MONOCLONAL-ANTIBODY ANALYSIS OF CRESCENTIC MEMBRANOUS GLOMERULONEPHROPATHY

Idiopathic membranous glomerulonephropathy (MG) has a rather benign pr ognosis. Acute renal failure with cellular crescents superimposed on M G is unusual and its pathogenesis is not fully understood. We report 3 patients with crescentic MG who showed strong glomerular and intersti tial infiltration of leukocytes (CD45), T lymphocytes (CD3), helper/in ducer T cells (CD4), cytotoxic/suppressor T cells (CD8), and monocyte- macrophages (CD14). A similar number of CD4+ and CD8+ cells contribute d to T cellularity within the glomerular tuft, whereas CD4+ cells were predominant over CD8+ cells in the crescents. Intercellular adhesion molecule-1 (ICAM-1) antigens (CD54) were found on renal vascular endot helium, interstitial cellular aggregates and proximal tubular epitheli al cells. The case reports illustrate the contribution of macrophages and T cells bearing predominantly CD4+ phenotype to cellular crescents , and the abnormal expression of ICAM-1 antigens on proximal tubular e pithelial cells. Both features suggest that cell-mediated immunity may play a role in the transformation of crescentic MG.