α-SM Actin Expression as Prognostic Indicator in IgA Nephropathy (Berger’s Disease)

M T Pastorello,M Dantas,M Coimbra,R S Costa,R C Ravinal,M.A Dos Reis

doi:10.1155/2005/360579

Abstract

Recent studies have demonstrated that α-Smooth Muscle actin expression in glomerular and tubulointerstitial compartments of renal tissue could represent a prognostic marker in several renal diseases. Our objective was to identify the prognostic value of α-SM actin actin expression on the evolution of renal damage in Primary IgA nephropathy (Berger’s Disease). 43 patients followed up from 1988 to 1999 at the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brazil, was studied. Clinical-laboratory data were obtained from the medical records of the patients using a protocol containing name, race, gender, origin, profession, age at clinical presentation of the disease and personal and family history. The parameters assessed in the approach to IgA nephropathy were serum creatinine, creatinine clearance, serum albumin, total serum protein, 24 hours proteinuria, glycaemia, serum sodium, potassium, calcium and phosphorus ions, analysis of urinary sediment, serum complement profile, blood count, and renal biopsy. Morphological evaluation was performed by renal biopsy using common light and immunofluorescence microscopy. Immunohistochemical studies were performed using a murine monoclonal antibody to α-SM actin. Our data showed that α-SM actin expression in the glomerular and tubulointerstitial compartments are not correlated with unfavorable clinical course of primary IgA nephropathy.

Highlights

Since its original description in 1968 by Jean Berger and Nicole Hinglais [4], nephropathy due to intercapillary IgA deposits, known as Berger’s Disease (BD), has been extensively studied in terms of clinical, pathological and immunological aspects and today is recognized as the most common primary glomerulopathy worldwide [12]
Important to say that in our service no renal biopsy is indicated for patients with microscopic hematuria without proteinuria or with asymptomatic proteinuria
We considered clinical remission (CR) and clinical improvement (CI) to indicate a favorable clinical course and clinical worsening (CW) plus chronic renal insufficiency (CRI) to indicate an unfavorable clinical course

Summary

Introduction

Since its original description in 1968 by Jean Berger and Nicole Hinglais [4], nephropathy due to intercapillary IgA deposits, known as Berger’s Disease (BD), has been extensively studied in terms of clinical, pathological and immunological aspects and today is recognized as the most common primary glomerulopathy worldwide [12]. Sion [10] indicating that, as is the case for other “primary” glomerulonephritis, the initial disorder of BD can revert spontaneously even after a long disease course. On this basis, the possible factors involved in its prognosis have been extensively studied. With respect to the clinical parameters, frequently recurring macroscopic hematuria, the absence of persistent proteinuria, the absence of hypertension, and age of less than 16 years at the onset of the disease favor a better prognosis for the patient [13,14,24]. With respect to the microscopic parameters, the lower the extent of the lesion in the glomerular [8], tubulointerstitial [5] and vascular [27] compartments and the presence of IgA restricted to the mesangium without reaching the capillary loops [16] the better the prognosis

Objectives

Methods

Results

Conclusion