Implications of tubulo-interstitial epithelial and mesenchymal relation in chronic kidney disease

Introduction: Several studies have shown the prognostic value of markers detecting interstitial infiltration, epithelial-mesenchymal transition (EMT) and tubulo-interstitial damage in chronic kidney disease evolution. Aim of our investigation was to further evaluate the pathological correlation of such parameters in a population with chronic kidney disease in early stages. Materials, Methods and Results: In a population of 16 patients, with a prior diagnosis of chronic kidney disease in early stages, that underwent a biopsy procedure for clinical indication, there were evaluated the expression in kidney tissue of mesenchymal, epithelial and proliferation markers. Material remaining after routine light microscopy and immunofluorescence was stained for mesenchymal markers such as vimentin, epithelial markers such as cytokeratin and E-cadherin. Quantitative evaluation was conducted by electronic image analysis on consecutive low power fields, avoiding glomeruli, and estimated as percentage of the total area. The clinical and biochemical characteristics evaluated during the hospitalization period showed the prevalence of multiple cardiovascular risk factors such as: arterial hypertension (68%), abnormal blood lipid levels (32%), obesity (27%), diabetes (19%). The histopathological characteristics of chronic kidney dysfunction was related with higher expression of mesenchymal markers (p<0.001) and a decrease expression of epithelial markers (p=0.003). Conclusions: The interrelation of epithelial and mesenchymal tubulo-interstitial markers was demonstrated even in early stages of chronic kidney dysfunction.