Value of immunohistochemical expression of podocalyxin in active lupus nephritis

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(b) An electron micrograph for the same case showing marked diffuse fusion of podocyte foot processes (arrows) and subendothelial electron dense deposits (asterisks) (negative magnification ×22,000)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Maha Abdelmoneim Behairy, Marwa Mosaad Shakweer, Tamer Wahid El Said, Nermin Hassan ElGharbawy" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Maha Abdelmoneim" "apellidos" => "Behairy" ] 1 => array:2 [ "nombre" => "Marwa Mosaad" "apellidos" => "Shakweer" ] 2 => array:2 [ "nombre" => "Tamer Wahid" "apellidos" => "El Said" ] 3 => array:2 [ "nombre" => "Nermin Hassan" "apellidos" => "ElGharbawy" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2013251418300221" "doi" => "10.1016/j.nefroe.2018.01.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" 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Among the nephrogenic autoantibodies are anti-dsDNA, anti-nucleosomes, and autoantibodies to laminin and collagen IV, which induce renal lesions by the in situ formation of immune complexes that cause complement activation.<a class="elsevierStyleCrossRef" href="#bib0155">2</a> Renal injury patterns in SLE including mesangial, endothelial, epithelial (podocytes), tubulointerstitial and vascular involvement, were associated with different pathogeneses, clinical presentations and outcomes. Although the 2004 International Society of Nephrology and Renal Pathology Society (ISN/RPS) LN classification has been widely used internationally,<a class="elsevierStyleCrossRef" href="#bib0160">3</a> there still exist some intriguing controversies, such as podocyte damage in different LN classes. Podocytes are highly differentiated glomerular epithelial cells that line the outside of the glomerular capillary with foot processes linked to the glomerular basement membrane with their actin cytoskeleton. The foot processes form a characteristic inter-digitating pattern leaving filtration slits in-between. Integrity of this filtration barrier is important in order to prevent the loss of protein into the urine.<a class="elsevierStyleCrossRef" href="#bib0165">4</a> There are different mechanisms of Podocyte injury In SLE including antibody-mediated, cell-mediated, and immune mediated podocyte injury.<a class="elsevierStyleCrossRef" href="#bib0170">5</a> Many studies focused about lupus podocytopathy in mesangial LN, which indicated that the overt proteinuria occurring in LN might involve pathways related to podocyte injury other than classical immune complex deposition.<a class="elsevierStyleCrossRefs" href="#bib0175">6,7</a> Furthermore, The podocyte effacement was obvious in most LN patients and the degree of foot process fusion varied within the different pathological classes of LN,<a class="elsevierStyleCrossRef" href="#bib0185">8</a> that may indicates that renal podocyte damage might also contribute to the pathogenesis, activity and progression of other types of LN, which may needs further studies. Podocyte injury is difficult to be evaluated by routine hematoxylin and eosin (H&E) method, that's why many studies assessed podocyte injury by the degree of podocyte loss in urine, and renal biopsy specimens by use of immunohistochemistry. Markers used to detect podocytes in renal tissue include CD10, podocalyxin, synaptopodin, glomerular epithelial protein 1, podocin, CD2AP, nephrin, and Wilms tumor antigen I (WT1).<a class="elsevierStyleCrossRefs" href="#bib0190">9,10</a> Podocyte effacement by the electron microscopy is due to rearrangement of the podocyte actin cytoskeleton leads to a change in podocyte shape and consequently function.<a class="elsevierStyleCrossRef" href="#bib0180">7</a>The main podocyte surface antigen podocalyxin is a highly electronegative sialoglycoprotein normally located at the apical part of podocyte foot processes prevents the podocyte from collapsing because of its high negative charge and absence of this protein was reported to have detrimental effect on glomerular filtration function.<a class="elsevierStyleCrossRefs" href="#bib0200">11,12</a>D’Agati described activity and chronicity indices as a histologic grading system of LN,<a class="elsevierStyleCrossRef" href="#bib0210">13</a> but didn’t include the degree of podocyte injury or effacement although podocytes loss seems to be a new marker for glomerular disease activity or adverse prognosis.We aimed to detect an association between glomerular immunohistochemical (IHC) expression of podocalyxin and the degree of podocyte effacement detected by electron microscopy and to evaluate the role of IHC expression of podocalyxin as a marker for pathological and clinical activity in lupus nephritis.Material and methodsThis is a cross sectional study was conducted on 32 randomly selected patients with renal biopsies of active LN recruited from Ain shams specialized hospital, Cairo, Egypt. Clinical and laboratory data were collected included: age, gender, blood pressure, serum creatinine, degree of proteinuria (nephrotic range proteinuria ≥3.5g/d, sub nephrotic range <3.5g/d and normal up to 150mg/d) by 24h urinary protein, urine analysis, serological tests for antinuclear antibodies (ANA), anti-double strand DNA antibodies (anti-dsDNA), C3 and C4. Systemic Lupus Activity Measure revised (SLAM-R) was measured for assessment the clinical disease activity of SLE (0–3=mild, 4–7=moderate, >7=severe).<a class="elsevierStyleCrossRef" href="#bib0215">14</a> Light and electron microscopic evaluation for renal biopsy specimens were performed. The majority of cases were the first time biopsied for diagnosis and classification. Two cores of renal biopsies were received for each patient. Inclusion criteria: renal biopsy specimens with minimum of 10 glomeruli according to Weening et al.<a class="elsevierStyleCrossRef" href="#bib0160">3</a> Class I, II and VI are excluded as our study is concerned with active lupus nephritis.Light microscopyThe specimens were fixed in 10% neutral formalin, routinely processed and embedded in paraffin blocks, from which 3 micrometer (μm) thick serial sections were cut and stained with H&E, PAS “periodic acid Schiff” and Masson's trichrome. Sections examined were evaluated according to the ISN/RPS classification.<a class="elsevierStyleCrossRef" href="#bib0160">3</a> Activity and chronicity indices were evaluated according to NIH scoring system.<a class="elsevierStyleCrossRefs" href="#bib0220">15,16</a>Electron microscopySpecimens were fixed in formaldehyde glutaraldehyde mixture pH 7.4 in cacodylate buffer, then embedded in Spurr's resin. Semithin sections, one micron thick were obtained by ultramicrotome using glass and/or diamond knife and stained with 1% toluidine blue and examined by light microscopy. Ultrathin sections (60–80nm thick), were cut from selected blocks then double stained with uranyl acetate and lead citrate. Examination was done by Philips-400 T transmission electron microscope at 80kV. The prints were examined for detection of changes in the mesangium, electron dense deposits (mesangial, subendothelial, intramembranous and subepithelial), epithelial cell changes (podocyte effacement) The electron dense deposits were graded as 1–3+ (minimum, moderate and massive) in accordance with their number and extension. Grade 1 was defined as one or two very small deposits, grade 2 as several small and large non-fused deposits and grade 3 as abundant amount of fused deposits. Most of them occupied a large part of the entire circumference of a capillary loop or most of the mesangial matrix.<a class="elsevierStyleCrossRef" href="#bib0230">17</a> The amount of podocyte effacement (defined as the percentage of total glomerular capillary surface area over which the podocyte foot processes were effaced) was graded as 1+ with involvement of <25%, 2+ with involvement of 25–50%, and 3+ with involvement of >50% of glomerular capillary surface area.<a class="elsevierStyleCrossRef" href="#bib0235">18</a>Immunofluorescence studyDirect immunofluorescence staining for IgA, IgG, IgM and C3 was done on frozen sections. The intensity of staining was graded as mild, moderated, and severe (1–3+).Immunohistochemical studyPodocalyxin like antibody was used as podocyte/Apical marker. The primary antibody was rabbit polyclonal antibody, podocalyxin (NBP1-83348), concentrate antibody (commercial house: Novus Biologicals), Country of origin: USA. Podocalyxin immunohistochemical expression in renal glomeruli of normal kidney tissue, acquired from a case of renal cell carcinoma, was used as positive control for podocalyxin. Evaluation of immunohistochemically expression was done using modified method of Wang et al.<a class="elsevierStyleCrossRef" href="#bib0240">19</a>A semi-quantitative score was graded from 0 to 4+ according to the percentage of total number of glomeruli involved in the renal biopsy specimen. The grade score was set as 0=0% when all glomeruli are negative for podoclyxin immunohistochemical expression, 1+=1–25% of glomeruli demonstrate mild to moderate segmental immunostaining, 2+=26–50% of glomeruli demonstrate moderate segmental and/or global immunostaining, 3+=51–75% of glomeruli demonstrate moderate to marked segmental and/or global immunostaining and 4+=76–100% of glomeruli demonstrate moderate to marked segmental and/or global immunostaining.