RELATIONSHIP BETWEEN INTERSTITIAL INFILTRATES AND STEROID RESPONSIVENESS OF PROTEINURIA IN MEMBRANOUS NEPHROPATHY

Mononuclear inflammatory cells were retrospectively analysed using mon oclonal antibodies in the interstitium and glomeruli of 16 renal biops y specimens from patients with nephrotic syndrome due to idiopathic me mbranous nephropathy (IMN). The aim of the study was to determine the composition of the infiltrate and to assess the ability to predict the response of proteinuria to corticosteroids. All patients had received prednisolone as a sole treatment. Nine patients had shown a complete or partial remission of proteinuria (group A) and seven did not respon d at all (group B). Both groups were matched for age and degree of pro teinuria; also both groups had normal renal function at the time of bi opsy. Very few intraglomerular leukocytes, mostly monocytes/macrophage s (MM) were found. The majority of interstitial cells were T lymphocyt es and MM. CD4+ve T helper/inducer cells predominated among the inters titial T cell population and B cells were a minor component. No signif icant differences were found between the two groups regarding the type s of the intraglomerular cells. However, interstitial T-cells, CD4+ve T helper/inducer cells, CD8+ve T cytotoxic/suppressor cells and MM wer e significantly higher in group A than in group B. Also HLA-DR express ing interstitial cells were much in excess in group A. In addition pat ients with complete remission of proteinuria had higher numbers of int erstitial cells compared to those with partial response. There was no correlation between the numbers of types of intraglomerular and inters titial cells and the degree of proteinuria at presentation. Also no as sociation was found between intraglomerular or interstitial cell popul ation and subsequent relapse of proteinuria. In conclusion, interstiti al but not intraglomerular mononuclear cells seem to determine the ini tial response of proteinuria to corticosteroids in patients with IMN.