colonization. Reticular fibers, rich in ECM glycoproteins, form a framework to which cells can migrate and attach. We suggest that the composition of these fibers might be important for lymphatic colonization and function of the spleen. </jats:p