Tubular lesions and tubular cell adhesion molecules for the prognosis of lupus nephritis.
BACKGROUND
To assess the prognostic value of tubular lesions and cell adhesion molecules' expression, a retrospective study with immunohistochemistry was performed on 152 patients presenting lupus nephritis from January 1985 to December 1999.


METHODS
The following clinical parameters were recorded: age, sex, race, time of systemic lupus erythematosus (SLE) diagnosis, time of the biopsy, proteinuria, creatininemia, and renal function at the end of follow-up. All biopsies were re-evaluated according to a tubular grading, an inflammatory grading, the percentage of sclerosed glomeruli, the percentage of crescents, and the current WHO classification. Immunohistochemistry was performed with anti-CD40, anti-CD44, and anti-intercellular adhesion molecule-1 (anti-ICAM-1) antibodies.


RESULTS
Patients were 136 women (89.5%) and 16 men with a mean age of 31.2 years +/- 12.8 at the time of biopsy. The mean follow-up period was 94.3 months +/- 64.1. Eighty-eight biopsies (58%) showed various degrees of tubular atrophy. Males (P = 0.001) and tubular grading (P = 0.0001) were linked with renal survival in univariate and multivariate analysis. CD40 (P = 0.01) and ICAM-1 (P = 0.001) tubular expressions were linked with renal survival. ICAM-1 tubular expression provided additional information for the prognosis of the patients with biopsies showing tubular atrophy (P = 0.005) or not (P = 0.05).


CONCLUSIONS
Our study shows that tubular lesions are good indicator of lupus nephritis outcome. Furthermore, tubular expression of cell adhesion molecules like ICAM-1 and CD40 also serves to predict the outcome.
Daniel
L
L
Departments of Pathology and Statistics, Timone Hospital, Marseilles, France. ldaniel@mail.ap-hm.fr
Sichez
H
H
Giorgi
R
R
Dussol
B
B
Figarella-Branger
D
D
Pellissier
J F
JF
Berland
Y
Y
D000328:Adult; D001284:Atrophy; D001706:Biopsy; D019013:CD40 Antigens / Q000378:metabolism; D015815:Cell Adhesion Molecules / Q000378:metabolism*; D002648:Child; D005260:Female; D006801:Humans; D018960:Hyaluronan Receptors / Q000378:metabolism; D007150:Immunohistochemistry; D018799:Intercellular Adhesion Molecule-1 / Q000378:metabolism; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000209:etiology; D007684:Kidney Tubules / Q000378:metabolism* / Q000473:pathology*; D008181:Lupus Nephritis / Q000150:complications / Q000378:metabolism* / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D011379:Prognosis; D016019:Survival Analysis
D019013:CD40 Antigens; D015815:Cell Adhesion Molecules; D018960:Hyaluronan Receptors; D018799:Intercellular Adhesion Molecule-1