[Role of intrarenal product TNF-alpha in the development of glomerular and tubulointerstitial tissues changes in elderly patients with diabetic nephropathy].

The aim of this study was to investigate the expression of TNF-alpha produced in the kidney in patients with diabetic nephropathy (DN) type 2 diabetes and its impact on the development of glomerular and tubulointerstitial tissue changes in these patients. The survey was conducted in 49 elderly patients (mean age 66.53 +/- 3.50 years) with type 2 diabetes complicated by the development of DN. The study included patients with serum creatinine less than 0.13-0.14 mmol/l and in the initial stage of chronic renal failure in the level of serum creatinine less than 0.20 mmol/l. Diabetes duration was 17.89 +/- 0.44 years, and the duration of diabetic nephropathy was 1.60 +/- 0.44 years. Light and immunofluorescence microscopy of the renal biopsy specimens obtained by needle lifetime biopsy was performed for all patients. Morphological changes in the tissue were assessed in accordance with the latest international classification of diabetic nephropathy. In addition to light and immunofluorescence microscopy the expression of TNF-alpha in the glomerulus and interstitial tissue by monoclonal antibodies labeled Fitc ("Dako", Germany) were determined in all patients. The location of TNF-alpha expression in the glomeruli (capillary loops, mesangial matrix, glomerular capsule) and in the interstitial tissue (urinary epithelium convoluted tubule basement membrane of urinary tubules, interstitial cells) were estimated. Correlation analysis of the influence of the expression of TNF-alpha on the expression of morphological changes of tissues revealed that a maximum of cytokine production in the glomeruli at the stage IIa class cytokine affected only the development of segmental glomerular sclerosis. With the decrease in TNF-alpha production in the glomeruli you can observe the progression of histological changes--periglomerulyarny sclerosis development, builds thickening of the glomerular basement membrane; mesangial expansion goes from mild to severe and affects more than 25% of mesangial matrix (IIb stage), nodular lesions of Kimmelstil-Wilson are forming. Interstitial produce of TNF-alpha remains relatively high in the epithelium of the urinary tubules and in the interstitial cells of the kidney regardless of the class of diabetic nephropathy and influence the development of tubulointerstitial fibrosis.