<a class="elsevierStyleCrossRef" href="#bib0240">19</a>Statistical analysisStatistical analysis was performed using SPSS version 20.0 for windows (IBM, USA). Categorical variables were presented as counts and percentages. Continuous variables were presented as mean±standard deviation or median (range) as indicated. Chi-square test for association and Spearman's correlation test were used as indicated. A two-sided P<0.05 was considered statistically significant.ResultsThis study included thirty Two randomly selected patients with a clinical diagnosis of LN indicated for biopsy to determine the activity and chronicity indices of lupus nephritis, 6 (18.8%) of them were males and 26 (81.2%) were females, with The mean of age at presentation was (25.41±10.13) years. Basic demographics for the study population are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The most frequent class of LN in this study was found to be class IV (68.8%) with 22 cases, followed by class III (18.8%) with 6 cases. The least frequent class was class V (12.5%), consisting of 4 cases. Semiquantitative score of IHC podocalyxin was 0 in 4 (12.5%), +1 in 8 (25%), +2 in 7 (21.9%), +3 in 8 (25%) and +4 in 5 (15.6%) of the total cases. The degree of glomerular immunohistochemical expression of podocalyxin in different classes of LN was shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> as number of cases with 0 expression of podocalyxin (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a) was more in class V LN cases and number of cases with +4 IHC podocalyxin expression (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>a) was more in class III LN cases. Focal segmental immunostaining for podocalyxin 2+ was shown in (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>a). There was significant negative association between IHC podocalyxin score and LN class (r=−0.701, P=0.000). L/M activity and chronicity parameters were shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. In our study; there was significant negative correlation between IHC podocalyxin score and activity parameters as leukocyte infiltration (r=−0.489, P=0.005) endocapillary proliferation (r=−0.473, P=0.006), fibrinoid necrosis (r=−0.351, P=0.049) and cellular crescent (r=−0.444, P=0.011) (P<0.05) but non-significant correlation with presence of wire loop or mononuclear cell infiltration (P>0.05).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>There was non-significant correlation between IHC podocalyxin score and L/M chronicity parameters of LN as glomerular sclerosis, presence of fibro cellular crescents, tubular atrophy and interstitial fibrosis (P>0.05). Finally there was a statistically significant negative correlation between IHC expression of podocalyxin and disease activity index in LN cases (rs=−0.609, P<0.0005) (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). However, there was no statistical significant correlation with chronicity index (rs=−0.200, P=0.273) by Spearman's correlation test (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>). E/M podocyte effacement and immune deposits results were shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>. There was a Highly Significant negative correlation between IHC podocalyxin and podocyte effacement by EM (rs=−0.903, P=0.000) by Spearman's rho correlation test (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1–3</a>b). Significant negative correlation between IHC podocalyxin score and E/M subepithelial immune deposits (r=−0.538, P=0.001) and intramembranous immune deposits (r=−0.541, P=0.001), no significant correlation with presence of mesangial or subendothelial immune deposits (P>0.05).<elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia>There was a statistically significant association between score for immune-histochemical expression of podocalyxin and degree of proteinuria as a clinical marker for lupus activity (χ2=17.611, P=0.024) by chi square test, with a strength of association as observed by Cramer's V=0.525, P=0.024 (P<0.05). No significant correlation between podocalyxin expression and serum creatinine (P>0.05). Significant statistical negative correlation between SLAM-R score of clinical disease activity and IHC podocalyxin score (rs=−0.709, P<0.000) by Spearman's correlation test.Significant association between IHC podocalyxin and positive serum ANA (χ2=9.759, P=0.045) but no significant association with positive dsDNA, C3 or C4 (P>0.05) as laboratory markers of SLE by chi square test. There was negative significant correlation between IHC podocalyxin expression score and diastolic BP (r=−0.432, P=0.014), and non-significant with systolic BP (r=−0.342, P=0.055), age or gender (P>0.05).DiscussionIn this study, there was a significant negative association between IHC podocalyxin score and LN class. We observed that all cases of class III LN showed high immunoexpression for podocalyxin (3+ and 4+) denoting minimal podocyte loss in this class, while in class IV, 15 cases showed negative to low expression (0–2+) indicating severe podocyte loss. This could be attributed to the percentage of glomeruli affected, as glomerular lesions including podocyte detachment in focal proliferative LN (class III) affect less than 50% while in diffuse proliferative LN (class IV); more than 50% of glomeruli are affected.Podocytes might also provide some potential antigen targets for circulating antibodies that directly injured the podocytes or formed immune complex deposits and subsequent complement activation, especially the formation of the membrane attack complex (MAC), might inflict cytotoxic injury on the podocytes in lupus membranous nephropathy (class V),<a class="elsevierStyleCrossRef" href="#bib0245">20</a> which showed zero to low expression of IHC podocalyxin score in this study.We reported in this study a significant negative correlation between IHC podocalyxin score and activity parameters as leukocyte infiltration, endocapillary proliferation, fibrinoid necrosis, cellular crescents and total NIH activity index score.Endocapillary hypercellularity with or without leukocyte infiltration and with substantial luminal reduction is an active glomerular lesion specified by the 2004 ISN/RPS lupus nephritis classification.<a class="elsevierStyleCrossRef" href="#bib0250">21</a> The significant association of podocyte loss detected by IHC podocalyxin score with endocapillary proliferation in active proliferative LN classes, could be explained by the immune-complex deposition in the capillary wall aggravating inflammation response with consequent podocyte injury.<a class="elsevierStyleCrossRef" href="#bib0170">5</a> Cell mediated immunity might play also an important role in podocyte lesions and also several autoantibodies were found to directly cross-react with podocyte proteins, like a-actinin-4, and lead to the podocyte cytoskeleton reorganization that presented with podocyte fusion morphologically in proliferative LN.<a class="elsevierStyleCrossRef" href="#bib0255">22</a>The significant association of IHC podocalyxin score with leukocyte infiltration could be attributed to the role of infiltrating leukocytes in inducing apoptosis of podocytes followed by podocyte loss.<a class="elsevierStyleCrossRef" href="#bib0260">23</a> The presence of cellular crescents association with low IHC podocalyxin score may indicate that podocyte loss may be inducible factor in crescent formation in active LN. In Le Hir et al.<a class="elsevierStyleCrossRef" href="#bib0245">20</a> study; they observed that podocytes detached from the glomerular basement membrane (GBM) migrate and infiltrate the parietal basement membrane initiating proliferation of parietal epithelial cells, resulting in a crescent. Using genetic tags in mouse models, it has been reported that up to 50% of the cells within crescents may originate from podocytes.<a class="elsevierStyleCrossRefs" href="#bib0265">24,25</a> Bariety and colleagues reported also the presence of podocytes in crescents identified by immunostaining for podocyte antigens in human glomerulonephritis including type IV lupus glomerulonephritis.<a class="elsevierStyleCrossRef" href="#bib0275">26</a> Thorner and colleagues<a class="elsevierStyleCrossRef" href="#bib0265">24</a> identified Nestin-positive cells, as podocyte marker, in glomerular crescents in human renal biopsies in a variety of renal pathologies including LN classes III and IV. Although the presence of podocytes in crescents remains unclear, the significant negative association of IHC podocalyxin score and cellular crescent observed in this study may indicates that podocyte injury is an important parameter of severity and activity in lupus nephritis.Other study concluded that counting and scoring shed Bowman's space podocytes showed a statistically significant association to the pattern of proliferation, necrosis and cellular crescents as parameters of activity index but not of chronicity index.<a class="elsevierStyleCrossRef" href="#bib0280">27</a> Although podocyte loss leading to initiation of inflammatory response with protein mediated cytotoxicity causes endothelial damage ends into sclerosis and fibrosis of the glomerulus and even end stage renal disease; we did not observed statistically significant correlation between IHC podocalyxin score and chronicity index.In the present study, there was a highly significant negative correlation between IHC podocalyxin score and the degree of podocyte effacement by EM. We suggest that decreased immunohistochemical expression of podocalyxin is due to podocyte morphogenesis and the maintenance of structural integrity through the negative charge leads to ultrastructural changes of foot processes, which disturb their function, eventually leading to fusion of foot processes. As Wang et al. study<a class="elsevierStyleCrossRef" href="#bib0185">8</a> reported that degree of podocyte effacement in proliferative LN assessed by foot process width by electron microscopy was positively correlated with the level of proteinuria and renal pathological indices, including cellular crescents, interstitial inflammatory and total chronicity index, and effacement of podocyte may be considered an important pathological parameter in active lupus nephritis.We also found a statistically significant correlation between negative podocalyxin immunoexpression and electron dense deposits by electron microscopy indicating that podocyte loss is related to amount of immune complex deposition. We assume that mesangial and subendothelial immune complexes may induce podocyte injury indirectly through complement activation and release of inflammatory mediators aggravating the inflammatory response with consequent apoptosis could result in podocyte loss.In the current study, IHC podocalyxin score was significantly associated with degree of proteinuria. Proteinuria is considered a very important clinical biomarker in the assessment of renal injury and LN activity, also considered as prognostic factor for renal outcomes in lupus nephritis, high proteinuria is associated with multi-systemic vascular damage leading to worsening GFR.