[Immune-mediated tubulointerstitial injury in hemorrhagic fever with renal syndrome].

OBJECTIVE

To study the presence of Hantan virus RNA and specific immune-complex deposits in the renal tubular epithelium of HFRS patients.

METHODS

Renal biopsy specimens from 15 cases of HFRS, 3 cases of ischemic ATN and 5 normal controls (donor of transplantation) were investigated. Human HLA-DR, ICAM-ILFA-1 and CD4+, CD8+, CD8+ cells in the renal tissue section were quatitatively analyzed by immuno-peroxidase staining 4 layers PAP. Histo-morphometric analysis of pathological section was made for each specimen.

RESULTS

HFRS presented abundant amount of HLA-DR and ICAM-1 in tubular cells both on cortical and medullary region, while ischemic ATN tended to have such positive results only in cells of cortical region. The intensity and extent of HLA-DR and ICAM-1 LFA-1 staining were closely correlated with the degree of tubulointerstitial damage of HFRS. Interstitial CD4, CD8 and monocytes increased in amount profoundly in HFRS with a preponderance in the medullary region, and particularly of CD8 positive cells. Less marked increment occurred in ATN cases, and no discrepancies were found between cortical and medullary region or cell types. The severity of tubulointerstitial lesion was closely associated with the extent of cellular infiltration and the expression of HLA-DR, ICAM-1 in renal tubular cells.

CONCLUSION

The characteristic changes of tubulointerstitial lesions in HFRS suggest that virus infection may be one of the mediators responsible for the immune kidney injuries in HFRS.