CD44-negative parietal-epithelial cell staining in minimal change disease: association with clinical features, response to corticosteroids and kidney outcome
Por:
Roca, N, Jatem, E, Abo, A, Santacana, M, Cruz, A, Madrid, A, Fraga, G, Martin, M, Gonzalez, J, Martinez, C, Balius, A, Segarra, A
Publicada:
22 feb 2022
Ahead of Print:
1 ene 2022
Resumen:
Background Activation of parietal-epithelial cells (PECs) with neo-expression of CD44 has been found to play a relevant role in the development of focal and segmental glomerulosclerosis (FSGS). The aim of this study was to analyse whether the expression of CD44 by PECs in biopsies of minimal change disease (MCD) is associated with the response to corticosteroids, with kidney outcomes and/or can be considered an early sign of FSGS. Methods This multicentric, retrospective study included paediatric and adult patients with MCD. Demographic, clinical and biochemical data were recorded, and biopsies were stained with anti-CD44 antibodies. The association between PECs, CD44 expression and the response to corticosteroids, and kidney outcomes were analysed using logistic, Kaplan-Meier and Cox regression analyses. Results A total of 54 patients were included: 35 (65%) <18 years and 19 (35%) adults. Mean follow-up was 68.3 +/- 37.9 months. A total of 19/54 patients (35.2%) showed CD44-positive staining. CD44-positive patients were younger (14.5 +/- 5 versus 21.5 +/- 13, P = 0.006), and showed a higher incidence of steroid-resistance [11/19 (57.8%) versus 7/35 (20%), P = 0.021; odds ratio: 5.5 (95% confidence interval 1.6-18), P = 0.007] and chronic kidney disease [9/19 (47.3%) versus 6/35 (17.1%), P = 0.021; relative risk: 3.01 (95% confidence interval 1.07-8.5), P = 0.037]. Follow-up re-biopsies of native kidneys (n = 18), identified FSGS lesions in 10/12 (83.3%) of first-biopsy CD44-positive patients versus 1/6 (16.7%) of first-biopsy CD44-negative patients (P = 0.026). Conclusions In patients with a light microscopy pattern of MCD, CD44-positive staining of PECs is associated with a higher prevalence of steroid resistance and worse kidney outcomes, and can be considered an early sign of FSGS.
Filiaciones:
Roca, N:
Univ Vic, Serv Nefrol Pediat, Hosp Univ Vic, Barcelona, Spain
Jatem, E:
Hosp Arnau Vilanova, Serv Nefrol, Lleida, Spain
Abo, A:
Inst Recerca Biomed Dr Pifarre, Lleida, Spain
Santacana, M:
Inst Recerca Biomed Dr Pifarre, Lleida, Spain
Cruz, A:
Hosp Univ Vall dHebron, Serv Nefrol Pediat, Barcelona, Spain
Madrid, A:
Hosp St Joan de Deu Barcelona, Serv Nefrol Pediat, Barcelona, Spain
Fraga, G:
Hosp Univ Vall dHebron, Serv Nefrol Pediat, Barcelona, Spain
Hosp Santa Creu & Sant Pau, Serv Nefrol Pediat, Barcelona, Spain
Martin, M:
Hosp Arnau Vilanova, Serv Nefrol, Lleida, Spain
Gonzalez, J:
Hosp Arnau Vilanova, Serv Nefrol, Lleida, Spain
Martinez, C:
Inst Recerca Biomed Dr Pifarre, Lleida, Spain
VHIR Vall dHebron Inst Recerca, Barcelona, Spain
Balius, A:
Fundacio Althaia Manresa, Serv Nefrol, Barcelona, Spain
Segarra, A:
Hosp Arnau Vilanova, Serv Nefrol, Lleida, Spain
Inst Recerca Biomed Dr Pifarre, Lleida, Spain
Green Published, gold
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