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Reiser J, Nast CC, Alachkar N. Permeability factors in focal and segmental glomerulosclerosis. Adv Chronic Kidney Dis 2014; 21:417-21. [PMID: 25168830 DOI: 10.1053/j.ackd.2014.05.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 05/30/2014] [Accepted: 05/30/2014] [Indexed: 01/30/2023]
Abstract
Focal and segmental glomerulosclerosis (FSGS) represents a group of glomerular disorders, identified on kidney biopsy, that progress in the histopathologic pattern of sclerosis in parts of some glomeruli. Damage to podocytes usually marks the beginning of the disease, most evident in primary FSGS. In addition to genetic predisposition, there are many acquired causes that disturb normal podocyte homeostasis and allow for the development of FSGS. The aim of this review was to summarize recent findings of the most relevant circulating permeability factors that may serve as biomarkers of active primary idiopathic FSGS and aid in the diagnosis and prediction of recurrent FSGS after kidney transplantation.
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Leca N. Focal segmental glomerulosclerosis recurrence in the renal allograft. Adv Chronic Kidney Dis 2014; 21:448-52. [PMID: 25168835 DOI: 10.1053/j.ackd.2014.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 06/06/2014] [Accepted: 06/06/2014] [Indexed: 01/31/2023]
Abstract
Focal segmental glomerulosclerosis (FSGS) represents a common histologic pattern of glomerular injury associated with a multitude of disease mechanisms. The etiology of FSGS is often classified into primary (idiopathic) and secondary forms in response to genetic abnormalities, infections, toxins, and systemic disorders that lead to adaptive changes, glomerular hyperfiltration, and proteinuria. Our understanding of the pathogenic mechanisms responsible for FSGS was substantially enhanced in recent years because of major advances in the cell biology of the podocyte and parietal epithelial cell. Recurrence of FSGS occurs mainly in its primary form and is only rarely described in secondary forms. The re-enactment of pathologic mechanisms of FSGS as recurrent disease after kidney transplantation represents a biologic experiment that can provide unique insight. Nonetheless, recurrent FSGS remains a notable clinical problem that correlates with poorer renal allograft outcomes. This is the focus of this particular review, concentrating on the most recent developments.
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Wada T, Nangaku M, Maruyama S, Matsuo S. The Authors Reply:. Kidney Int 2014; 86:208-9. [DOI: 10.1038/ki.2014.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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55
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Deegens JK, Wetzels JF. The search goes on: suPAR is not the elusive FSGS factor. Nat Rev Nephrol 2014; 10:431-2. [DOI: 10.1038/nrneph.2014.113] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Meijers B, Poesen R, Claes K, Dietrich R, Bammens B, Sprangers B, Naesens M, Storr M, Kuypers D, Evenepoel P. Soluble urokinase receptor is a biomarker of cardiovascular disease in chronic kidney disease. Kidney Int 2014; 87:210-6. [PMID: 24897037 DOI: 10.1038/ki.2014.197] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/26/2014] [Accepted: 04/03/2014] [Indexed: 12/30/2022]
Abstract
Soluble urokinase-type plasminogen activator receptor (suPAR) accumulates in patients with chronic kidney disease (CKD). In various non-CKD populations, suPAR has been proposed as a prognostic marker for mortality and cardiovascular disease. However, it is not known whether suPAR holds prognostic information in patients with mild-to-moderate CKD. In a prospective observational study of 476 patients with mild-to-moderate kidney disease, we examined multivariate associations between suPAR, overall mortality, and cardiovascular events. After a mean follow-up of 57 months, 52 patients died and 76 patients had at least one fatal or nonfatal cardiovascular event. Higher suPAR was directly and significantly associated with both overall mortality (univariate hazard ratio 5.35) and cardiovascular events (univariate hazard ratio 5.06). In multivariate analysis, suPAR remained significantly associated with cardiovascular events (full model, hazard ratio 3.05). Thus, in patients with mild-to-moderate CKD, suPAR concentrations show a clear, direct, and graded association with a higher risk for new-onset cardiovascular disease.