<a class="elsevierStyleCrossRef" href="#bib0285">28</a> We observed a significant negative correlation between the IHC podocalyxin score with SLE disease activity (SLAM-R) score as degree of effacement of podocytes may be considered a measurement not only for activity and severity of lupus nephritis but for global SLE activity, that's may need further studies.As hypertension is an important factor influencing the prognosis of patients with LN.<a class="elsevierStyleCrossRef" href="#bib0290">29</a> we reported a significant negative correlation between IHC podocalyxin score and diastolic blood pressure but not systolic BP, as podocyte injury with hypertension may be explained by mechanical stress and oxidative stress that are key mediators of podocyte damage in hypertension. We observed also the association between IHC podocalyxin and presence of ANA. Interventional studies with drug therapy that preserve expression of podocalyxin as target therapy in active lupus nephritis may be needed.ConclusionsImmunohistochemical expression of podocalyxin significantly correlated to degree of podocyte effacement by EM and may be a novel marker for assessment of disease activity and severity of lupus nephritis.Conflict of interestThe authors declare no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres985602" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:1 [ "identificador" => "abst0005" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec953250" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres985601" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:1 [ "identificador" => "abst0025" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec953249" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Light microscopy" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Electron microscopy" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Immunofluorescence study" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Immunohistochemical study" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-09-13" "fechaAceptado" => "2017-06-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec953250" "palabras" => array:4 [ 0 => "Lupus nephritis" 1 => "Proteinuria" 2 => "Podocyte effacement" 3 => "Podocalyxin" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec953249" "palabras" => array:4 [ 0 => "Nefritis lúpica" 1 => "Proteinuria" 2 => "Borramiento podocitario" 3 => "Podocalixina" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Podocalyxin is an electronegative sialoglycoprotein that prevents the podocyte foot process from collapsing. The aim of this study was to detect an association between the glomerular immunohistochemical (IHC) expression of podocalyxin and the degree of podocyte effacement detected by electron microscopy, and to evaluate the role of podocalyxin IHC expression as a novel marker for disease activity in lupus nephritis (LN). MethodsThirty-two renal biopsies of active lupus nephritis patients were studied. Clinical assessment by the systemic lupus activity measure (SLAM-R) score and laboratory data were included [serum creatinine, 24-h urinary protein, antinuclear antibodies (ANA), anti-double-strand DNA antibodies (anti-dsDNA), C3 and C4]. Light (L/M) and electron microscopic (E/M) examination was conducted. Podocyte loss was evaluated by immunohistochemistry with monoclonal anti-podocalyxin antibodies by means of a semiquantitative score that was graded from 0 to 4+ according to the percentage of glomerular involvement. Results22 cases (68.8%) with LN class IV, 6 (18.8%) with class III and 4 (12.5%) with class V. The mean age was (25.41±10.13) years. There was a significant negative correlation between IHC podocalyxin score and LN class, and NIH activity parameters such as leukocyte infiltration, endocapillary proliferation, fibrinoid necrosis and cellular crescent and disease activity index but not chronicity index. There was a highly significant negative correlation between IHC podocalyxin and podocyte effacement by E/M (rs=−0.903, P=0.000), and E/M immune deposits (r=−0.53, P=0.001), and a significant association with degree of proteinuria, ANA and SLAM score (P<0.05). ConclusionsPodocyte loss indicated by podocalyxin immunohistochemical expression reflects the degree of activity and severity of LN and the degree of podocyte effacement by E/M." "secciones" => array:4 [ 0 => array:1 [ "identificador" => "abst0005" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "La podocalixina es una sialoglicoproteína electronegativa que evita el colapso del proceso podocitario. Nuestro objetivo fue detectar una asociación entre la expresión inmunohistoquímica (IHQ) glomerular de la podocalixina y el grado de borramiento podocitario detectado mediante microscopia electrónica, además de evaluar la función de la expresión IHQ de la podocalixina como un nuevo marcador de la actividad de la enfermedad en la nefritis lúpica (NL). MétodosSe evaluaron 32 biopsias renales de pacientes con NL activa. Se incluyeron la evaluación clínica mediante la puntuación de la determinación de la actividad del lupus sistémico (systemic lupus activity measure, SLAM-R) y datos analíticos (creatinina sérica, proteína en la orina de 24h, anticuerpos antinucleares [AAN], anticuerpos anti-ADN de doble cadena [anti-ADNdc], C3 y C4). Evaluación mediante microscopio de luz (M/L) y microscopio electrónico (M/E). La evaluación de la pérdida podocitaria se realizó mediante inmunohistoquímica con anticuerpos antipodocalixina monoclonales, por medio de una puntuación semicuantitativa que se clasificó de 0 a 4+ en función del porcentaje de afectación glomerular. ResultadosEncontramos 22 (68,8%) casos con clase iv de NL, 6 (18,8%) con clase iii y 4 (12,5%) con clase v. La media de edad fue de 25,41±10,13 años. Se observó una asociación negativa significativa entre la puntuación de la podocalixina en la IHQ con la clase de NL y los parámetros de actividad del NIH, como la infiltración leucocitaria, la proliferación endocapilar, la necrosis fibrinoide y los drepanocitos y el índice de actividad de la enfermedad, pero no el índice de cronicidad. Se observó una correlación negativa muy significativa entre la podocalixina en la IHQ y el borramiento podocitario mediante M/E (rs=−0,903; p=0,000), depósitos inmunes mediante M/E (r=−0,53; p=0,001) y una asociación significativa con el grado de proteinuria, AAN y puntuación en el índice SLAM (p<0,05). ConclusionesLa pérdida podocitaria indicada mediante la expresión IQH de la podocalixina refleja el grado de actividad y la intensidad de la NL, así como el grado de borramiento podocitario mediante M/E." "secciones" => array:4 [ 0 => array:1 [ "identificador" => "abst0025" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:9 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1232 "Ancho" => 2668 "Tamanyo" => 631230 ] ] "descripcion" => array:1 [ "en" => "(a) Active lupus nephritis ISN/RPS class V (A), NIH activity index (12/24) NIH chronicity index (4/12) showing negative immunostaining for podocalyxin (original magnification ×400). (b) An electron micrograph for the same case showing marked diffuse fusion of podocyte foot processes (arrows) and subepithelial electron dense deposits (asterisks) (negative magnification ×22,000)." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1118 "Ancho" => 2668 "Tamanyo" => 556335 ] ] "descripcion" => array:1 [ "en" => "(a) Active lupus nephritis ISN/RPS class IV (A), NIH activity index (14/24) NIH chronicity index (4/12) showing focal segmental immunostaining for podocalyxin 2+ (left half of the glomerulus) with lost immunostaining in the right half of the glomerulus involved by leukocyte infiltration and endocapillary proliferation (original magnification ×400). (b) An electron micrograph for the same case showing marked diffuse fusion of podocyte foot processes (arrows) and subendothelial electron dense deposits (asterisks) (negative magnification ×22,000)." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1194 "Ancho" => 2668 "Tamanyo" => 527579 ] ] "descripcion" => array:1 [ "en" => "(a) Active lupus nephritis ISN/RPS class III (A), NIH activity index (4/24) NIH chronicity index (3/12) showing strong diffuse global immunostaining for podocalyxin 4+ (original magnification ×400). (b) An electron micrograph for the same case showing minimal fusion of podocyte foot processes (arrows) (negative magnification ×2800)." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1892 "Ancho" => 2350 "Tamanyo" => 184775 ] ] "descripcion" => array:1 [ "en" => "Scattered Plots showing significant negative correlation between IHC podocalyxin score and NIH activity index of lupus nephritis (P<0.01)." ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1920 "Ancho" => 2369 "Tamanyo" => 181802 ] ] "descripcion" => array:1 [ "en" => "Scattered plot showing non-significant correlation between IHC podocalyxin and NIH chronicity index of lupus nephritis (P>0.05)." ] ] 5 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Categorical data are presented as number (frequency); numerical data are presented as mean±standard deviation or median (range) as indicated." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (year) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25.41±10.13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="middle">Gender</td><td class="td" title="table-entry " align="left" valign="top">6 males (18.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">26 females (81.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Blood pressure</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Systolic BP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">125±16.84 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diastolic BP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">83.43±13.10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Serum creatinine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.291±1.0418 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Proteinuria</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Normal range \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (21.