Expression de CMIP au cours du syndrome néphrotique idiopathique

Abstract : Idiopathic nephrotic syndrom (INS) pools two entities: minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS). MCD and FSGS are podocyte diseases. Podocyte foot process effacement is the first step of INS (MCD), the second one is the podocytes loss (FSGS). Our goal is to show if glomerular c-mip expression is a specific and prognostic biomarker of INS. Indeed, this protein plays a key role in the podocyte architecture and in apoptosis mechanisms. We included all the kidney biopsies, of Aquitaine centralized by two pathology laboratories of Bordeaux, with the final diagnosis was primitive MCD or FSGS. These biopsies were taken from January 2007 to December 2014 and were all native kidney biopsies. Biopsies of diabetic nephropathy (DiabN), IgA nephropathy (IgAN) or preimplantation tissue (preimp, before kidney allograft) were also included for comparison. We tested glomerular (podocytes) and tubular c-mip expression by immunohistochemistry. We tested 148 kidney biopsies (86 MCD, 39 FSGS, 10 diabN, 10 IgAN, 3 preimp). Interpretation of glomerular c-mip staining was performed for 120 biopsies: 68.3 % were positive. All the diabN and IgAN had a positive glomerular c-mip staining. The renal function estimated by MDRD at the time of biopsy (M0) is lower for glomerular positive c-mip patients than for negative c-mip patients (84.3 mL/min/1.73m2 vs 60.5, p = 0.0024). This difference was not significative at M12 (78.5 mL/min/1.73m2 vs 64.2, p = 0.10). The MDRD slope during the first year after the biopsy was better for glomerular positive c-mip patients (MDRD slope > 40 %: 33.3 % vs 8.7 %, p = 0.041). C-mip positive patients had more vascular chronic lesions in their biopsies than negative c-mip patients (p = 0.034). Glomerular c-mip staining was nonspecific of INS. But c-mip expression may allow us to distinguish MCD or HSF patients with a better renal course at M12.
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Master Thesis
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Agathe Vermorel. Expression de CMIP au cours du syndrome néphrotique idiopathique. Médecine humaine et pathologie. 2018. ⟨dumas-02075891⟩

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