The Significance Of Snail And α-SMA In Patients With IgA Nephropathy

Objective and background IgA nephropathy is all over the world, especially in Asian countries, the most common primary glomerular disease. Approximately 15%-40% of patients progress to end-stage renal disease (end stage rend diseases, ESRD), IgA nephropathy has become one of the leading cause of ESRD. At first, the researchers understood IgA nephropathy more focus on glomerular lesions, and with the development of the research, the damage of tubulointerstitium in the role of IgA nephropathy gradually be taken seriously. Glomerular disease, interstitial renal vascular lesions and damage of tubulointerstitium direct relevance in the development of IgA nephropathy, causal, and promote each other. In 2009, Oxford classification was proposed by international IgA nephropathy collaboration (International IgA Nephrology Network), including the mesangial cell hyperplasia (M), segmental glomerular sclerosis (S), endothelial cell hyperplasia (E), tubular atrophy and interstitial fibrosis (T), is thought to be able to more clearly and objectively evaluate the degree of kidney damage.This study through test the expression of a-SMA, Snail in patients with IgA nephropathy by immunohistochemistry, analysis the level of a-SMA, Snail in patients with IgA nephropathy by immunohistochemistry, analysis the correlation among the level of α-SMA, Snail and renal tubular interstitial fibrosis degree of pathological changes, clinical indicators as well as biochemical indexes. Explore the significance of α-SMA, Snail in renal tubular interstitial fibrosis with IgA nephropathy.Methods 168 cases of patients with IgA nephropathy by renal biopsy were included and devided into three groupps by Oxford classification in January 2011 to December 2013 in xinqiao hospital:the group T0, the group T1 and the group T2, whose kidney tissue paraffin embedding block were obtained and stored.18 cases normal renal tissues adjacent to cancer were selected as countrol group in the same periods. Immunohistochemistry staining method was employed to detect the expression of Snail, α-SMA. The correlation mong the level of α-SMA, Snail and renal tubular interstitial fibrosis degree of pathological changes, clinical indicators as well as biochemical indexes were analysised.Results 1.The patients with IgA nephropathy in 168 patients were divided into three groups:the group TO had 106 cases,52 cases were male, 53 cases were femal, the mean age was (31±16) years; the group T1 had 50 cases,27 cases were male,23 cases were femal the mean age was (39±15) years; the group T0 12 cases,7 cases were male,5 cases were femal the mean age was (43±26) years. There were no statistical difference among gender, age, body mass index (BMI), total cholesterol, serum total protein and serum albumin in three groups (P>0.05). The course of the group T2 were significantly longer than the group T1 and TO (P<0.05). The level of serum creatinine, urea nitrogen, triglyceride and 24 hours urinary protein quantitative in the group T2 were significantly higher than the group T1 and TO (P<0.05).2.Expression of a-SMA by immunohistochemistry staining: immunohistochemical staining of a-SMA were deep with tan to brown in renal tubular interstitial of the group T2 and T1, whose positive expression rate were 83.3%,64.0%, respectively, and both expression level had statistically difference (P< 0.05). However, the positive expression rate of a-SMA in the group TO and countrol grop were just 17.0%,11.1%, respectively,whose immunohistochemical staining were shallow with pale yellow, and both expression level had no statistically difference(P>0.05). There were no expression and dyeing in negative control.3.Expression of Snail by immunohistochemistry staining: immunohistochemical staining of Snail were deep with tan to brown in renal tubular interstitial of the group T2 and T1, whose positive expression rate were 91.8.3%,60.0%, respectively, and both expression level had statistically difference (P< 0.05). However, the positive expression rate of Snail in the group TO and countrol grop were just 20.0%,16.6%, respectively, whose immunohistochemical staining were shallow with pale yellow, and both expression level had no statistically difference(P>0.05). There were no expression and dyeing in negative control.4.The correlation between the expression of a-SMA, Snail and clinical pathological parameters in patients with IgA nephropathy:there were no statistical significance between the high expression with the lower expression of a-SMA, Snail and different gender and different age groups in IgA nephropathy (P> 0.05). The expression of a-SMA, Snail correlated with renal function and 24-hour urinary protein quantity (P<0.001), the expression of a-SMA, Snail increased in the group of renal failure and massive proteinuria. There were no statistical significance between the high expression with the lower expression of a-SMA, Snail and in different mesangial cell hyperplasia (M), segmental glomerular sclerosis (S), and endothelial cell hyperplasia (E) (P> 0.05). However, the expression of a-SMA, Snail associated with the degree of interstitial fibrosis (T) (all P< 0.001), the expression level of the group T2 and T1 increased significantly compared with TO group. Conclusion The study through the observation of the expression of Snail, a-SMA in kieney tissue with IgA nephropathy showde that the expression of a-SMA, Snail in renal tubular interstitial lesions stage Tl and T2 is significantly higher than TO period and the control group, which released that the expression of a-SMA, Snail may participate in the renal tubular atrophy/the pathogenesis of interstitial fibrosis; the expression level of a-SMA, Snail correlated with patients’ renal function,24 hours urinary protein quantitative and renal tubular atrophy/quantitative degree of interstitial fibrosis, which suggests that the expression of a-SMA,Snail may be involved in the pathogenesis of IgA nephropathy process. Therefore, inhibition of the a-SMA, Snail may become a feasible treatment strategy of IgA nephropathy.