Abstract: SA-OR34
Glomerular Exostosin as a New Subtype and Activity Marker for Membranous Lupus Nephritis
Session Information
- Glomerular Diseases: Trials, Prognostic Markers, and Podocyte Biology
November 06, 2021 | Location: Simulive, Virtual Only
Abstract Time: 04:30 PM - 06:00 PM
Category: Glomerular Diseases
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Hu, Weixin, National Clinical Research Center for Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China
- Wang, Chengyu, National Clinical Research Center for Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China
- Liu, Yang, National Clinical Research Center for Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China
- Xu, Feng, National Clinical Research Center for Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China
- Liu, Zhihong, National Clinical Research Center for Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China
Background
Exostosin (EXT) expression has been shown to be related to membranous lupus nephritis (MLN). This study analyzed the distribution of EXT in MLN and its correlation with the activity, histological transformation and prognosis of MLN.
Methods
The renal biopsy specimens from MLN, other types of lupus nephritis (LN), other disease-related membranous nephropathy (MN), and PLA2R-related MN were included. EXT expression was detected by immunohistochemistry and was quantitatively determined by computer image analysis. The correlations between proteinuria and EXT expression, the differences between EXT-positive and EXT-negative MLN, and the relationship between pathological changes and EXT expression were analyzed by repeated renal biopsy.
Results
Of the 153 MLN, 47.7% were EXT positive; of the other types of LN, only 6.8% were EXT positive. The EXT-positive rates for Hashimoto’s thyroiditis, Sjogren and HBV related MN were 16.7%, 10.0% and 10.0%, respectively. EXT was negative in psoriasis, mercury poisoning, tumor and GVHD or the PLA2R related MN. The EXT-positive rates in groups with 24-h urinary protein of <1 g, 1.0-2.9 g, 3.0g-4.9 g and ≥5.0 g were 32.3%, 39.6%, 50.0% and 68.4%, respectively (P=0.013), and EXT expression intensity was also positively correlated with proteinuria (r=0.78, P<0.001). When the EXT-positive was compared with the EXT-negative MLN, 24h urinary protein (P<0.001) and the proportion of massive subepithelial immune deposits (P<0.001) were higher, and the serum albumin (P<0.001), and CI (P<0.05) and renal tubular atrophy score (P<0.05) were lower. There were no significant differences in renal survival between the two groups. A total of 47 MLN (18 EXT-positive and 29 EXT-negative) underwent repeat renal biopsy after treatment or recurrence. For EXT-negative MLN, EXT remained negative in repeated biopsy regardless of pathological type (class V or class V+III/IV after transformation); for EXT-positive MLN, EXT became negative or EXT expression was reduced after renal remission, and as shown in repeated biopsy after recurrence: 62.5% of MLN without histological transformation were still EXT positive, but 80% of cases whose histological class became class V with III or IV were EXT negative.
Conclusion
Our study indicated that EXT expression in MLN could be used as a marker of diagnosis and activity , and a histological subtype marker of MLN.