Renal α-smooth muscle actin: A new prognostic factor for lupus nephritis

SUMMARY Aim: Systemic lupus erythematosus (SLE) is the prototype of autoimmune disease where renal involvement is frequent and always severe. Histological prognostic factors proposed for lupus nephritis (LN) including the World Health Organization and International Society of Nephrology/Renal Patho...

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Published in:	Nephrology (Carlton, Vic.) Vol. 14; no. 5; pp. 499 - 505
Main Authors:	MAKNI, KAOUTHAR, JARRAYA, FAÏÇAL, KHABIR, ABDELMAJID, HENTATI, BASMA, HMIDA, MOHAMED BEN, MAKNI, HAFEDH, BOUDAWARA, TAHIA, JLIDI, RCHID, HACHICHA, JAMIL, AYADI, HAMMADI
Format:	Journal Article
Language:	English
Published:	Melbourne, Australia Blackwell Publishing Asia 01-08-2009
Subjects:	Actins - analysis activity indice Biopsy chronicity indice Fibrosis Humans Immunohistochemistry interstitial α-smooth muscle actin Kidney - chemistry Kidney - pathology Lupus Nephritis - metabolism Lupus Nephritis - pathology mesangial α-smooth muscle actin Prognosis systemic lupus erythematosus
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Summary:	SUMMARY Aim: Systemic lupus erythematosus (SLE) is the prototype of autoimmune disease where renal involvement is frequent and always severe. Histological prognostic factors proposed for lupus nephritis (LN) including the World Health Organization and International Society of Nephrology/Renal Pathology Society – Working Group on the Classification classifications, active (AI) and chronicity (CI) indices may not predict response to treatment. The aim of this study was to correlate α‐smooth muscle actin (α‐SMA) expression, an early marker of glomerular and interstitial response to injury, to AI and CI, renal scarring progression and response to treatment. Methods: Fifty‐seven kidney biopsy specimens obtained from 32 patients suffering from LN were studied. Twenty patients with class IV LN at first biopsy were identified to study renal progression to chronic renal failure until the use of immunosuppressive treatment. Results: Interstitial α‐SMA (I‐α‐SMA) was correlated only with CI (P < 0.001) whereas mesangial α‐SMA (M‐α‐SMA) was correlated with neither LN activity (P = 0.126) nor sclerosis (P = 0.297). Only I‐α‐SMA was correlated with renal failure (P = 0.01). We divided patients with class IV LN into progressors and non‐progressors based on the slope of serum creatinine. At first biopsy, M‐α‐SMA and I‐α‐SMA, but not AI and CI, were correlated with renal failure progression (M‐α‐SMA, 9.7b1.1 vs 7.8b1.4, P = 0.004; and I‐α‐SMA, 9.3b1.1 vs 6.5b3.2, P = 0.011). Conclusion: The study data highlight that I‐α‐SMA immunostain in class IV LN patients was correlated with chronicity indices. Moreover, M‐α‐SMA and I‐α‐SMA expression in first biopsy predicted renal progression modality. α‐SMA expression may therefore be a useful marker to predict renal prognosis in LN.
Bibliography:	istex:970CAAA11B39E5E4EA82D0998602B55393F1C2E5 ark:/67375/WNG-17VKFH8D-J ArticleID:NEP1140 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1320-5358 1440-1797
DOI:	10.1111/j.1440-1797.2009.01140.x