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Predicting the prognosis of renal dysfunction by renal expression of alpha-smooth muscle actin in children with MPGN type 1.

BACKGROUND
To clarify whether renal alpha-smooth muscle actin (alpha-SMA)-positive cell and macrophage accumulation can predict the prognosis of renal dysfunction, we evaluated them by means of multivariate analysis and compared them with other clinical predictors in patients with membranoproliferative glomerulonephritis (MPGN) type 1 with normal renal function.


METHODS
We enrolled 35 patients with MPGN type 1 who had normal creatinine clearance at the time of renal biopsy. These patients were divided into 2 groups based on clinical status at the last examination. Group 1 consisted of 12 patients with normal urine and 12 patients with minor urinary abnormalities at the latest observation, whereas group 2 consisted of 7 patients with persistent nephropathy and 4 patients with renal insufficiency. The first and second renal biopsy findings, including alpha-SMA and CD68-positive staining, were investigated for both groups.


RESULTS
Mean scores for glomerular and interstitial alpha-SMA staining in group 2 were significantly higher than those in group 1. At the second biopsy, mean scores for interstitial CD68-positive staining in group 2 were higher than those in group 1. Mean scores for glomerular and interstitial alpha-SMA at the first biopsy correlated with the chronicity index at the second biopsy in both groups.


CONCLUSION
Our results suggest that glomerular and interstitial alpha-SMA expression at the first biopsy can predict the prognosis of children with MPGN type 1.