DETECTION OF MATURE MACROPHAGES IN URINARY SEDIMENTS - CLINICAL-SIGNIFICANCE IN PREDICTING PROGRESSIVE RENAL-DISEASE

The ability to predict the rate of progression of renal parenchymal di sease may help in its clinical management. We undertook characterizati on of urinary macrophages obtained from patients with various renal di seases paying special attention to the differentiation from nonprogres sive to progressive renal diseases. A total of 84 patients were divide d into one of three categories. A highly progressive group included pa tients with rapidly progressive glomerulonephritis, diabetic nephropat hy, membranoproliferative glomerulonephropathy, primary focal segmenta l sclerosis and diffuse proliferative lupus nephropathy, moderately pr ogressive group included those with IgA nephropathy and Alport's syndr ome and non-progressive group included patients with thin basement mem brane nephropathy, minimal change nephrotic syndrome, idiopathic renal hematuria and urolithiasis. Urinary sediments were reacted with four monoclonal antibodies (CD68/macrophages vimentin, cytokeratin, and 25F 9/mature macrophages). In normal individuals mature macrophages (25F9( +) cells) were absent in urinary sediments. The number of 25F9(+) cell s in the urine was highest in the highly progressive group, less promi nent in the moderately progressive group, and virtually absent in the non-progressive group. The 25F9(+) cells reacted with anti-CD68 and an tivimentin antibody, whereas the 25F9(+) cells did not react with anti -cytokeratin antibody. These findings indicate that the defection of m ature macrophages in urine is useful to estimate the prognosis of rena l parenchymal diseases and may help to differentiate some glomerular d iseases (e.g. thin basement membrane disease vs. Alport's syndrome, an d minimal change nephrotic syndrome vs. primacy focal segmental sclero sis).