The Effects of EMMPRIN/CD147 on Late Function and Histopathological Lesions of the Renal Graft

Background/Aims:Chronic kidney disease is associated with renal fibrosis, develops with the participation of fibroblasts and myofibroblasts from epithelial-to-mesenchymal transition (EMT). In cancer research, the key role of the glycoprotein EMMPRIN/CD147 in EMT has been proven. We evaluates how CD147/EMMPRIN affects long-term renal graft function and renal biopsy specimen lesions. Patients and methods:49 renal graft recipients who had a renal biopsy within the last 18 months were retrospectively reviewed. The mean period after kidney transplantation (Tx) was 70 months. At their most recent appointments, their concentrations of CD147/EMMPRIN were evaluated. Renal function at their most recent appointment was assessed, and so was the occurrence of delayed graft function (DGF) and estimated glomerular filtration rate (EGFR) at 1 year and the subsequent years of the follow-up period. Renal biopsy specimen lesions, mainly those related to renal fibrosis and tubular atrophy, were evaluated.Results: EMMPRIN concentration correlated positively with eGFR at the most recent appointment and with eGFR at 1 and 2 years after Tx, with p<0.05, R-0.69, R-0.39 and R-0.40, respectively. CD147/EMMPRIN levels correlated positively with urine protein concentrations, with p<0.05 and R=0.73. A positive correlation was found with the severity of renal biopsy specimen lesions such as CI, CT, CG, MM and AH ( p<0.05, R=0.39, R=0.29, R=0.41, R=0.32 and R=0.40, respectively). Patients with a history of DGF had higher CD147/EMMPRIN concentrations (<0.05).Conclusions:EMMPRIN/CD147 is a glycoprotein that is linked to poorer long-term renal graft function. Also, its high concentration is associated with exacerbated IF/TA lesions and proteinuria.

Imported haemorrhagic fever with renal syndrome caused by Dobrava–Belgrade hantavirus in France

Acute kidney injury (AKI) caused by hantavirus infections is rare but should be suspected in any patient presenting with flu-like symptoms, signs of haemolytic–uraemic syndrome or presence of anti-glomerular basement membrane (anti-GBM) antibodies. We report the first case of Dobrava–Belgrade virus in France imported from southeastern Europe. The characteristic macroscopic appearance of the fresh renal biopsy specimen, displaying a haemorrhagic appearance of the medulla, suggested hantavirus infection. AKI caused by hantavirus infections remains a diagnostic challenge, especially outside endemic areas.

MPGN Type 3 Associated with Pemphigus Herpetiformis Mimicking PGNMID and Dermatitis Herpetiformis

A 45-year-old man suffering from dermal blistering disease with proteinuria and hematuria underwent renal biopsy. The renal biopsy specimen suggested proliferative glomerulonephritis with monoclonal IgG deposits under routine light, immunofluorescence and electron microscopy. The staining for IgG subclasses (IgG1 and IgG2) and κ/λ light chain indicated secondary immune complex type MPGN type 3. The patient had been diagnosed as having dermatitis herpetiformis (DH), a phenotype of gluten hypersensitivity prior to the appearance of the renal abnormality. Although common autoantibodies might be related to the pathogenesis of disorders in the skin and kidney, DH is mainly driven by IgA autoantibody, while MPGN is induced by IgG immune complexes. IgA was not observed in the glomeruli by immunofluorescence. Neither the examination for DH specific autoantibodies nor HLA-DQB1 genotype supported the diagnosis of DH. Reassessment of the skin biopsy record revealed that the blister was localized in the epidermis, suggesting pemphigus herpetiformis by IgG class anti-epidermal autoantibody, which also affected the renal disorder.

Unexpected Identification of Trophreyma whippelii in a Renal Biopsy Specimen

Extended abstract of a paper presented at Microscopy and Microanalysis 2010 in Portland, Oregon, USA, August 1 – August 5, 2010.