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Subnephrotic range \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 (37.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nephrotic range \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 (40.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ANA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27 (84.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anti-dsDNA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29 (90.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">C3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">53.63±22.023 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">C4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.38±5.399 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">SLAM-R score</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (18.75%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (31.25%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Severe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 (50%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">ISN/RPS lupus class</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (18.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22 (68.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">V \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (12.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1672118.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Basic demographics." ] ] 6 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="5" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Semi-quantitative IHC podocalyxin score<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a></th><th class="td" title="table-head " align="center" valign="top" scope="col">Total \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">0 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">1+ \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">2+ \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">3+ \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">4+ \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top">Lupus ISN class</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lupus class III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lupus class IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lupus class V \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1672117.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Evaluation of immune-histochemical expression was done by means of a semi-quantitative score that was graded from 0 to 4+ according to the percentage of glomerular involvement. The grade score was set as 0=0%, 1+=1–25%, 2+=26–50%, 3+=51–75% and 4+=76–100%." ] ] ] "descripcion" => array:1 [ "en" => "Degree of glomerular immunohistochemical expression of podocalyxin in different classes of lupus nephritis." ] ] 7 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">L/M activity parameters \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">N (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">L/M chronicity parameters \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">N (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Endocapillary proliferation</td><td class="td" title="table-entry " colspan="2" align="left" valign="top">Glomerular sclerosis</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (21.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Nil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 (34.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 (43.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 (50.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Severe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 (34.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (9.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Severe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (6.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Fibrinoid necrosis</td><td class="td" title="table-entry " colspan="2" align="left" valign="top">Fibro cellular crescent</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (21.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Nil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17 (53.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17 (53.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 (40.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (15.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (6.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Severe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (9.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Cellular crescent</td><td class="td" title="table-entry " colspan="2" align="left" valign="top">Tubular atrophy</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 (50.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Nil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (28.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 (37.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 (50.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (3.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (21.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Severe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (9.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Wire loop hyaline thrombi</td><td class="td" title="table-entry " colspan="2" align="left" valign="top">Interstitial fibrosis</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (3.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Nil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (25.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 (59.37%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 (50.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 (34.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (25.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Severe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (3.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Leukocyte infiltration</td><td class="td" title="table-entry " align="left" valign="top">Chronicity index (mean±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.40±2.39 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (3.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 (40.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17 (53.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Severe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (3.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Mononuclear cell infiltration</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (12.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 (46.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 (40.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Activity index (mean±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.78±4.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1672116.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Light microscopy activity and chronicity parameters of lupus nephritis." ] ] 8 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">E/M parameters \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">N (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Mesangial immune deposits</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (12.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (34.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (40.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Severe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (12.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Sub endothelial immune deposits</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (3.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (15.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (46.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Severe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (34.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Subepithelial immune deposits</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (68.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (18.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (6.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Severe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (6.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Intramembranous immune deposits</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 (87.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (6.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (6.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Podocyte effacement</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No effacement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (6.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (34.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (34.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Severe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (25.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1672119.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Electron microscopy studied parameters." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib0150" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antiproteinuric effect of angiotensin-converting enzyme inhibitors and an angiotensin II receptor blocker in patients with lupus nephritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N. Kitamura" 1 => "Y. Matsukawa" 2 => "M. Takei" 3 => "S. Sawada" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/147323000903700335" "Revista" => array:6 [ "tituloSerie" => "J Int Med Res" "fecha" => "2009" "volumen" => "37" "paginaInicial" => "892" "paginaFinal" => "898" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19589275" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0155" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systemic lupus erythematosus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Rahman" 1 => "D.A. 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Original article

