Urinary monocyte chemoattractant protein-1 levels and interstitial changes in the renal cortex and their relationship with loss of renal function in renal transplant patients with delayed graft function.

BACKGROUND: Inflammatory cell infiltration and residual areas of fibrosis in kidneys after renal transplantation can lead to functional abnormalities with long-term implications. OBJECTIVES: The aim of this study was to determine urinary monocyte chemoattractant protein-1 (uMCP-1) levels, relative cortical interstitial area (RCIA), and cortical tubulointerstitial macrophage infiltration in renal transplant patients with delayed graft function (DGF) and their possible correlation with graft outcome. DESIGN: Patients were followed after biopsies for one year, and their renal function and structure were evaluated, as well as parameters of inflammatory process. SETTING: Clinical Hospital of the School of Medicine of Ribeirão Preto. PATIENTS: Twenty-two cadaveric kidney transplant recipients with DGF were followed for one year. MEASUREMENTS: Renal function, RCIA, macrophages infiltration and uMCP-1 levels were evaluated. METHODS: Renal function was evaluated by plasma creatinine levels. RCIA was determined by morphometry. Immunohistochemical staining of macrophages was performed using an anti-CD68 monoclonal antibody. uMCP-1 levels were determined using a human MCP-1/CCL2 immunoassay kit. RESULTS: There was a significant increase in uMCP-1 levels in transplant patients compared with controls (p < 0.001). RCIA was 7.1% (6.4 to 9.2; median and 25th to 75th percentiles) in controls and 37.1% (28.1 to 43.7) in patients with kidney transplants (p < 0.001). The patients who presented with a higher RCIA in the first biopsy showed higher levels of plasma creatinine one year after transplantation (r = 0.44; p < 0.05). The number of tubulointerstitial macrophages per 0.10 mm(2) grid field was higher in the renal cortex of transplant patients compared with the controls (19.4 (9.0 to 47.1) vs. 2.5 (1.8 to 3.4), p < 0.001). There was also a positive correlation between the RCIA and the number of tubulointerstitial macrophages in the renal cortex of these patients (r = 0.49; p < 0.001). LIMITATIONS: The number of patients studied was relatively small and may not be reflecting outcomes over a larger spectrum of kidney cadaveric transplants. CONCLUSIONS: Our results demonstrate increased levels of uMCP-1 in transplant patients with DGF, in addition to increased tubulointerstitial macrophage infiltration and RCIA, which could predict the outcome of renal function in these patients.

CONTEXTE: L'infiltration de cellules inflammatoires et la présence de zone de fibrose résiduelle, après la transplantation rénale, peuvent entraîner des anomalies fonctionnelles ayant des incidences à long-terme. OBJECTIFS: Le but de cette étude était de déterminer, chez les patients transplantés avec retard de fonctionnement du greffon (RFG), les taux urinaires de protéine chimiotactique monocytaire-1 (uMCP-1), la zone relative de l'interstitium cortical, et l'infiltration tubulo-interstitielle de macrophages dans le cortex rénal afin d'évaluer la possible corrélation de ses informations et de l'évolution de la transplantation. TYPE D'ÉTUDE: Les patients ont été suivis pendant un an, après biopsie, avec évaluations stucturelle et fonctionnelle, et évaluation des paramètres du processus inflammatoire. CONTEXTE: Hôpital clinique de l'école de médecine de Ribeirão Preto. PATIENTS: Vingt-deux patients ayant reçu un greffon rénal cadavérique avec RFG ont été suivis pendant un an. MESURES: La fonction rénale, l'infiltration de macrophages et les taux d'uMCP-1 ont été évalués. MÉTHODES: La fonction rénale a été évaluée en utilisant les concentrations sériques de créatinine. Une coloration immunohistochimique des macrophages par anticorps monoclonal anti-CD68 a été effectuée. Les concentrations d'uMCP-1 ont été déterminées en utilisant les tests immunologiques de MCP-1/CCL2 humaine. RÉSULTATS: Les concentrations d'uMCP-1 étaient significativement plus élevées chez les patients transplantés que chez les sujets du groupe témoin (p < 0.001). Les médianes de la zone relative de l'interstitium cortical étaient de 7,1% (25ème au 75ème percentiles : de 6,4% à 9,2%) pour le groupe témoin et de 37,1% (de 28,1% à 43,7%) chez les patients transplantés rénaux (p < 0.001). Les patients ayant une la zone relative de l'interstitium cortical plus grande au moment de la première biopsie présentaient une concentration plasmatique de créatinine plus grande un an après la transplantation (r = 0.44; p < 0.05). Le nombre de macrophages dans l'espace tubulo-interstitiel, par champs de 0,10 mm2, était plus élevé dans le cortex rénal des patients transplantés que chez le groupe témoin (19,4 (de 9.0 à 47.1) et 2,5 (de 1.8 à 3,4), p < 0.001). Il existait également une corrélation positive entre la zone relative de l'interstitium cortical et le nombre de macrophages dans l'espace tubulo-interstitiel du cortex rénal de ces patients (r = 0.49; p < 0.001). LIMITES DE L'ÉTUDE: l'échantillon étudié était relativement petit et ne représente pas nécessairement les résultats d'un échantillon plus vaste constitué de patients transplantés avec greffon rénal cadavérique. CONCLUSIONS: Nos résultats démontrent des concentrations d'uMCP-1 plus élevées chez les patients avec RFG, accompagnées d'une infiltration de macrophages dans l'espace tubulo-interstitiel et d'une zone relative de l'interstitium cortical plus grandes, faits qui pourraient prédire l'évolution de la fonction rénale chez ces patients.

