Lupus nephritis, one of the most serious manifestations of systemic lupus erythematosus (SLE) .It is histological evident in most patients with SLE, even those without clinical manifestations of renal disease. Sixty to 80% of patients develop clinically relevant nephritis at some point in the progression of the disease and approximately 5-15% of patients develop End Stage Renal Disease (ESRD) at 10 years. Death associated with renal disease has been reported in 5-10%.
In lupus nephritis, a widespread activation of vascular endothelium has been demonstrated. EPCR is a type 1 transmembrane glycoprotein which belongs to CD1 receptors expressed in the endothelium of large vessels & to a lesser extent on capillaries
In response to injury, glomerular mesangial cells proliferate; express new antigens resulting in activated phenotype and lead to extra cellular deposition. In particularly, there is a phenotypic transformation of mesangial cells to myofibroblasts expressing α- smooth muscle actin (α-SMA. Myofibroblasts are well known to be the major cell type responsible for extracellular matrix synthesis and scarring
The current retrospective study was carried on 94 cases LN patients with different classes. Eleven cases (12%) class II, 20(21%) class III, 48(51%) class IV, 9(10%) class V, 6(6%) class VI.
Histopathological and immunoflurecence examination were done for reviewing of histopathological data. Activity and chronicity index were applied for all cases.
Immunohistochemical detection of EPCR and SMA was done. The expression of each marker was correlated with clinicopathological findings as well as with the progression of the disease.
The present study reported that EPCR was expressed in 42% of studied cases while SMA showed glomerular expression in 44% of cases and 63% interstitial expression. There was a significant correlation between EPCR expression and both G-α SMA and I-α SMA
The current study showed insignificant correlation between both EPCR and G-α SMA and class of LN while I-α SMA showed significant correlation. There was different proportion of expression of the markers inside each class
The present study showed a significant correlation between EPCR expression and interstitial inflammation, TID and renal function impairment (serum creatinine).
There was a significant correlation between G-α SMA and activity index while I-α SMA showed positive correlation with chronicity index.
The present study revealed that there was a significant correlation between I-α SMA and interstitial inflammation, TID, proteinuria as well as serum creatinine level while G-α SMA showed insignificant correlation
As regard subendothelial immune deposit, there was a significant correlation between subendothelial immune deposit and activity index as well as renal function impairment.
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