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Tubular and interstitial factors in the progression of glomerulonephritis

  • Nephrology Review
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Abstract

All recent studies of the outcome of different forms of progressive glomerulonephritis concur that a major factor, apparently determining outcome, is the presence and severity of tubulointerstitial changes, and not the degree of glomerular alteration. Moreover, at the time of biopsy, tubulointerstitial changes correlate much better with the glomerular filtration rate. These at first surprising findings are not only useful clinically, but should make us think about our models of how progression takes place in so-called glomerular nephritides. In fact, a major tubulointerstitial infiltrate of immune-competent cells is present in all forms of progressive glomerulonephritis, and again correlates with outcome. In addition, it is now clear the tubular epithelium is capable of synthesising and secreting a number of factors important in fibrogenesis, and of displaying major histocompatibility complex class II antigens and leucocyte-adhesion molecules. Tubular cells could thus present peptides to T helper cells and amplify, or maybe even initiate, immune reactions. Finally, fibrogenesis within the kidney is at last being studied, long after studies have been performed on liver and lung. In the past, too much attention has been paid to reversible inflammation and not enough to irreversible cirrhosis of the kidney.

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Abbreviations

Ig:

immunoglobulin, e. g. IgA, IgG, IgM etc.

TBM:

tubular basement membrane

GBM:

glomerular basement membrane

WHO:

World Health Organization

MHC:

major histocompatibility complex

CD:

cluster determinant

NK:

natural killer

IL-1:

interleukin-1

IL-2:

interleukin-2

TNF-α:

tumour necrosis factor alpha

ADCC:

antibody-dependent complement mediated cytolysis

ACE:

angiotensin-converting enzyme

mΦ:

macrophage

ICAM-1:

intercellular adhesion molecule-1

ELAM-1:

endothelial leucocyte adhesion molecule-1

VCAM-1:

vascular cell adhesion molecule-1

LFA:

leucocyte function associated molecule, e. g. LFA-1, LFA-3

C:

complement e. g. C3=third component of complement, etc.

TGF-β:

transforming growth factor beta

TGF-α:

transforming growth factor alpha

PDGF:

platelet derived growth factor

PAS:

periodic acid Schiff

TCR:

T cell receptor

PTEC:

proximal tubular epithelial cell

GM-CSF:

granulocyte colony stimulating factor

M-CSF:

monocyte colony stimulating factor

FGF:

fibroblast growth factor

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  1. Renal Unit, Clinical Science Laboratories, Guy's Hospital, 17th Floor Guy's Tower, SE1 9RT, London, UK

    J. Stewart Cameron

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Cameron, J.S. Tubular and interstitial factors in the progression of glomerulonephritis. Pediatr Nephrol 6, 292–303 (1992). https://doi.org/10.1007/BF00878382

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