title: Endothelial cell injury in acute and chronic glomerular lesions in patients with IgA nephropathy.
abstract: Endothelial cell injury may contribute to the progression of various glomerular diseases. In the present study, we examined glomerular capillary injury in acute and chronic glomerular lesions in patients with Immunoglobulin A nephropathy (IgAN). We selected renal biopsy samples of IgAN (n = 200), and glomerular capillary injury in the acute and chronic glomerular lesions was assessed using immunohistochemistry for CD34 and electron microscopy. We examined the correlations between acute and chronic glomerular lesions and proteinuria, hematuria, and the renal function. The injured glomerular capillaries in the acute glomerular lesions were characterized morphologically by the separation of CD34+ endothelial cells from the glomerular basement membrane and the loss of glomerular endothelial cells and capillaries, together with inflammatory cell infiltration, fibrin exudation, rupture of the glomerular basement membrane, and/or crescent formation. In addition, the injured capillaries in the chronic glomerular lesions were characterized by the loss of CD34+ glomerular endothelial cells and capillaries exhibiting segmental and global glomerular sclerosis with or without fibrous crescents. In the acute glomerular lesions, the presence of endocapillary hypercellularity, fibrinoid necrosis, and cellular and fibrocellular crescents correlated significantly with hematuria, with or without proteinuria. In the chronic glomerular lesions, a significant relationship was evident between segmental or global sclerosis and proteinuria and/or the serum creatinine level. In conclusion, injuries of glomerular capillaries and the loss of endothelial cells occurred in the acute and chronic glomerular lesions in IgAN and may contribute to the development of hematuria, proteinuria, and renal dysfunction.
authors.affiliation: Department of Analytic Human Pathology, Nippon Medical School, Tokyo, 113-8602, Japan; Division of Nephrology, Tokyo Teishin Hospital, Tokyo, 102-8798, Japan.
authors.forename: Taiko
authors.initials: T
authors.lastname: Kusano
authors.affiliation: Department of Analytic Human Pathology, Nippon Medical School, Tokyo, 113-8602, Japan; Division of Nephrology, Tokyo Teishin Hospital, Tokyo, 102-8798, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Takano
authors.affiliation: Department of Analytic Human Pathology, Nippon Medical School, Tokyo, 113-8602, Japan.
authors.forename: Dedong
authors.initials: D
authors.lastname: Kang
authors.affiliation: Department of Analytic Human Pathology, Nippon Medical School, Tokyo, 113-8602, Japan.
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Nagahama
authors.affiliation: Department of Analytic Human Pathology, Nippon Medical School, Tokyo, 113-8602, Japan.
authors.forename: Michiko
authors.initials: M
authors.lastname: Aoki
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Nippon Medical School, Tokyo, 113-8603, Japan.
authors.forename: Megumi
authors.initials: M
authors.lastname: Morita
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Nippon Medical School, Tokyo, 113-8603, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kaneko
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Nippon Medical School, Tokyo, 113-8603, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Tsuruoka
authors.affiliation: Department of Analytic Human Pathology, Nippon Medical School, Tokyo, 113-8602, Japan. Electronic address: ashimizu@nms.ac.jp.
authors.forename: Akira
authors.initials: A
authors.lastname: Shimizu
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000032:analysis; D015415:Biomarkers / Q000032:analysis; D001706:Biopsy; D002196:Capillaries / Q000737:chemistry / Q000473:pathology* / Q000648:ultrastructure; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D042783:Endothelial Cells / Q000737:chemistry / Q000473:pathology* / Q000648:ultrastructure; D005260:Female; D005921:Glomerulonephritis / Q000378:metabolism / Q000473:pathology*; D005922:Glomerulonephritis, IGA / Q000378:metabolism / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D007678:Kidney Glomerulus / Q000098:blood supply*; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D018952:Antigens, CD34; D015415:Biomarkers
keywords: Acute glomerular lesion; CD34; Chronic glomerular lesion; Endothelial cell injury; Glomerular capillary injury; IgA nephropathy; Pathology