Is CD44 in glomerular parietal epithelial cells a pathological marker of renal function deterioration in primary focal segmental glomerulosclerosis?

• Published in: Pediatric nephrology (Berlin, West) West), 2017-11, Vol.32 (11), p.2165-2169
• Main Authors: Froes, Brunna Pinto, de Almeida Araújo, Stanley, Bambirra, Eduardo Alves, Oliveira, Eduardo Araújo, Simões e Silva, Ana Cristina, Pinheiro, Sérgio Veloso Brant
• Format: Article
• Language: English
• Subjects: Adolescent; Biomarkers - metabolism; Brief Report; Care and treatment; CD44 antigen; Child; Child, Preschool; Children; Diagnosis; Disease Progression; End-stage renal disease; Epidermal growth factor receptors; Epithelial cells; Epithelial Cells - metabolism; Female; Glomerular Filtration Rate; Glomerulosclerosis, Focal Segmental - complications; Glomerulosclerosis, Focal Segmental - metabolism; Glomerulosclerosis, Focal Segmental - pathology; Humans; Hyaluronan Receptors - metabolism; Immunohistochemistry; Kidney diseases; Kidney Failure, Chronic - etiology; Kidney Glomerulus - metabolism; Kidney Glomerulus - pathology; Kidney transplantation; Male; Medical prognosis; Medicine; Medicine & Public Health; Nephrology; Pediatric diseases; Pediatrics; Renal function; Retrospective Studies; Risk factors; Survival; Survival Analysis; Urology
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/s00467-017-3775-4

Background The search for risk factors for chronic kidney disease in children with focal segmental glomerulosclerosis (FSGS) is important in defining prognosis and individualized treatment. This study preliminarily investigated whether CD44 immunostaining in glomerular parietal epithelial cells (PECs) is a prognostic marker in pediatric FSGS. Methods In this retrospective study, 26 patients with FSGS, biopsied from 1985 to 2010, were evaluated. Immunohistochemistry for CD44 was performed in all cases. For analysis purposes, patients were grouped according to whether or not they were positive for CD44 in PECs. The primary outcome was a decline in baseline estimated glomerular filtration rate (eGFR) of 50% or more. Results Median follow-up was 6.9 years. Median renal survival was 14.5 years and probability of a 50% decline of eGRF was 30% in 10 years. Nine children exhibited the primary outcome and 7 developed end-stage renal disease (ESRD). In comparison with PEC CD44-negative patients ( n  = 18), PEC CD44-positive patients ( n  = 8) presented lower baseline eGFR (99 ± 41 versus 141 ± 44 ml/min/1.73 m 2 , p  = 0.035) and a significant decline in eGFR (−38.6 ± 39.5 versus −5.6 ± 25.3 ml/min/1.73 m 2 /year, p  = 0.018). No difference was observed in FSGS subtypes or other glomerular features. Presence of CD44 staining in PECs was significantly associated with the decline in baseline eGFR of 50% or more. Renal survival was significantly reduced in PEC CD44-positive patients (3.8 vs 14.6 years in C4d-negative, p