Gleason score and tumor laterality in radical prostatectomy and transrectal ultrasound-guided biopsy of the prostate: a comparative study.

We aimed to compare Gleason score and tumor laterality between transrectal ultrasound-guided biopsy of the prostate (TRUSBX) and radical prostatectomy (RP). Some factors that could cause a discrepancy in results between these two procedures were also evaluated. Among the 318 cases reviewed, 191 cases were selected for inclusion in this comparative study. We divided the patients into two groups using the Gleason score: an intermediate/high-grade group (≥7) and a low-grade group (<6). Exploratory analyses were conducted for comparisons between groups. We also performed comparisons between TRUSBX and RP for tumor laterality. TRUSBX overestimated 6% and underestimated 24% cases in comparison with RP for Gleason score, and overestimated 2.6% and underestimated 46% cases compared with RP for tumor laterality. Biopsy specimens were slightly smaller in TRUSBX cases with underestimated tumor laterality (P < 0.05), and no relationship between the biopsy specimen size and underestimated Gleason score in TRUSBX was found. Prostatic volume showed no statistical correlation with the likelihood of under or overestimation (P > 0.05). Thus, our study showed that TRUSBX has a high likelihood of underestimating both the Gleason score and tumor laterality in prostate cancer (PCa). The size of the fragment appears to be an important factor influencing the likelihood of laterality underestimation and Gleason score overestimation via TRUSBX. Due to the high likelihood of underestimation of the Gleason score and tumor laterality by 12-core prostate biopsy, we conclude that this type of biopsy should not be used alone to guide therapy in PCa.

A novel case report of sickle cell disease-associated immunoglobulin A nephropathy: the diagnostic value of erythrocyte dysmorphism evaluation.

Sickle cell disease is a severe disease with a genetic pattern; it may cause anemia, vaso-occlusive phenomena, and multiorgan injury. It may damage any renal compartment, thereby causing tubular abnormalities, papillary necrosis, or glomerulopathies such as focal and segmental glomerulosclerosis and membranoproliferative pattern. The clinical consequences are hematuria and proteinuria. Hematuria associated with SCD is characteristically isomorphic (non-glomerular). This case report describes a novel case of a patient with sickle cell disease who presented with proteinuria and microscopic dysmorphic (glomerular) hematuria. A renal biopsy revealed immunoglobulin A nephropathy. Despite the fact that immunoglobulin A nephropathy is the most commonly diagnosed glomerulonephritis worldwide, an association between this entity and sickle cell disease has not yet been reported, probably because all cases of hematuria in patients with sickle cell disease have been regarded as secondary to sickle cell disease. Thus, new approaches are necessary to differentiate these conditions, such as evaluation of urinary erythrocyte dysmorphism, even more so because these two entities have different therapeutic options, morbidity, and mortality rates.