| Objective: Systemic lupus erythematosus (SLE) is an autoimmune disorder caused by the multifactor. And the kidney is the most commonly affects vital organs in SLE disease.Early, urine abnormal or kidney dysfu- nction is 25% to 50%, and the renal biopsy revealed almost all SLE patients have the varying degree of kidney damage and the renal damage increased the mortality of SLE patients. Currently LN is the leading cause of secondary glomerular disease. At presence it has confirmed that LN patients often companion of tubular-interstitial lesion (TIL), TIL has close relationship with renal damage, and in the early stage it can appears many pathological changes such as renal tubular degeneration and necrosis and interstitial inflammatory cells infiltrating.Along with the further aggravate of the disease it can cause renal tubular atrophy and interstitial fibrosis. Studies show that the active LN patients has the higher incidence of impairment of the renal tubules fuction than the tubulointerstitium pathological change.Renal tubularinterstitial fib- rosis(TIF) is an important characteristic of renal sclerosis.The renal fibrosis is the common pathways of the progression to end-stage renal failure in many chronic kidney diseases(CKD). Renal tubular interstitial fibrosis manifests the renal tubules basement membrane thickened,tubular epithelial cells shrink,the infiltration of interstitial inflammatory and small interstitial arterial wall thickening, collagen and fibronectin secretion increased, renal tubular and interstitial capillary loss and extracellular matrix (ECM) excessive accumu- lation. Recently findings show that neutrophil gelatinase-associated lipocalin (NGAL) has played an important role in restraining the interstitial fibrosis in kidney and then delayed the development of chronic kidney disease. This study is aimed to analyse the expression level of the NGAL in patients with lupus nephritis active renal lesions and inactive renal lesions,and the relations- hip between the expression and the pathological change,clinical manifestation was analyzed to explore the significance of NGAL in the progression of LN nephropathy and to provide theory for treatment and prevention of the clinical renal fibrosis.Methods: This study was approved by the Department of Nephrology, the second hospital of Hebei Medical University. We chosen 23 cases of LN nephropathy by renal biopsy diagnosed from May 2009 to Dce.2009(5 males and 18 females, mean age 31.2±13.2 years). All patients are according with the revision of American Rheumatism Association, 1997(ARA) about the four or above criteria of diagnosis of SLE, all have the clinical manifestations of renal leison, and all have the renal biopsy and renal pathology check, taken respectively by biopsy organization (HE, PAS, MASSON and PASM staining) and immunofluorescence (IgA, IgG, IgM and C3, C4, C1q and Fib dyeing) examination.Before the biopsy are unused glucocorticoid, inmunoinhibitors, low molecular heparin and angiotensin converting enzyme inhibitors, etc. Pathological type according to 2003 LN ISN/RPS pathological type. Disease activity score adopt SLEDAI rating criteria,and defined greater than nine scor- es as active group ,less than nine scores as nonactive group. Active group includingⅣtype 9cases,Ⅳ+Ⅴtype 7cases,Ⅴ+Ⅲtype 4cases, nonactive group isⅡtype 2cases,Ⅲtype 1case,Ⅱ+Ⅴ1case andⅢ+Ⅴtype 1case. Six specimens as control group (optical microscope and immunofluorescence all normal) which from normal renal tissus in patients with renal tumor after resection of the tumor tissue (male 2cases, female 4cases, average age 50.8±11.7 years). All datas are applied by SPSS13.0 software for statistical analysis. Immunohistochemical method (SP method) was used to detection the distribution and expression of NGAL in renal tissues.The semiquantitative analysis of renal tissue immunohistochemistry were analyzed. Collecting clinical indicators: gender, age, 24 hour urinary protein quantitative (Upro),C3,serum albumin (ALB), anti-dsDNA antibody, glomerular filtration rate (GFR), and the activity (AI),chronicity (CI) indices and tubulointerstitial damage index(TDI).Then the expression of NGAL was analyzed with clinical and pathological datas.Result: 1 LN Patients with clinical data: including 25 cases:male 5cases, female 18cases, the ratio between male and female is 1:3.6;for men have a rising trend to have this disease.The average age is 31.2±13.2 years, Between the active and the nonactive group the age,GFR, C3, the chronic renal pathology index and tubulointerstitial damage index was no statistical significance (P>0.05). The urinary protein and the positive rate of anti-dsDNA antibody in active group was obviously higher than nonactive and normal groups (P<0.05),and the serum albumin was distinctly lower than nonactive group.The activity (AI) indices between the active and nonactive groups was significant differrence (P<0.05). 2 The expression of NGAL in the renal tissue of LN patient is higher than the healthy control . 3 In the control group and the group with lupus nephritis the NGAL express mainly in the proximal tubular epithelial cells, renal glomerulus and renal interstitial and infiltration of inflammatory cells did not have the NGAL exspression. The exspression of NGAL in normal renal tissue is only a little.4 In LN patients,the active group have the highest expression of NGALcompared to the nonactive group, and have statistically significant difference (P<0.01),There was significant difference between control group and nonactive groups (P<0.05). 5 The expression of the NGAL had positive correlation with Upro and renal pathology activity index (P<0.01);negative correlation with ALB (P<0.01).No correlation was found between the expression of NGAL and GFR,C3, anti-dsDNA antibody.Conclusion: 1 NGAL mainly expressed in normal renal tissue and patients with lupus nephritis renal tissue proximal tubular epithelial cell cytoplasm.2 In renal tissue from normal kidneys, the expression of NGAL could be detected a little. The expression of NGAL in the active group is greatly higher than the nonactive and healthy control groups. The expression of the NGAL had positive correlation with Upro and AI, negative correlation with ALB.3The expression of NGAL in patients with lupus nephritis kidney tissues may be as a monitor of the LN activity level... |
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