Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2024; 12(1): 188-195
Published online Jan 6, 2024. doi: 10.12998/wjcc.v12.i1.188
Changes in macrophage infiltration and podocyte injury in lupus nephritis patients with repeated renal biopsy: Report of three cases
Shi-Yuan Liu, Hao Chen, Li-Jia He, Chun-Kai Huang, Pu Wang, Zhang-Ru Rui, Jue Wu, Yang Yuan, Yue Zhang, Wen-Ju Wang, Xiao-Dan Wang
Shi-Yuan Liu, Li-Jia He, Chun-Kai Huang, Pu Wang, Wen-Ju Wang, Xiao-Dan Wang, Central Laboratory, Key Laboratory of Tumor Immunological Prevention and Treatment of Yunnan Province, Yan'an Hospital Affiliated to Kunming Medical University, Kunming 650051, Yunnan Province, China
Hao Chen, Zhang-Ru Rui, Jue Wu, Yang Yuan, Yue Zhang, Department of Nephropathy, Yan'an Hospital Affiliated to Kunming Medical University, Kunming 650051, Yunnan Province, China
Co-first authors: Shi-Yuan Liu and Hao Chen.
Co-corresponding authors: Xiao-Dan Wang and Wen-Ju Wang.
Author contributions: Wang XD and Wang WJ contributed equally to this work; Liu SY and Chen H contributed equally to this work; Wang XD and Wang WJ designed the research study; Liu SY and Chen H performed the research; Liu SY, He LJ, Huang CK, and Wang P analyzed the data and wrote the manuscript; Rui ZR, Wu J, Yuan Y, and Zhang Y contributed medical records; Wang XD made critical revisions related to important intellectual content of the manuscript; all authors have read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 81960136; the Science and Technology Department of Yunnan Province, No. 202101AT070243.
Informed consent statement: All three patients provided written informed consent for renal biopsy.
Conflict-of-interest statement: All the authors have no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Dan Wang, MD, Associate Chief Physician, Central Laboratory, Key Laboratory of Tumor Immunological Prevention and Treatment of Yunnan Province, Yan'an Hospital Affiliated to Kunming Medical University, No. 245 Renmin East Road, Kunming 650051, Yunnan Province, China. wxdky001@163.com
Received: October 11, 2023
Peer-review started: October 11, 2023
First decision: November 22, 2023
Revised: December 5, 2023
Accepted: December 13, 2023
Article in press: December 13, 2023
Published online: January 6, 2024
Processing time: 83 Days and 3.7 Hours
Abstract
BACKGROUND

In this study, we retrospectively analysed macrophage infiltration and podocyte injury in three patients with diffuse proliferative lupus nephritis (LN) who underwent repeated renal biopsy.

CASE SUMMARY

Clinical data of three diffuse proliferative LN patients with different pathological characteristics (case 1 was LN IV-G (A), case 2 was LN IV-G (A) + V, and case 3 was LN IV-G (A) + thrombotic microangiopathy) were reviewed. All patients underwent repeated renal biopsies 6 mo later, and renal biopsy specimens were studied. Macrophage infiltration was assessed by CD68 expression detected by immunohistochemical staining, and an immunofluorescence assay was used to detect podocin expression to assess podocyte damage. After treatment, Case 1 changed to LN III-(A), Case 2 remained as type V LN lesions, and Case 3, which changed to LN IV-S (A), had the worst prognosis. We observed reduced macrophage infiltration after therapy. However, two of the patients with active lesions after treatment still showed macrophage infiltration in the renal interstitium. Before treatment, the three patients showed discontinuous expression of podocin. Notably, the integrity of podocin was restored after treatment in Case 1.

CONCLUSION

It may be possible to reverse podocyte damage and decrease the infiltrating macrophages in LN patients through effective treatment.

Keywords: Lupus nephritis; Macrophage; Podocyte; Repeat renal biopsy; Thrombotic microangiopathy; Case report

Core Tip: In this study, we retrospectively analysed the clinical and pathological data of three patients who underwent repeated renal biopsies after treatment for diffuse proliferative lupus nephritis (LN) with different pathological characteristics. Immunohistochemistry and immunofluorescence tests were used to assess the podocyte damage and infiltration of macrophages. Diffuse proliferative LN with different pathological features has different prognoses, and the prognosis of LN with thrombotic microangiopathy is relatively poor. Podocyte injury and macrophage infiltration may be involved in the pathogenesis of LN. It may be possible to reverse podocyte damage and decrease the infiltrating macrophages in LN patients through effective treatment.