Histological differences in new-onset IgA nephropathy between children and adults
Histological differences in new-onset IgA nephropathy between children and adults
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DOI：
10.1093/ndt/gfl455
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发表时间：
2006-12-01
影响因子：
6.1
通讯作者：
Uchiyama, Makoto
中科院分区：
文献类型：
--
作者：
Ikezumi, Yohei;Suzuki, Toshiaki;Uchiyama, Makoto
背景。根据活检结果，IgA肾病（IgAN）在儿童和成人中的表现不同。然而，由于成人IgAN发病时间的不确定性，这一点很难确定。我们通过比较最近诊断的儿童和成人igan的组织学和活组织检查中的白细胞积累来解决这个问题。我们对33例儿童（10 +/- 3岁）和38例成人（35 +/- 6岁）IgAN患者在发生肾脏异常后2年内的组织学变化（系膜、毛细血管内和毛细血管外区域的细胞结构、基质扩张、粘连/月牙状和间质损伤）、肾小球免疫球蛋白和补体沉积、巨噬细胞、活化巨噬细胞和T细胞的存在进行了免疫组织化学检查。肾小球细胞增多是由于系膜区细胞增多引起的，在儿童IgAN中表现突出，明显高于成人IgAN。与儿童IgAN相比，成人肾小球基质扩张、新月形成和间质损伤更为严重。的确，肾小球高细胞性与儿童蛋白尿相关，但与成人IgAN无关，而肾小球基质与成人蛋白尿和肾功能相关，但与儿童IgAN无关。在儿童IgAN中，C3c的沉积程度更大，而在成人IgAN中，纤维蛋白原的沉积程度更大。在儿童和成人IgAN中均发现肾小球和间质CD68+巨噬细胞和唾液黏附素(Sn)+激活的巨噬细胞亚群，在成人IgAN中数量显著增加。两组肾小球白细胞浸润与蛋白尿相关，间质白细胞浸润与间质损伤相关。然而，只有Sn+巨噬细胞亚群与肾功能、肾小球高细胞性和肾小球基质有显著相关性。该研究表明，IgAN在儿童和成人的早期肾小球病变方面存在显著差异。此外，在两组患者中，Sn+活化的巨噬细胞与IgAN的发病机制有关。这些发现的预后意义值得进一步研究。
Background. It is suggested that IgA nephropathy (IgAN) manifests differently in children vs adults on the basis of biopsy findings. However, this has been difficult to establish owing to the uncertainty of the timing of disease onset in adult IgAN. We addressed this question by comparing both histology and leucocyte accumulation in biopsies of recently diagnosed childhood and adult IgAN.Methods. Biopsies taken within 2 years from the onset of renal abnormalities in 33 childhood (10 +/- 3 years of age) and 38 adult (35 +/- 6 years) cases of IgAN were examined for histological changes (cellularity in mesangial, endocapillary and extracapillary areas, matrix expansion, adhesions/crescents and interstitial damage), glomerular deposition of immunoglobulin and complement, and the presence of macrophages, activated macrophages and T cells by immunohistochemistry.Results. Glomerular hypercellularity owing to increased cells in mesangial area was prominent in paediatric IgAN and significantly greater than in adult IgAN. In contrast, glomerular matrix expansion, crescent formation and interstitial damage were more severe in adults compared to paediatric IgAN. Indeed, glomerular hypercellularity correlated with proteinuria in paediatric but not in adult IgAN, whereas glomerular matrix correlated with proteinuria and renal function in adult but not in paediatric IgAN. The degree of C3c deposition was significantly greater in paediatric IgAN, while deposition of fibrinogen was greater in adult IgAN. Glomerular and interstitial CD68+ macrophages and a subset of sialoadhesin (Sn)+ activated macrophages were identified in both paediatric and adult IgAN, being significantly greater in number in adult IgAN. Glomerular leucocyte infiltration correlated with proteinuria while interstitial leucocyte infiltration correlated with interstitial damage in both groups. However, only the subset of Sn+ macrophages gave a significant correlation with renal function, glomerular hypercellularity and glomerular matrix.Conclusions. This study has demonstrated significant differences in the early glomerular lesions of IgAN in children vs adults. Furthermore, Sn+ activated macrophages are implicated in the pathogenesis of IgAN in both patient groups. The prognostic significance of these findings warrants further study.