ABSTRACT
Introduction:
Minimal change nephrotic syndrome (MCNS) and
focal segmental glomerulosclerosis (FSGS) are the two common causes of
nephrotic syndrome (NS) in both
children and
adults with overlapping clinical features, but with distinct prognostic and
therapeutic implications. The distinction between these relies entirely on histopathology, which can sometimes be difficult. CD44 is expressed by activated parietal
epithelial cells,
plays a
role in matrix deposition and thus in the pathogenesis of FSGS.
Aims:
To assess the expression of CD44 in MCNS and FSGS and to evaluate its
association with the known clinical and histopathological
prognostic factors. Materials and
Methods:
Thirty cases each of MCNS and FSGS were studied. The clinical,
laboratory, histopathological, and CD 44 immunohistochemical data were recorded. The findings were analyzed and correlated. A P value of < 0.05 was considered statistically significant.
Results:
Statistical
association was noted between CD44 positivity and
serum creatinine (p = 0.031), estimated
glomerular filtration rate (p = 0.040), segmental
sclerosis (p < 0.001), tubular
atrophy (p = 0.027), interstitial
fibrosis (p = 0.027), and histological
diagnosis (p < 0.001). The
sensitivity,
specificity, positive predictive, and
negative predictive values were 90%, 76.67%, 79.41% and 88.46%, respectively.
Conclusions:
CD44 immunostain can effectively distinguish MCNS from FSGS. The congruent results of CD44 positivity with known
prognostic factors support the possibility of using the CD44 marker as a predictive tool in selecting high-
risk patients and offering appropriate
therapeutic measures.