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Podocyte Detachment Is Associated with Renal Prognosis in ANCA-Associated
Glomerulonephritis: A Retrospective Cohort Study
#MMPMID27082569
Zou R
; Wang SX
; Liu G
; Yu F
; Chen M
; Zhao MH
Medicine (Baltimore)
2016[Apr]; 95
(15
): e3294
PMID27082569
show ga
The prognosis of antineutrophil cytoplasmic antibody (ANCA)-associated
glomerulonephritis (ANCA-GN) is unfavorable despite immunosuppressive therapy. It
has been suggested that the loss of podocytes is a hallmark of progressive kidney
disease. However, it is unclear about podocyte injuries and their predictive
values on the prognosis in ANCA-GN. Therefore, the current study aimed to
investigate the podocyte injury in renal histopathology and its association with
renal prognosis of patients with ANCA-GN. A total of 170 patients with ANCA-GN
were recruited in this study. Morphometric investigation of podocytes by electron
microscopy including foot process width (FPW), podocyte density per glomerulus
(Nv), and glomerular basement membrane (GBM) width were measured and calculated
in ANCA-GN patients. Cox regression analysis was used to analyze the association
between podocyte injuries and prognosis of patients with ANCA-GN. Foot processes
broadening, podocyte detachment, and GBM thickening could be observed in electron
micrographs in the specimens of 158/170 (92.9%), 142/170 (83.5%), and 150/170
(88.2%) patients, respectively. Compared with normal controls, FPW and GBM width
in ANCA-GN patients was significantly higher (1269.39?±?680.19 vs 585.81?±?77.16,
P?=?0.004; 668.23?±?208.73 vs 354.23?±?52.70, P?=?0.000, respectively), while the
podocyte density was significantly lower (55.90?±?36.32 vs 255.23?±?47.29,
P?=?0.000). The podocyte density was independently associated with the recovery
of renal function in logistic regression analysis (OR, 1.083; 95% CI,
1.025-1.440; P?=?0.005). Furthermore, multivariate analysis revealed that
podocyte density was an independent predictor of end-stage renal disease (ESRD)
(model A: HR, 0.950; 95% CI, 0.919-1.982; P?=?0.002; model B: HR, 0.953; 95% CI,
0.922-0.985; P?=?0.004). Podocyte structural damage and detachment occurred
frequently in patients with ANCA-GN. Moreover, podocyte detachment was an
independent predictor of renal outcomes.
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