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Role of renal expression of CD68 in the long-term prognosis of proliferative lupus nephritis

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Abstract

Introduction

Renal histology of proliferative lupus nephritis (LN) shows increased macrophage infiltration, but its association with renal outcome is a matter of debate. Here, we investigate the potential relationship that macrophage expression has with renal prognosis in patients with proliferative LN.

Methods

Fifty patients newly diagnosed with proliferative LN were followed for a median of 8 years. Laboratory testing was conducted at diagnosis, after induction therapy and at the final follow-up evaluation. Renal biopsies were obtained at diagnosis and underwent immunohistochemical analysis with anti-CD68 and monocyte chemoattractant protein 1 monoclonal antibodies. Patients were stratified at final follow-up evaluation into glomerular filtration rate (GFR) >60 ml/min/1.73 m2 (non-progressor group; n = 24) and GFR ≤60 ml/min/1.73 m2 (progressor group; n = 26). All patients were treated with prednisone and six pulses of cyclophosphamide on induction therapy. Conventional maintenance therapy was administered in both groups.

Results

Compared to progressors, the non-progressor group showed a lower chronicity index (p = 0.01) and fewer CD68-positive cells in the renal tubules (p = 0.01) and particularly in the renal interstitium (p = 0.0003). Baseline and final serum creatinine correlated positively with the chronicity index (r = 0.3, p = 0.01 and r = 0.3, p = 0.04, respectively), and final serum creatinine correlated positively with interstitial expression of CD68 (r = 0.4, p = 0.0006).

Conclusion

Renal expression of CD68 and the chronicity index are associated with progression to chronic kidney disease in patients with proliferative LN.

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Authors and Affiliations

  1. Nephrology Department, University of São Paulo School of Medicine Hospital das Clínicas, Rua Dr. Ovídio Pires de Campos, 225, Cerqueira César, São Paulo, SP, 05403-010, Brazil

    Cristiane B. Dias, Patrícia Malafronte, Aline Resende, Lectícia Jorge, Cilene C. Pinheiro & Viktoria Woronik

  2. Department of Pathology, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil

    Jin Lee & Denise Malheiros

Authors
  1. Cristiane B. Dias
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  2. Patrícia Malafronte
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  3. Jin Lee
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  4. Aline Resende
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  5. Lectícia Jorge
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  6. Cilene C. Pinheiro
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  7. Denise Malheiros
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  8. Viktoria Woronik
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Correspondence to Cristiane B. Dias.

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The authors declare that they have no conflict of interest

Ethical statement

The procedures involved in this study have been performed in accordance with the ethical. The Research Ethics Committee of the University of São Paulo School of Medicine Hospital das Clínicas approved the study protocol

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Informed consent was obtained from all individual participants included in the study.

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Dias, C.B., Malafronte, P., Lee, J. et al. Role of renal expression of CD68 in the long-term prognosis of proliferative lupus nephritis. J Nephrol 30, 87–94 (2017). https://doi.org/10.1007/s40620-015-0252-7

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  • DOI: https://doi.org/10.1007/s40620-015-0252-7

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