title: The role of renin-angiotensin system in the chronic allograft nephropathy: an immunohistochemical study.
abstract: BACKGROUND
  Evidences suggest a role of renin-angiotensin system (RAS) in the development of chronic allograft injury.
  
  
  METHODS
  We correlated intrarenal angiotensin-converting enzyme, angiotensin II (Angio II) and transforming growth factor β1 (TGFβ1) expression in 58 biopsies-proven chronic allograft nephropathy (CAN) with tissue injury and allograft survival.
  
  
  RESULTS
  The biopsies with CAN were graded according to Banff classification as I (22 cases), II (17) and III (19); 27 biopsies also showed a mononuclear inflammatory infiltrate in scarred areas. There were increased expression of angiotensin converting-enzyme (ACE), Angio II and TGFβ1 mainly in tubulointerstitial compartment in the group with CAN; there was no association of Angio II and TGFβ1 expression with interstitial fibrosis. There were no significant differences of ACE, Angio II and TGFβ1 expression between the patients treated and untreated with RAS blockade, and with the graft outcome. Interstitial inflammatory infiltrate had positive correlation with interstitial fibrosis and significant impact on graft survival at 8 years.
  
  
  CONCLUSIONS
  Our study showed in a group of cases with CAN a high percentage of inflammatory infiltrate that correlated with interstitial fibrosis and graft outcome. The chronic inflammatory changes in these cases did not show significant association with local RAS expression.
authors.affiliation: a Department of Pathology , Botucatu Medical School, São Paulo State University (UNESP) , Botucatu , São Paulo , Brazil and.
authors.forename: Rosa Marlene
authors.initials: RM
authors.lastname: Viero
authors.forename: Márcia Guimarães
authors.initials: MG
authors.lastname: da Silva
authors.forename: Daniela Cristina
authors.initials: DC
authors.lastname: dos Santos
authors.forename: Maria Fernanda Cordeiro
authors.initials: MF
authors.lastname: de Carvalho
authors.forename: Luis Gustavo Modelli
authors.initials: LG
authors.lastname: de Andrade
mesh_terms: D000293:Adolescent; D000328:Adult; D064591:Allografts; D000804:Angiotensin II / Q000378:metabolism; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000473:pathology*; D006084:Graft Rejection / Q000378:metabolism*; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000473:pathology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D007703:Peptidyl-Dipeptidase A / Q000378:metabolism; D011183:Postoperative Complications; D012084:Renin-Angiotensin System / Q000502:physiology*; D053773:Transforming Growth Factor beta1 / Q000378:metabolism; D055815:Young Adult
chemical_list: D053773:Transforming Growth Factor beta1; D000804:Angiotensin II; C488034:ACE protein, human; D007703:Peptidyl-Dipeptidase A
keywords: Allograft survival; chronic allograft nephropathy; renal allograft fibrosis; renin–angiotensin system; transforming growth factor