CD68 and MCP-1/CCR2 expression of initial biopsies reflect the outcomes of membranous nephropathy.
BACKGROUND
A considerable diversity of prognosis is seen with idiopathic membranous nephropathy (IMN). The initial factors affecting long-term outcome remain unclear.


METHODS
We studied retrospectively 30 patients with IMN who had been followed up for at least 5 years, or until end-stage renal failure (ESRF). We analyzed the prognostic factors of ESRF in the first renal biopsies; these factors included presence of tubulointerstitial lesions and foam cells, as well as expression of CD68, monocyte chemoattractant protein-1 (MCP-1), its cognate receptor chemokine receptor 2 (CCR2) and alpha-smooth muscle actin.


RESULTS
The patients who developed ESRF showed higher percentages of glomerular segmental sclerosis, interstitial MCP-1 expression, CCR2- or CD68-positive monocyte/macrophages and foam cells in the interstitium, and these proved on multivariate analysis to be independent risk factors for ESRF. Finally, ESRF was characterized by the presence of ten interstitial CD68-positive cells per visual field at 200x magnification (hazard ratio 4.096, CI 1.271-15.029, p < 0.001).


CONCLUSIONS
Our results suggested that an interstitial infiltration of CD68-positive cells accompanied by MCP-1/CCR2 expression is the most significant indicator of ESRF in IMN.
Yoshimoto
Keiichi
K
Department of Gastroenterology and Nephrology and Division of Blood Purification, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan. dialysis@medf.m.kanazawa-u.ac.jp
Wada
Takashi
T
Furuichi
Kengo
K
Sakai
Norihiko
N
Iwata
Yasunori
Y
Yokoyama
Hitoshi
H
D015703:Antigens, CD / Q000032:analysis*; D015214:Antigens, Differentiation, Myelomonocytic / Q000032:analysis*; D015415:Biomarkers / Q000032:analysis; D001706:Biopsy; D018932:Chemokine CCL2 / Q000032:analysis*; D005355:Fibrosis; D005487:Foam Cells / Q000473:pathology; D015433:Glomerulonephritis, Membranous / Q000473:pathology*; D007668:Kidney / Q000737:chemistry* / Q000473:pathology*; D007678:Kidney Glomerulus / Q000737:chemistry / Q000648:ultrastructure; D054390:Receptors, CCR2; D019707:Receptors, Chemokine / Q000032:analysis*; D012189:Retrospective Studies; D016896:Treatment Outcome; D000097382:CD68 Molecule
D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D015415:Biomarkers; D018932:Chemokine CCL2; D054390:Receptors, CCR2; D019707:Receptors, Chemokine; C111835:CCL2 protein, human; C515334:CCR2 protein, human; C067980:CD68 antigen, human; D000097382:CD68 Molecule