Division of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China.
Key Laboratory of Organ Transplantation, Ministry of Education, Chinese Academy of Medical Sciences, Wuhan, China.
J Nephrol. 2024 Jun;37(5):1285-1298. doi: 10.1007/s40620-024-01903-0. Epub 2024 Mar 25.
Various immune cells, including T cells, B cells, macrophages, and neutrophils contribute to the development of crescentic glomerulonephritis. Previous animal studies have suggested that lymphangiogenesis is involved in the migration of inflammatory cells and the activation of adaptive immunity. However, the extent of the association between lymphatic vessels and crescentic glomerulonephritis severity and prognosis remains unknown.
In this study, we assessed lymphatic vessel density in 71 patients with crescentic glomerulonephritis who underwent renal biopsies between June 2017 and June 2022. By immunohistochemistry and immunofluorescence, we identified increased lymphatic vessel density in the kidneys of patients with crescentic glomerulonephritis compared to controls. Lymphatic vessels were categorized as total, periglomerular, and interstitial. Spearman's rank correlation analysis showed a positive correlation between total and periglomerular lymphatic vessel density and glomerular crescent proportion. High lymphatic vessel density (total and periglomerular) correlated with declining kidney function, increased proteinuria, and severe glomerular and interstitial pathology. Interstitial lymphatic vessel density had minimal relationship with renal lesions. After a median duration of 13 months of follow-up, higher total and periglomerular lymphatic vessel density was associated with poorer prognosis. Transcriptomic analysis revealed increased immune cell activation and migration in crescentic glomerulonephritis patients compared to healthy controls. Periglomerular lymphatic vessels might play a significant role in immune cell infiltration and renal injury.
Elevated lymphatic vessel density in patients with crescentic glomerulonephritis is associated with poor prognosis and may serve as a predictive factor for adverse outcomes in these patients.
各种免疫细胞，包括 T 细胞、B 细胞、巨噬细胞和中性粒细胞，都有助于新月体肾小球肾炎的发展。以前的动物研究表明，淋巴管生成与炎症细胞的迁移和适应性免疫的激活有关。然而，淋巴管与新月体肾小球肾炎严重程度和预后之间的关联程度尚不清楚。
本研究评估了 71 例 2017 年 6 月至 2022 年 6 月期间接受肾活检的新月体肾小球肾炎患者的淋巴管密度。通过免疫组化和免疫荧光，我们发现与对照组相比，新月体肾小球肾炎患者的肾脏中淋巴管密度增加。淋巴管分为总淋巴管、肾小球周淋巴管和间质淋巴管。Spearman 秩相关分析显示，总淋巴管和肾小球周淋巴管密度与肾小球新月体比例呈正相关。高淋巴管密度（总淋巴管和肾小球周淋巴管）与肾功能下降、蛋白尿增加以及严重的肾小球和间质病理相关。间质淋巴管密度与肾脏病变的关系最小。中位随访 13 个月后，总淋巴管和肾小球周淋巴管密度较高与预后较差相关。转录组分析显示，与健康对照组相比，新月体肾小球肾炎患者的免疫细胞激活和迁移增加。肾小球周淋巴管可能在免疫细胞浸润和肾损伤中起重要作用。
新月体肾小球肾炎患者的淋巴管密度升高与预后不良相关，可能是这些患者不良结局的预测因素。
