Abstract
BackgroundExperimental studies have linked peritubular capillary (PTC) loss with progression of chronic kidney disease. Minimal information on PTC in lupus nephritis (LN) has been reported. We therefore evaluated the PTC area in different classes of LN and determined if specific clinical characteristics correlated with PTC changes.MethodsRenal biopsies of 253 subjects with LN (categorized using the ISN/RPS 2003 classification) and 13 normal renal donors (the controls) were retrospectively evaluated for PTC morphology by staining for CD31 with immunohistochemistry method. The percent positive area of PTC (% PTC) was correlated with serum and urinary measures of renal function and renal pathology.ResultsSignificant PTC loss was observed in all classes of LN compared to controls. The % PTC area was highest in controls (7.64±1.48 %) with levels of 1.95±1.50, 4.16±3.85, 4.19±4.45, 5.02±1.79, and 4.45±3.75 in classes II, III, IV, IV combined with V and V, respectively (all p values < 0.05). The lowest PTC density was observed in class II LN, but this may be because some cases with worse classes of LN showed increased PTC density due to abnormally dilated capillaries associated with acute inflammation and angiogenesis. %PTC was increased in those with hematuria (5.8±5.2 vs. 3.6±3.4 %, red blood cells 3-10 vs. < 3 cells/high power field, p < 0.05) and was reduced in those with a moderately declined renal function (3.29±3.40 vs. 4.42±4.12, eGFR 15-59 vs. ≥ 60 ml/min/1.73 m2, p < 0.05). Nephrotic-range proteinuria also trended to be associated with lower PTC density although it did not reach statistical significance (3.1±2.6 vs. 4.9±4.5, p= 0.067).ConclusionsLN is associated with PTC loss and the severity correlates with reduced renal function. Further studies are needed to investigate whether a loss of PTC can predict long term renal outcomes in LN.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0388-2) contains supplementary material, which is available to authorized users.
Highlights
Experimental studies have linked peritubular capillary (PTC) loss with progression of chronic kidney disease
According to the International Society of Nephrology/Renal Pathology Society (ISN/RPS) 2003 lupus nephritis (LN) classification, there was a respective 23, 6, 171, 3, and 50 cases in class II, III, IV, IV combined with V (IV + V), and V
The mean Systolic blood pressure (SBP) was highest in the class IV group (140 ± 24 mmHg), whereas the respective level in the class II, III, IV + V and V groups was 129 ± 15, 134 ± 22, 125 ± 19 and 125 ± 16 mmHg
Summary
Experimental studies have linked peritubular capillary (PTC) loss with progression of chronic kidney disease. Renal injury in LN is known to affect glomerular, tubulointerstitial, and vascular compartments [2, 3]. In addition to the predominantly glomerular involvement in LN, renal vascular lesions may affect glomerular capillaries, arterioles and arteries leading to thrombotic microangiopathy, lupus vasculopathy and lupus vasculitis [3, 6,7,8,9], while tubulointerstitial injury manifests as interstitial inflammation, renal tubular atrophy and/or interstitial fibrosis [10, 11]. Information on the integrity of the peritubular capillaries (PTC), which is the primary vascular supply for the renal tubules, has been limited to date
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