EXPRESSION OF ADHESION MOLECULE IN HEMORRHAGIC-FEVER WITH RENAL SYNDROME

초록

Hemorrhagic fever with renal syndrome (HFRS) infected by virus is clinically characterized by high fever, hypotension, hemorrhagic diasthesis and acute renal failure, and is spontaneously resolved without significant sequelae. The characteristic pathologic findings are hemorrhagic necrosis of the right atrium, renal medulla and anterior pituitary gland. In microscopically diffuse mononuclear cell infiltration, systemic microvascular dilation and capillary disruption could be found. Recently, the relationship between interstitial T lymphocyte infiltration and renal dysfunction, including proteinuria, has been reported. Therefore, this finding suggests that the lymphoid systemmay have an important role in the pathogenesis of HFRS. We investigated the role of adhesion molecules, such as ICAM-I and VCAM-I, in the pathophysiologic mechanism, such as T cell infiltration, in the renal interstitium in HFRS. The following results were obtained: (1) The mean age of patients was 44 years, and the male to female ratio 5:1. (2) The mean serum BUN and creatinine levels were 61.17 18.41 mg/dl and 7.38 3.34mg/dl, respectively. (3) Expression of ICAM-I was strongly positive in glomerular capillary endothelium in 4 cases (80%), and weakly positive in parietal epithelium and mesangium at 20%, 40% in each. In renal tubules, 2 cases (33%) showed positive reaction and 3 cases (50%) were positive in the peritubular capillary wall. ICAM-I expression could not be found in renal interstitial cells. (4) Expression of VCAM-I was negative in all cases at renal glomeruli, but 4 of 6 cases (67%) revealed a strongpositive reaction in the renal tubules. In renal peritubular capillary, 1 case (17%) showed positive reaction and VCAM-I expression could not be found in the renal interstitium in all cases. (5) In 5 ATN patients (control group), ICAM-I and VCAM-I expression revealed similar patterns. Fromthe above findings, strong VCAM-I expression in renal tubules may have a significant role in the recruitment of T lymphocytes in HFRS, and the role of ICAM-I seems to be less likely. However, the control group in this study was not comprised of normal persons, and considering various reports that ICAM-I and VCAM-I are not expressed in normal renal tubules, a strong positive reaction of VCAM-I at renal tubules in this study suggests a possibility of role of adhesion molecules in the pathogenesis of HFRS. Future studies are required to identify the exact role of adhesion molecules in the pathophysiology of HFRS.