Nephrology Dialysis Transplantation, Vol 13, Issue 1 99-105, Copyright © 1998 by Oxford University Press
A Dinda, M Mathur, S Guleria, S Saxena, S Tiwari and S Dash
Background: Prolonged dialysis is associated with
acquired cystic kidney disease (ACKD) and also higher incidence of renal
cell carcinoma. Relationship among dialysis, tubular cell proliferation,
development of cystic change and neoplastic transformation is not clearly
known. Whether dialysis causes additional stress on tubular cells is also
conjectural. Study of heat shock protein (HSP) expression which are rapidly
synthesized in cells in response to a variety of stresses may be helpful in
this regard. Methods: To evaluate dialysis induced
early changes in end stage renal disease (ESRD), kidneys from eight adult
autopsied patients were examined (group I) who were on weekly maintenance
haemodialysis for 3-12 months. The heat shock protein (HSP 72/73)
expression of tubular epithelial cells and their proliferating cell nuclear
antigen (PCNA) labelling index (LI) were studied by immunohistochemistry
using monoclonal antibodies. For comparison similar study was carried out
in 10 cases of ESRD (Group II) of similar age and sex distribution who were
not dialysed. The atrophic tubules were not dialysed. The atrophic tubules
were subtyped morphologically into (1) classic, (2) thyroid, (3) endocrine
and (4) super tubules. Results: In the dialysed group
(I) the percentage of hyperplastic super tubules (10.6±4.1%) was
significantly higher than in the non-dialysed group (II)
(5.2±1.3%) with a higher PCNA LI (6.8±2.04%) (group
II 4.9±1.9%) P <0.001 to <0.001). Though grossly
not detected, but microscopic cysts and microadenoma like areas were seen
in all the cases in group I with a mean diameter of
522.66±315.25 &mgr;m and 494.85±262.46 &mgr;m
respectively. They were seen in one case of group II, PCNA LI of the cells
in microadenoma (7.2±3.1%) and microcysts (6.6±2.6%)
were similar to that of super tubules in group I. Quantitation of HSP
expression by image analysis (optical density 2.309±0.155)
showed a positive correlation (r=0.7555) (P <0.001) with PCNA LI in
super tubules indicating a higher induction in the dialysed group.
Conclusions: This study suggests that haemodialysis
may cause injury to tubular cells and aggravate stress on an already
compromised situation of ESRD leading to increased cell proliferation and
more hyperplastic supertubule formation which may be the forerunner of cyst
formation as well as neoplastic transformation. Key
words: Dialysis; ESRD; HSP expression; PCNA labelling
ORIGINAL ARTICLES
Heat shock protein (HSP) expression and proliferation of tubular cells in end stage renal disease with and without haemodialysis
Department of Pathology, Department of Surgery and Department of Nephrology, All India Institute of Medical Sciences, New Delhi 110 029, India; Corresponding author
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