Tubular lesions and tubular cell adhesion molecules for the prognosis of lupus nephritis

Background. To assess the prognostic value of tubular lesions and cell adhe sion molecules' expression, a retrospective study with immunohistochemistry was performed on 152 patients presenting lupus nephritis from January 1985 to December 1999. Methods. The following clinical parameters were recorded: age, sex, race, t ime of systemic lupus erythematosus (SLE) diagnosis, time of the biopsy, pr oteinuria, creatininemia, and renal function at the end of follow-up. All b iopsies were reevaluated according to a tubular grading, an inflammatory gr ading, the percentage of sclerosed glomeruli, the percentage of crescents, and the current WHO classification. Immunohistochemistry was performed with anti-CD40, anti-CD44, and anti-intercellular adhesion molecule-1 (anti-ICA M-1) antibodies. Results. Patients were 136 women (89.5%) and 16 men with a mean age of 31.2 years +/- 12.8 at the time of biopsy. The mean follow-up period was 94.3 m onths +/- 64.1. Eighty-eight biopsies (58%) showed various degrees of tubul ar atrophy. Males (P = 0.001) and tubular grading (P = 0.0001) were linked with renal survival in univariate and multivariate analysis. CD40 (P = 0.01 ) and ICAM-1 (P = 0.001) tubular expressions were linked with renal surviva l. ICAM-1 tubular expression provided additional information for the progno sis of the patients with biopsies showing tubular atrophy (P = 0.005) or no t (P = 0.05). Conclusions. Our study shows that tubular lesions are good indicator of lup us nephritis outcome. Furthermore, tubular expression of cell adhesion mole cules like ICAM-1 and CD40 also serves to predict the outcome.