Valor de la expresión inmunohistoquímica de la podocalixina en la nefritis lúpica activa

Maha Abdelmoneim Behairya,

Corresponding author

Mahabehairy80@gmail.com

Corresponding author.

, Marwa Mosaad Shakweerb, Tamer Wahid El Saidc, Nermin Hassan ElGharbawyd

a Ain Shams Internal Medicine and Nephrology Abassya, Ramsses St. Faculty of Medicine, Cairo 1156, Egypt

b Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt

c Internal Medicine and Nephrology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt

d Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Lupus nephritis &#40;LN&#41; represents a major serious manifestation in systemic lupus erythematosus &#40;SLE&#41; as it is associated with significant morbidity and mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a> The pathogenesis of SLE includes a deregulation of humoral and cellular immune activity&#44; reflected in a broad production of autoantibodies&#44; cytokines&#44; and tissue damage&#46; Among the nephrogenic autoantibodies are anti-dsDNA&#44; anti-nucleosomes&#44; and autoantibodies to laminin and collagen IV&#44; which induce renal lesions by the <span class="elsevierStyleItalic">in situ</span> formation of immune complexes that cause complement activation&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">2</span></a> Renal injury patterns in SLE including mesangial&#44; endothelial&#44; epithelial &#40;podocytes&#41;&#44; tubulointerstitial and vascular involvement&#44; were associated with different pathogeneses&#44; clinical presentations and outcomes&#46; Although the 2004 International Society of Nephrology and Renal Pathology Society &#40;ISN&#47;RPS&#41; LN classification has been widely used internationally&#44;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a> there still exist some intriguing controversies&#44; such as podocyte damage in different LN classes&#46; Podocytes are highly differentiated glomerular epithelial cells that line the outside of the glomerular capillary with foot processes linked to the glomerular basement membrane with their actin cytoskeleton&#46; The foot processes form a characteristic inter-digitating pattern leaving filtration slits in-between&#46; Integrity of this filtration barrier is important in order to prevent the loss of protein into the urine&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a> There are different mechanisms of Podocyte injury In SLE including antibody-mediated&#44; cell-mediated&#44; and immune mediated podocyte injury&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a> Many studies focused about lupus podocytopathy in mesangial LN&#44; which indicated that the overt proteinuria occurring in LN might involve pathways related to podocyte injury other than classical immune complex deposition&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">6&#44;7</span></a> Furthermore&#44; The podocyte effacement was obvious in most LN patients and the degree of foot process fusion varied within the different pathological classes of LN&#44;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a> that may indicates that renal podocyte damage might also contribute to the pathogenesis&#44; activity and progression of other types of LN&#44; which may needs further studies&#46; Podocyte injury is difficult to be evaluated by routine hematoxylin and eosin &#40;H&#38;E&#41; method&#44; that&#39;s why many studies assessed podocyte injury by the degree of podocyte loss in urine&#44; and renal biopsy specimens by use of immunohistochemistry&#46; Markers used to detect podocytes in renal tissue include CD10&#44; podocalyxin&#44; synaptopodin&#44; glomerular epithelial protein 1&#44; podocin&#44; CD2AP&#44; nephrin&#44; and Wilms tumor antigen I &#40;WT1&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">9&#44;10</span></a> Podocyte effacement by the electron microscopy is due to rearrangement of the podocyte actin cytoskeleton leads to a change in podocyte shape and consequently function&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The main podocyte surface antigen podocalyxin is a highly electronegative sialoglycoprotein normally located at the apical part of podocyte foot processes prevents the podocyte from collapsing because of its high negative charge and absence of this protein was reported to have detrimental effect on glomerular filtration function&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">11&#44;12</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">D&#8217;Agati described activity and chronicity indices as a histologic grading system of LN&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">13</span></a> but didn&#8217;t include the degree of podocyte injury or effacement although podocytes loss seems to be a new marker for glomerular disease activity or adverse prognosis&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">We aimed to detect an association between glomerular immunohistochemical &#40;IHC&#41; expression of podocalyxin and the degree of podocyte effacement detected by electron microscopy and to evaluate the role of IHC expression of podocalyxin as a marker for pathological and clinical activity in lupus nephritis&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Material and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This is a cross sectional study was conducted on 32 randomly selected patients with renal biopsies of active LN recruited from Ain shams specialized hospital&#44; Cairo&#44; Egypt&#46; Clinical and laboratory data were collected included&#58; age&#44; gender&#44; blood pressure&#44; serum creatinine&#44; degree of proteinuria &#40;nephrotic range proteinuria &#8805;3&#46;5<span class="elsevierStyleHsp" style=""></span>g&#47;d&#44; sub nephrotic range &#60;3&#46;5<span class="elsevierStyleHsp" style=""></span>g&#47;d and normal up to 150<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#41; by 24<span class="elsevierStyleHsp" style=""></span>h urinary protein&#44; urine analysis&#44; serological tests for antinuclear antibodies &#40;ANA&#41;&#44; anti-double strand DNA antibodies &#40;anti-dsDNA&#41;&#44; C3 and C4&#46; Systemic Lupus Activity Measure revised &#40;SLAM-R&#41; was measured for assessment the clinical disease activity of SLE &#40;0&#8211;3<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>mild&#44; 4&#8211;7<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>moderate&#44; &#62;7<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>severe&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> Light and electron microscopic evaluation for renal biopsy specimens were performed&#46; The majority of cases were the first time biopsied for diagnosis and classification&#46; Two cores of renal biopsies were received for each patient&#46; Inclusion criteria&#58; renal biopsy specimens with minimum of 10 glomeruli according to Weening et al&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a> Class I&#44; II and VI are excluded as our study is concerned with active lupus nephritis&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Light microscopy</span><p id="par0030" class="elsevierStylePara elsevierViewall">The specimens were fixed in 10&#37; neutral formalin&#44; routinely processed and embedded in paraffin blocks&#44; from which 3 micrometer &#40;&#956;m&#41; thick serial sections were cut and stained with H&#38;E&#44; PAS &#8220;periodic acid Schiff&#8221; and Masson&#39;s trichrome&#46; Sections examined were evaluated according to the ISN&#47;RPS classification&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a> Activity and chronicity indices were evaluated according to NIH scoring system&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">15&#44;16</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Electron microscopy</span><p id="par0035" class="elsevierStylePara elsevierViewall">Specimens were fixed in formaldehyde glutaraldehyde mixture pH 7&#46;4 in cacodylate buffer&#44; then embedded in Spurr&#39;s resin&#46; Semithin sections&#44; one micron thick were obtained by ultramicrotome using glass and&#47;or diamond knife and stained with 1&#37; toluidine blue and examined by light microscopy&#46; Ultrathin sections &#40;60&#8211;80<span class="elsevierStyleHsp" style=""></span>nm thick&#41;&#44; were cut from selected blocks then double stained with uranyl acetate and lead citrate&#46; Examination was done by Philips-400 T transmission electron microscope at 80<span class="elsevierStyleHsp" style=""></span>kV&#46; The prints were examined for detection of changes in the mesangium&#44; electron dense deposits &#40;mesangial&#44; subendothelial&#44; intramembranous and subepithelial&#41;&#44; epithelial cell changes &#40;podocyte effacement&#41; The electron dense deposits were graded as 1&#8211;3&#43; &#40;minimum&#44; moderate and massive&#41; in accordance with their number and extension&#46; Grade 1 was defined as one or two very small deposits&#44; grade 2 as several small and large non-fused deposits and grade 3 as abundant amount of fused deposits&#46; Most of them occupied a large part of the entire circumference of a capillary loop or most of the mesangial matrix&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a> The amount of podocyte effacement &#40;defined as the percentage of total glomerular capillary surface area over which the podocyte foot processes were effaced&#41; was graded as 1&#43; with involvement of &#60;25&#37;&#44; 2&#43; with involvement of 25&#8211;50&#37;&#44; and 3&#43; with involvement of &#62;50&#37; of glomerular capillary surface area&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Immunofluorescence study</span><p id="par0040" class="elsevierStylePara elsevierViewall">Direct immunofluorescence staining for IgA&#44; IgG&#44; IgM and C3 was done on frozen sections&#46; The intensity of staining was graded as mild&#44; moderated&#44; and severe &#40;1&#8211;3&#43;&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Immunohistochemical study</span><p id="par0045" class="elsevierStylePara elsevierViewall">Podocalyxin like antibody was used as podocyte&#47;Apical marker&#46; The primary antibody was rabbit polyclonal antibody&#44; podocalyxin &#40;NBP1-83348&#41;&#44; concentrate antibody &#40;commercial house&#58; Novus Biologicals&#41;&#44; Country of origin&#58; USA&#46; Podocalyxin immunohistochemical expression in renal glomeruli of normal kidney tissue&#44; acquired from a case of renal cell carcinoma&#44; was used as positive control for podocalyxin&#46; Evaluation of immunohistochemically expression was done using modified method of Wang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">A semi-quantitative score was graded from 0 to 4&#43; according to the percentage of total number of glomeruli involved in the renal biopsy specimen&#46; The grade score was set as 0<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#37; when all glomeruli are negative for podoclyxin immunohistochemical expression&#44; 1&#43;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#8211;25&#37; of glomeruli demonstrate mild to moderate segmental immunostaining&#44; 2&#43;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#8211;50&#37; of glomeruli demonstrate moderate segmental and&#47;or global immunostaining&#44; 3&#43;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&#8211;75&#37; of glomeruli demonstrate moderate to marked segmental and&#47;or global immunostaining and 4&#43;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>76&#8211;100&#37; of glomeruli demonstrate moderate to marked segmental and&#47;or global immunostaining&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">Statistical analysis was performed using SPSS version 20&#46;0 for windows &#40;IBM&#44; USA&#41;&#46; Categorical variables were presented as counts and percentages&#46; Continuous variables were presented as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation or median &#40;range&#41; as indicated&#46; Chi-square test for association and Spearman&#39;s correlation test were used as indicated&#46; A two-sided <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 was considered statistically significant&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">This