Evaluation of Endothelial Cell Enlargement in Glomerulitis.
Marialuisa Valente, Lucrezia Furian, Paolo Rigotti, Mila Della Barbera, Francesco Marchini, Stefano Marino, Massimo Cardillo, Francesca B Aiello. University of Padua, Medical School, Padova, Italy; Azienda Ospedaliera Padova, Padova, Italy; Azienda Ospedaliera ULSS 12, Venezia, Iraq; Centre for Organ and Tissue Transplant, IRCCS, Ospedale Maggiore, Milano, Italy; University of Chieti, Italy
Background: Glomerulitis is defined by mononuclear cells in glomeruli and endothelial cell enlargement. In T cell mediated acute rejection, according to the Banff classification, glomerulitis is scored but not utilized to grade T cell mediated acute rejection, in contrast, in antibody mediated acute rejection its prognostic significance has been proposed to be relevant.
Design: Glomerulitis was studied in 90 consecutive acute rejections, time interval 2004-2009, matched as closely as possible for type and grade. CD68 and C4d immunostaining was performed in all cases. Glomerular endothelial cell enlargement (ECE) was measured morphometrically following CD31 immunostaining (ECE = endothelial cell area/total capillary area x 100)
Results: Glomerulitis was present in 36 cases (group 1) and absent in 54 (group 2). ECE was measured in 15 biopsies of group 1, 8 of group 2 and in 8 control biopsies with no evidence of rejection. The ECE mean value of group 1 (69.3 + 6.7%) but not that of group 2 (58.5 + 6.6%) was higher than in controls (57.0 + 3.56%) (P< 0.05). C4d deposition, observed in 14/36 rejections of group 1 (38.9%) and in 7/54 rejections of group 2 (13.0%) (P< 0.05), was associated with steroid resistance (OR = 4.97 95% CI 1.76-14.02, P< 0.05). In patients with C4d+ rejections the presence of glomerulitis markedly increased the association (OR = 9.17, 95% CI 1.15-73.24, P< 0.05).
Conclusions: Our results indicate a significant endothelial cell enlargement in glomerulitis. In C4d+ acute rejection glomerulitis, associated with steroid resistance, may have an important prognostic significance.
Category: Kidney (does not include tumors)
Wednesday, March 2, 2011 1:00 PM
Poster Session VI # 268, Wednesday Afternoon