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Is CD44 in glomerular parietal epithelial cells a pathological marker of renal function deterioration in primary focal segmental glomerulosclerosis?

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Abstract

Background

The search for risk factors for chronic kidney disease in children with focal segmental glomerulosclerosis (FSGS) is important in defining prognosis and individualized treatment. This study preliminarily investigated whether CD44 immunostaining in glomerular parietal epithelial cells (PECs) is a prognostic marker in pediatric FSGS.

Methods

In this retrospective study, 26 patients with FSGS, biopsied from 1985 to 2010, were evaluated. Immunohistochemistry for CD44 was performed in all cases. For analysis purposes, patients were grouped according to whether or not they were positive for CD44 in PECs. The primary outcome was a decline in baseline estimated glomerular filtration rate (eGFR) of 50% or more.

Results

Median follow-up was 6.9 years. Median renal survival was 14.5 years and probability of a 50% decline of eGRF was 30% in 10 years. Nine children exhibited the primary outcome and 7 developed end-stage renal disease (ESRD). In comparison with PEC CD44-negative patients (n = 18), PEC CD44-positive patients (n = 8) presented lower baseline eGFR (99 ± 41 versus 141 ± 44 ml/min/1.73 m2, p = 0.035) and a significant decline in eGFR (−38.6 ± 39.5 versus −5.6 ± 25.3 ml/min/1.73 m2/year, p = 0.018). No difference was observed in FSGS subtypes or other glomerular features. Presence of CD44 staining in PECs was significantly associated with the decline in baseline eGFR of 50% or more. Renal survival was significantly reduced in PEC CD44-positive patients (3.8 vs 14.6 years in C4d-negative, p < 0.05).

Conclusion

Our preliminary findings indicate, for the first time, that positivity for CD44 in PECs seems to be a pathological marker of renal function deterioration in pediatric patients with FSGS.

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Acknowledgements

The authors dedicate this work to the deceased Professor José Silvério Santos Diniz, founder of the Pediatric Nephrology Unit, Clinics Hospital, Federal University of Minas Gerais, Brazil. The authors thank Dr Luiz Sérgio Bahia Cardoso and all other colleagues who processed medical records, managed patients, performed renal biopsies, and assisted with follow-up.

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Authors and Affiliations

  1. Department of Pediatrics, Pediatric Nephrourology Unit, Faculty of Medicine, Federal University of Minas Gerais, Avenida Alfredo Balena 190/sala 331, Belo Horizonte, Minas Gerais, 30130-100, Brazil

    Brunna Pinto Froes, Eduardo Araújo Oliveira, Ana Cristina Simões e Silva & Sérgio Veloso Brant Pinheiro

  2. Division of Renal Pathology, Clinics Hospital, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

    Stanley de Almeida Araújo & Eduardo Alves Bambirra

  3. Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

    Ana Cristina Simões e Silva

Authors
  1. Brunna Pinto Froes
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  2. Stanley de Almeida Araújo
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  3. Eduardo Alves Bambirra
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  4. Eduardo Araújo Oliveira
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  5. Ana Cristina Simões e Silva
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  6. Sérgio Veloso Brant Pinheiro
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Corresponding author

Correspondence to Sérgio Veloso Brant Pinheiro.

Ethics declarations

The ethics committee of our institution approved the study under the protocol CAAE03203413.0.0000.5149.

Financial support

FAPEMIG (Fundação de Amparo à Pesquisa do Estado de Minas Gerais, Brazil), CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil), and CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior).

Conflicts of interest

The authors have no conflicts to declare.

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Froes, B.P., de Almeida Araújo, S., Bambirra, E.A. et al. Is CD44 in glomerular parietal epithelial cells a pathological marker of renal function deterioration in primary focal segmental glomerulosclerosis?. Pediatr Nephrol 32, 2165–2169 (2017). https://doi.org/10.1007/s00467-017-3775-4

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  • DOI: https://doi.org/10.1007/s00467-017-3775-4

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