study included thirty Two randomly selected patients with a clinical diagnosis of LN indicated for biopsy to determine the activity and chronicity indices of lupus nephritis&#44; 6 &#40;18&#46;8&#37;&#41; of them were males and 26 &#40;81&#46;2&#37;&#41; were females&#44; with The mean of age at presentation was &#40;25&#46;41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;13&#41; years&#46; Basic demographics for the study population are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The most frequent class of LN in this study was found to be class IV &#40;68&#46;8&#37;&#41; with 22 cases&#44; followed by class III &#40;18&#46;8&#37;&#41; with 6 cases&#46; The least frequent class was class V &#40;12&#46;5&#37;&#41;&#44; consisting of 4 cases&#46; Semiquantitative score of IHC podocalyxin was 0 in 4 &#40;12&#46;5&#37;&#41;&#44; &#43;1 in 8 &#40;25&#37;&#41;&#44; &#43;2 in 7 &#40;21&#46;9&#37;&#41;&#44; &#43;3 in 8 &#40;25&#37;&#41; and &#43;4 in 5 &#40;15&#46;6&#37;&#41; of the total cases&#46; The degree of glomerular immunohistochemical expression of podocalyxin in different classes of LN was shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> as number of cases with 0 expression of podocalyxin &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>a&#41; was more in class V LN cases and number of cases with &#43;4 IHC podocalyxin expression &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>a&#41; was more in class III LN cases&#46; Focal segmental immunostaining for podocalyxin 2&#43; was shown in &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>a&#41;&#46; There was significant negative association between IHC podocalyxin score and LN class &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;701&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000&#41;&#46; L&#47;M activity and chronicity parameters were shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; In our study&#59; there was significant negative correlation between IHC podocalyxin score and activity parameters as leukocyte infiltration &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;489&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41; endocapillary proliferation &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;473&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006&#41;&#44; fibrinoid necrosis &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;351&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;049&#41; and cellular crescent &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;444&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;011&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; but non-significant correlation with presence of wire loop or mononuclear cell infiltration &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">There was non-significant correlation between IHC podocalyxin score and L&#47;M chronicity parameters of LN as glomerular sclerosis&#44; presence of fibro cellular crescents&#44; tubular atrophy and interstitial fibrosis &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; Finally there was a statistically significant negative correlation between IHC expression of podocalyxin and disease activity index in LN cases &#40;<span class="elsevierStyleItalic">r</span>s<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;609&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0005&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; However&#44; there was no statistical significant correlation with chronicity index &#40;<span class="elsevierStyleItalic">r</span>s<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;200&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;273&#41; by Spearman&#39;s correlation test &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46; E&#47;M podocyte effacement and immune deposits results were shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46; There was a Highly Significant negative correlation between IHC podocalyxin and podocyte effacement by EM &#40;<span class="elsevierStyleItalic">r</span>s<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;903&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000&#41; by Spearman&#39;s rho correlation test &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1&#8211;3</a>b&#41;&#46; Significant negative correlation between IHC podocalyxin score and E&#47;M subepithelial immune deposits &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;538&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and intramembranous immune deposits &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;541&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; no significant correlation with presence of mesangial or subendothelial immune deposits &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">There was a statistically significant association between score for immune-histochemical expression of podocalyxin and degree of proteinuria as a clinical marker for lupus activity &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&#46;611&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;024&#41; by chi square test&#44; with a strength of association as observed by Cramer&#39;s V<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;525&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;024 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; No significant correlation between podocalyxin expression and serum creatinine &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; Significant statistical negative correlation between SLAM-R score of clinical disease activity and IHC podocalyxin score &#40;<span class="elsevierStyleItalic">r</span>s<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;709&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;000&#41; by Spearman&#39;s correlation test&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Significant association between IHC podocalyxin and positive serum ANA &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#46;759&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;045&#41; but no significant association with positive dsDNA&#44; C3 or C4 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; as laboratory markers of SLE by chi square test&#46; There was negative significant correlation between IHC podocalyxin expression score and diastolic BP &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;432&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;014&#41;&#44; and non-significant with systolic BP &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;342&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;055&#41;&#44; age or gender &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">In this study&#44; there was a significant negative association between IHC podocalyxin score and LN class&#46; We observed that all cases of class III LN showed high immunoexpression for podocalyxin &#40;3&#43; and 4&#43;&#41; denoting minimal podocyte loss in this class&#44; while in class IV&#44; 15 cases showed negative to low expression &#40;0&#8211;2&#43;&#41; indicating severe podocyte loss&#46; This could be attributed to the percentage of glomeruli affected&#44; as glomerular lesions including podocyte detachment in focal proliferative LN &#40;class III&#41; affect less than 50&#37; while in diffuse proliferative LN &#40;class IV&#41;&#59; more than 50&#37; of glomeruli are affected&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Podocytes might also provide some potential antigen targets for circulating antibodies that directly injured the podocytes or formed immune complex deposits and subsequent complement activation&#44; especially the formation of the membrane attack complex &#40;MAC&#41;&#44; might inflict cytotoxic injury on the podocytes in lupus membranous nephropathy &#40;class V&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">20</span></a> which showed zero to low expression of IHC podocalyxin score in this study&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">We reported in this study a significant negative correlation between IHC podocalyxin score and activity parameters as leukocyte infiltration&#44; endocapillary proliferation&#44; fibrinoid necrosis&#44; cellular crescents and total NIH activity index score&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Endocapillary hypercellularity with or without leukocyte infiltration and with substantial luminal reduction is an active glomerular lesion specified by the 2004 ISN&#47;RPS lupus nephritis classification&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a> The significant association of podocyte loss detected by IHC podocalyxin score with endocapillary proliferation in active proliferative LN classes&#44; could be explained by the immune-complex deposition in the capillary wall aggravating inflammation response with consequent podocyte injury&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a> Cell mediated immunity might play also an important role in podocyte lesions and also several autoantibodies were found to directly cross-react with podocyte proteins&#44; like a-actinin-4&#44; and lead to the podocyte cytoskeleton reorganization that presented with podocyte fusion morphologically in proliferative LN&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">22</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">The significant association of IHC podocalyxin score with leukocyte infiltration could be attributed to the role of infiltrating leukocytes in inducing apoptosis of podocytes followed by podocyte loss&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a> The presence of cellular crescents association with low IHC podocalyxin score may indicate that podocyte loss may be inducible factor in crescent formation in active LN&#46; In Le Hir et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">20</span></a> study&#59; they observed that podocytes detached from the glomerular basement membrane &#40;GBM&#41; migrate and infiltrate the parietal basement membrane initiating proliferation of parietal epithelial cells&#44; resulting in a crescent&#46; Using genetic tags in mouse models&#44; it has been reported that up to 50&#37; of the cells within crescents may originate from podocytes&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">24&#44;25</span></a> Bariety and colleagues reported also the presence of podocytes in crescents identified by immunostaining for podocyte antigens in human glomerulonephritis including type IV lupus glomerulonephritis&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">26</span></a> Thorner and colleagues<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">24</span></a> identified Nestin-positive cells&#44; as podocyte marker&#44; in glomerular crescents in human renal biopsies in a variety of renal pathologies including LN classes III and IV&#46; Although the presence of podocytes in crescents remains unclear&#44; the significant negative association of IHC podocalyxin score and cellular crescent observed in this study may indicates that podocyte injury is an important parameter of severity and activity in lupus nephritis&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Other study concluded that counting and scoring shed Bowman&#39;s space podocytes showed a statistically significant association to the pattern of proliferation&#44; necrosis and cellular crescents as parameters of activity index but not of chronicity index&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">27</span></a> Although podocyte loss leading to initiation of inflammatory response with protein mediated cytotoxicity causes endothelial damage ends into sclerosis and fibrosis of the glomerulus and even end stage renal disease&#59; we did not observed statistically significant correlation between IHC podocalyxin score and chronicity index&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In the present study&#44; there was a highly significant negative correlation between IHC podocalyxin score and the degree of podocyte effacement by EM&#46; We suggest that decreased immunohistochemical expression of podocalyxin is due to podocyte morphogenesis and the maintenance of structural integrity