title: Glomerular expression of monocyte chemoattractant protein-1 is predictive of poor renal prognosis in pediatric lupus nephritis.
abstract: BACKGROUND
  Monocyte chemoattractant protein-1 (MCP-1) is upregulated and it recruits and activates inflammatory cells in murine lupus nephritis (LN).
  
  
  METHODS
  Clinical outcomes of children with LN were examined in relation to glomerular expression of MCP-1 and macrophage infiltration, as determined by immunohistochemical staining of renal biopsy sections with MCP-1 and CD68. Sections were analysed using a modified histological score (H-score; maximum of 300) based on both percentage of positively stained cells and intensity of staining.
  
  
  RESULTS
  Renal biopsies were examined from 34 children [27 (79%) female] aged 7.7-17.3 (median 13.7) years with 50% ISN/RPS Class IV LN. Renal dysfunction and proteinuria at follow-up of 2.2-15.4 (median 6.5) years were analysed with estimated glomerular filtration rates (eGFR) of 11.2-124.1 (median 93.6) ml/min/1.73 m(2) and urine albumin:creatinine ratios of 1-535 (median 63) mg/mmol. There was a correlation between glomerular expression of MCP-1 and CD68 (r = 0.98, P = 0.04; median modified H-score of 219.7 and 230.8, respectively). Patients with Class III and IV LN had increased glomerular expression of both MCP-1 and PGM1 compared to the other classes (P = 0.01) with Class IV-G LN patients having the most glomerular expression of MCP-1 (median of 227.3) and PGM1 (median of 237.5) and the worst renal prognosis (with proteinuria and reduced eGFR).
  
  
  CONCLUSIONS
  There is a correlation between glomerular expression of MCP-1 and PGM1 and worsening renal prognosis in paediatric LN. Larger prospective studies of paediatric LN are required to further evaluate MCP-1 and other markers of disease progression.
authors.affiliation: Institute of Child Health, 30 Guilford Street, London, UK. s.marks@ich.ucl.ac.uk
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Marks
authors.forename: Sue J
authors.initials: SJ
authors.lastname: Williams
authors.forename: Kjell
authors.initials: K
authors.lastname: Tullus
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Sebire
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000378:metabolism; D001706:Biopsy; D018932:Chemokine CCL2 / Q000378:metabolism*; D002648:Child; D018450:Disease Progression; D005260:Female; D006801:Humans; D007678:Kidney Glomerulus / Q000378:metabolism* / Q000473:pathology; D008181:Lupus Nephritis / Q000175:diagnosis* / Q000378:metabolism* / Q000473:pathology; D008264:Macrophages / Q000473:pathology; D008297:Male; D010733:Phosphoglucomutase / Q000378:metabolism; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; C111835:CCL2 protein, human; D018932:Chemokine CCL2; C488050:PGM1 protein, human; D010733:Phosphoglucomutase