Dysregulation of apoptosis: a possible mechanism leading to chronic progressive renal histological changes in lupus nephritis.
OBJECTIVE
To evaluate apoptosis in lupus nephritis and the relationship between the existence of apoptotic cells in renal tissue and histopathological or clinical changes.


METHODS
Apoptosis was detected by in situ nick-end labeling techniques (TUNEL) in renal biopsies from 25 patients with type IV lupus nephritis (LN), 12 patients with IgA nephropathy IgAN, 4 patients with idiopathic mesangioproliferative glomerulonephritis (MsPGN) and 3 patients with acute poststreptococcal glomerulonephritis (APGN). Normal renal tissue obtained at nephrectomy for hypernephroma in 4 adults was used as control. Proliferating cells were identified by proliferating cell nuclear antigen (PCNA) in these patients.


RESULTS
Compared to other proliferative glomerulonephritis and controls, the patients with lupus nephritis had less apoptotic cells, a higher ratio of PCNA + cells/TdT + cells (P/T) in renal tissues; and their P/T ratio in glomeruli and tubulointerstitium correlated with the chronicity index, r = 0.4983 (P = 0.0132), r = 0.8399 (P < 0.001), r = 0.6614 (P = 0.0033), respectively. P/T ratios in the glomerulus and tubule had a positive correlation with 24-hour urinary protein, r = 0.8554 (P < 0.001) and r = 0.7134 (P = 0.001); and a negative correlation with creatinine clearance (Ccr), r = -0.4880 (P = 0.0133) and r = -0.7229 (P = 0.001), which in tubules positively correlated with serum creatinine (Scr), r = 0.4107 (P = 0.0414).


CONCLUSIONS
Apoptosis is reduced in proliferative lupus nephritis. Intense proliferation without a commensurate increase in apoptosis is a possible mechanism that leads to chronic progressive renal histopathological changes.
Lu
F
F
Department of Nephrology, Huashan Hospital, Shanghai 200040, China.
Shen
W
W
Zhang
X
X
Guo
M
M
Lin
S
S
D000328:Adult; D017209:Apoptosis; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D020287:In Situ Nick-End Labeling; D007668:Kidney / Q000378:metabolism / Q000473:pathology*; D007678:Kidney Glomerulus / Q000378:metabolism / Q000473:pathology; D007684:Kidney Tubules / Q000378:metabolism / Q000473:pathology; D008181:Lupus Nephritis / Q000378:metabolism / Q000473:pathology*; D008297:Male; D018809:Proliferating Cell Nuclear Antigen / Q000032:analysis; D011507:Proteinuria / Q000652:urine
D018809:Proliferating Cell Nuclear Antigen; D003404:Creatinine