through the negative charge leads to ultrastructural changes of foot processes&#44; which disturb their function&#44; eventually leading to fusion of foot processes&#46; As Wang et al&#46; study<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a> reported that degree of podocyte effacement in proliferative LN assessed by foot process width by electron microscopy was positively correlated with the level of proteinuria and renal pathological indices&#44; including cellular crescents&#44; interstitial inflammatory and total chronicity index&#44; and effacement of podocyte may be considered an important pathological parameter in active lupus nephritis&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">We also found a statistically significant correlation between negative podocalyxin immunoexpression and electron dense deposits by electron microscopy indicating that podocyte loss is related to amount of immune complex deposition&#46; We assume that mesangial and subendothelial immune complexes may induce podocyte injury indirectly through complement activation and release of inflammatory mediators aggravating the inflammatory response with consequent apoptosis could result in podocyte loss&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">In the current study&#44; IHC podocalyxin score was significantly associated with degree of proteinuria&#46; Proteinuria is considered a very important clinical biomarker in the assessment of renal injury and LN activity&#44; also considered as prognostic factor for renal outcomes in lupus nephritis&#44; high proteinuria is associated with multi-systemic vascular damage leading to worsening GFR&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">28</span></a> We observed a significant negative correlation between the IHC podocalyxin score with SLE disease activity &#40;SLAM-R&#41; score as degree of effacement of podocytes may be considered a measurement not only for activity and severity of lupus nephritis but for global SLE activity&#44; that&#39;s may need further studies&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">As hypertension is an important factor influencing the prognosis of patients with LN&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a> we reported a significant negative correlation between IHC podocalyxin score and diastolic blood pressure but not systolic BP&#44; as podocyte injury with hypertension may be explained by mechanical stress and oxidative stress that are key mediators of podocyte damage in hypertension&#46; We observed also the association between IHC podocalyxin and presence of ANA&#46; Interventional studies with drug therapy that preserve expression of podocalyxin as target therapy in active lupus nephritis may be needed&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusions</span><p id="par0135" class="elsevierStylePara elsevierViewall">Immunohistochemical expression of podocalyxin significantly correlated to degree of podocyte effacement by EM and may be a novel marker for assessment of disease activity and severity of lupus nephritis&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflict of interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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          "identificador" => "xres985602"
          "titulo" => "Abstract"
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            0 => array:1 [
              "identificador" => "abst0005"
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          "titulo" => "Keywords"
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          "titulo" => "Resumen"
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          "titulo" => "Palabras clave"
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          "identificador" => "sec0005"
          "titulo" => "Introduction"
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          "identificador" => "sec0010"
          "titulo" => "Material and methods"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Light microscopy"
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            1 => array:2 [
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              "titulo" => "Electron microscopy"
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              "identificador" => "sec0025"
              "titulo" => "Immunofluorescence study"
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              "identificador" => "sec0030"
              "titulo" => "Immunohistochemical study"
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              "titulo" => "Statistical analysis"
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          "titulo" => "Results"
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          "titulo" => "Discussion"
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          "titulo" => "Conclusions"
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    "fechaRecibido" => "2016-09-13"
    "fechaAceptado" => "2017-06-13"
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          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec953250"
          "palabras" => array:4 [
            0 => "Lupus nephritis"
            1 => "Proteinuria"
            2 => "Podocyte effacement"
            3 => "Podocalyxin"
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      ]
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        0 => array:4 [
          "clase" => "keyword"
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          "palabras" => array:4 [
            0 => "Nefritis l&#250;pica"
            1 => "Proteinuria"
            2 => "Borramiento podocitario"
            3 => "Podocalixina"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Podocalyxin is an electronegative sialoglycoprotein that prevents the podocyte foot process from collapsing&#46; The aim of this study was to detect an association between the glomerular immunohistochemical &#40;IHC&#41; expression of podocalyxin and the degree of podocyte effacement detected by electron microscopy&#44; and to evaluate the role of podocalyxin IHC expression as a novel marker for disease activity in lupus nephritis &#40;LN&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Thirty-two renal biopsies of active lupus nephritis patients were studied&#46; Clinical assessment by the systemic lupus activity measure &#40;SLAM-R&#41; score and laboratory data were included &#91;serum creatinine&#44; 24-h urinary protein&#44; antinuclear antibodies &#40;ANA&#41;&#44; anti-double-strand DNA antibodies &#40;anti-dsDNA&#41;&#44; C3 and C4&#93;&#46; Light &#40;L&#47;M&#41; and electron microscopic &#40;E&#47;M&#41; examination was conducted&#46; Podocyte loss was evaluated by immunohistochemistry with monoclonal anti-podocalyxin antibodies by means of a semiquantitative score that was graded from 0 to 4&#43; according to the percentage of glomerular involvement&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">22 cases &#40;68&#46;8&#37;&#41; with LN class IV&#44; 6 &#40;18&#46;8&#37;&#41; with class III and 4 &#40;12&#46;5&#37;&#41; with class V&#46; The mean age was &#40;25&#46;41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;13&#41; years&#46; There was a significant negative correlation between IHC podocalyxin score and LN class&#44; and NIH activity parameters such as leukocyte infiltration&#44; endocapillary proliferation&#44; fibrinoid necrosis and cellular crescent and disease activity index but not chronicity index&#46; There was a highly significant negative correlation between IHC podocalyxin and podocyte effacement by E&#47;M &#40;<span class="elsevierStyleItalic">r</span>s<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;903&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000&#41;&#44; and E&#47;M immune deposits &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;53&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; and a significant association with degree of proteinuria&#44; ANA and SLAM score &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Podocyte loss indicated by podocalyxin immunohistochemical expression reflects the degree of activity and severity of LN and the degree of podocyte effacement by E&#47;M&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La podocalixina es una sialoglicoprote&#237;na electronegativa que evita el colapso del proceso podocitario&#46; Nuestro objetivo fue detectar una asociaci&#243;n entre la expresi&#243;n inmunohistoqu&#237;mica &#40;IHQ&#41; glomerular de la podocalixina y el grado de borramiento podocitario detectado mediante microscopia electr&#243;nica&#44; adem&#225;s de evaluar la funci&#243;n de la expresi&#243;n IHQ de la podocalixina como un nuevo marcador de la actividad de la enfermedad en la nefritis l&#250;pica &#40;NL&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se evaluaron 32 biopsias renales de pacientes con NL activa&#46; Se incluyeron la evaluaci&#243;n cl&#237;nica mediante la puntuaci&#243;n de la determinaci&#243;n de la actividad del lupus sist&#233;mico &#40;<span class="elsevierStyleItalic">systemic lupus activity measure</span>&#44; SLAM-R&#41; y datos anal&#237;ticos &#40;creatinina s&#233;rica&#44; prote&#237;na en la orina de 24<span class="elsevierStyleHsp" style=""></span>h&#44; anticuerpos antinucleares &#91;AAN&#93;&#44; anticuerpos anti-ADN de doble cadena &#91;anti-ADNdc&#93;&#44; C3 y C4&#41;&#46; Evaluaci&#243;n mediante microscopio de luz &#40;M&#47;L&#41; y microscopio electr&#243;nico &#40;M&#47;E&#41;&#46; La evaluaci&#243;n de la p&#233;rdida podocitaria se realiz&#243; mediante inmunohistoqu&#237;mica con anticuerpos antipodocalixina monoclonales&#44; por medio de una puntuaci&#243;n semicuantitativa que se clasific&#243; de 0 a 4&#43; en funci&#243;n del porcentaje de afectaci&#243;n glomerular&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Encontramos 22 &#40;68&#44;8&#37;&#41; casos con clase <span class="elsevierStyleSmallCaps">iv</span> de NL&#44; 6 &#40;18&#44;8&#37;&#41; con clase <span class="elsevierStyleSmallCaps">iii</span> y 4 &#40;12&#44;5&#37;&#41; con clase <span class="elsevierStyleSmallCaps">v</span>&#46; La media de edad fue de 25&#44;41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;13 a&#241;os&#46; Se observ&#243; una asociaci&#243;n negativa significativa entre la puntuaci&#243;n de la podocalixina en la IHQ con la clase de NL y los par&#225;metros de actividad del NIH&#44; como la infiltraci&#243;n leucocitaria&#44; la proliferaci&#243;n endocapilar&#44; la necrosis fibrinoide y los drepanocitos y el &#237;ndice de actividad de la enfermedad&#44; pero no el &#237;ndice de cronicidad&#46; Se observ&#243; una correlaci&#243;n negativa muy significativa entre la podocalixina en la IHQ y el borramiento podocitario mediante M&#47;E &#40;rs<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#44;903&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;000&#41;&#44; dep&#243;sitos inmunes mediante M&#47;E &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#44;53&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y una asociaci&#243;n significativa con el grado de proteinuria&#44; AAN y puntuaci&#243;n en el &#237;ndice SLAM &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La p&#233;rdida podocitaria indicada mediante la expresi&#243;n IQH de la podocalixina refleja el grado de actividad y la intensidad de la NL&#44; as&#237; como el grado de borramiento podocitario mediante M&#47;E&#46;</p></span>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Active lupus nephritis ISN&#47;RPS class V &#40;A&#41;&#44; NIH activity index &#40;12&#47;24&#41; NIH chronicity index &#40;4&#47;12&#41; showing negative immunostaining for podocalyxin &#40;original magnification &#215;400&#41;&#46; &#40;b&#41; An electron micrograph for the same case showing marked diffuse fusion of podocyte foot processes &#40;arrows&#41; and subepithelial electron dense deposits &#40;asterisks&#41; &#40;negative magnification &#215;22&#44;000&#41;&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Active lupus nephritis ISN&#47;RPS class IV &#40;A&#41;&#44; NIH activity index &#40;14&#47;24&#41; NIH chronicity index &#40;4&#47;12&#41; showing focal segmental immunostaining for podocalyxin 2&#43; &#40;left half of the glomerulus&#41; with lost immunostaining in the right half of the glomerulus involved by leukocyte infiltration and endocapillary proliferation &#40;original magnification &#215;400&#41;&#46; &#40;b&#41; An electron micrograph for the same case showing marked diffuse fusion of podocyte foot processes &#40;arrows&#41; and subendothelial electron dense deposits &#40;asterisks&#41; &#40;negative magnification &#215;22&#44;000&#41;&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Active lupus nephritis ISN&#47;RPS class III &#40;A&#41;&#44; NIH activity index &#40;4&#47;24&#41; NIH chronicity index &#40;3&#47;12&#41; showing strong diffuse global immunostaining for podocalyxin 4&#43; &#40;original magnification &#215;400&#41;&#46; &#40;b&#41; An electron micrograph for the same case showing minimal fusion of podocyte foot processes &#40;arrows&#41; &#40;negative magnification &#215;2800&#41;&#46;</p>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Scattered Plots showing significant negative correlation between IHC podocalyxin score and NIH activity index of lupus nephritis &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46;</p>"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Categorical data are presented as number &#40;frequency&#41;&#59; numerical data are presented as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation or median &#40;range&#41; as indicated&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age &#40;year&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#46;41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="middle">Gender</td><td class="td" title="table-entry  " align="left" valign="top">6 males &#40;18&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">26 females &#40;81&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Blood pressure</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Systolic BP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">125<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diastolic BP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&#46;43<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Serum creatinine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;291<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;0418&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Proteinuria</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Normal range&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;21&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Subnephrotic range&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;37&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nephrotic range&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;40&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ANA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;84&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Anti-dsDNA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29 &#40;90&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>C3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53&#46;63<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&#46;023&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>C4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;399&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">SLAM-R score</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;18&#46;75&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;31&#46;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Severe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">ISN&#47;RPS lupus class</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;18&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;68&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;12&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1672118.png"
              ]
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Basic demographics&#46;</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="5" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Semi-quantitative IHC podocalyxin score<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></th><th class="td" title="table-head  " align="center" valign="top" scope="col">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">1&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">2&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">3&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">4&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Lupus ISN class</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lupus class III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lupus class IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lupus class V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Total</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab1672117.png"
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          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Evaluation of immune-histochemical expression was done by means of a semi-quantitative score that was graded from 0 to 4&#43; according to the percentage of glomerular involvement&#46; The grade score was set as 0<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#37;&#44; 1&#43;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#8211;25&#37;&#44; 2&#43;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#8211;50&#37;&#44; 3&#43;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&#8211;75&#37; and 4&#43;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>76&#8211;100&#37;&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Degree of glomerular immunohistochemical expression of podocalyxin in different classes of lupus nephritis&#46;</p>"
        ]
      ]
      7 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">L&#47;M activity parameters&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">L&#47;M chronicity parameters&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Endocapillary proliferation</span></td><td class="td" title="table-entry  " colspan="2" align="left" valign="top">Glomerular sclerosis</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;21&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;34&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;43&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;50&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Severe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;34&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;9&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Severe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;6&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Fibrinoid necrosis</span></td><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Fibro cellular crescent</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;21&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;53&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;53&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;40&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;15&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;6&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Severe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;9&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Cellular crescent</span></td><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Tubular atrophy</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;50&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;28&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;37&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;50&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;3&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;21&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Severe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;9&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Wire loop hyaline thrombi</span></td><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Interstitial fibrosis</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;3&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;25&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;59&#46;37&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;50&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;34&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;25&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Severe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;3&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Leukocyte infiltration</span></td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Chronicity index</span> &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;3&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;40&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;53&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Severe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;3&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Mononuclear cell infiltration</span></td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;12&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;46&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;40&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"></td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Activity index</span> &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;78<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">E&#47;M parameters&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Mesangial immune deposits</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;12&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;34&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;40&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Severe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;12&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Sub endothelial immune deposits</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;3&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;15&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;46&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Severe&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;68&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;18&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;6&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Severe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;6&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;87&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;6&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;6&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Podocyte effacement</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No effacement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;6&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;34&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;34&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Severe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;25&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Electron microscopy studied parameters&#46;</p>"
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Article information

ISSN: 20132514
Original language: English

DOI:10.1016/j.nefroe.2018.01.009

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2024 August	86	79	165
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2021 February	73	36	109
2021 January	76	21	97
2020 December	57	27	84
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2020 May	60	20	80
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2020 January	70	36	106
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2019 November	70	41	111
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2019 September	62	34	96
2019 August	42	29	71
2019 July	41	31	72
2019 June	47	45	92
2019 May	50	38	88
2019 April	83	54	137
2019 March	67	31	98
2019 February	35	35	70
2019 January	47	26	73
2018 December	252	34	286
2018 November	500	15	515
2018 October	289	24	313
2018 September	94	25	119
2018 August	58	12	70
2018 July	52	11	63
2018 June	49	12	61
2018 May	72	19	91
2018 April	119	11	130
2018 March	184	16	200
2018 February	47	6	53

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