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Affiliation(s)
- Björn Meijers
- 1] UZ Leuven, Department of Nephrology, Leuven, Belgium [2] KU Leuven, Department of Microbiology and Immunology, Leuven, Belgium
| | - Ruben Poesen
- KU Leuven, Department of Microbiology and Immunology, Leuven, Belgium
| | - Kathleen Claes
- 1] UZ Leuven, Department of Nephrology, Leuven, Belgium [2] KU Leuven, Department of Microbiology and Immunology, Leuven, Belgium
| | - Ruth Dietrich
- Research and Development, Gambro Dialysatoren GmbH, Hechingen, Germany
| | - Bert Bammens
- 1] UZ Leuven, Department of Nephrology, Leuven, Belgium [2] KU Leuven, Department of Microbiology and Immunology, Leuven, Belgium
| | - Ben Sprangers
- 1] UZ Leuven, Department of Nephrology, Leuven, Belgium [2] KU Leuven, Department of Microbiology and Immunology, Leuven, Belgium
| | - Maarten Naesens
- 1] UZ Leuven, Department of Nephrology, Leuven, Belgium [2] KU Leuven, Department of Microbiology and Immunology, Leuven, Belgium
| | - Markus Storr
- Research and Development, Gambro Dialysatoren GmbH, Hechingen, Germany
| | - Dirk Kuypers
- 1] UZ Leuven, Department of Nephrology, Leuven, Belgium [2] KU Leuven, Department of Microbiology and Immunology, Leuven, Belgium
| | - Pieter Evenepoel
- 1] UZ Leuven, Department of Nephrology, Leuven, Belgium [2] KU Leuven, Department of Microbiology and Immunology, Leuven, Belgium
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Huang J, Liu G, Zhang YM, Cui Z, Wang F, Liu XJ, Chu R, Zhao MH. Urinary soluble urokinase receptor levels are elevated and pathogenic in patients with primary focal segmental glomerulosclerosis. BMC Med 2014; 12:81. [PMID: 24884842 PMCID: PMC4064821 DOI: 10.1186/1741-7015-12-81] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 03/31/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Focal segmental glomerulosclerosis (FSGS) is a major cause of end-stage renal disease. Recent studies have proposed that plasma soluble urokinase receptor (suPAR) might be a causative circulating factor but this proposal has caused controversy. This study aimed to measure urinary suPAR levels in patients with primary FSGS and its significance in the pathogenesis of FSGS. METHODS Sixty-two patients with primary FSGS, diagnosed between January 2006 and January 2012, with complete clinical and pathologic data were enrolled, together with disease and normal controls. Urinary suPAR levels were measured using commercial ELISA kits and were corrected by urinary creatinine (Cr). The associations between urinary suPAR levels and clinical data at presentation and during follow up were analyzed. Conditionally immortalized human podocytes were used to study the effect of urinary suPAR on activating β3 integrin detected by AP5 staining. RESULTS The urinary suPAR level of patients with primary FSGS (500.56, IQR 262.78 to 1,059.44 pg/μmol Cr) was significantly higher than that of patients with minimal change disease (307.86, IQR 216.54 to 480.18 pg/μmol Cr, P = 0.033), membranous nephropathy (250.23, IQR 170.37 to 357.59 pg/μmol Cr, P <0.001), secondary FSGS (220.45, IQR 149.38 to 335.54 pg/μmol Cr, P <0.001) and normal subjects (183.59, IQR 103.92 to 228.78 pg/μmol Cr, P <0.001). The urinary suPAR level of patients with cellular variant was significantly higher than that of patients with tip variant. The urinary suPAR level in the patients with primary FSGS was positively correlated with 24-hour urine protein (r = 0.287, P = 0.024). During follow up, the urinary suPAR level of patients with complete remission decreased significantly (661.19, IQR 224.32 to 1,115.29 pg/μmol Cr versus 217.68, IQR 121.77 to 415.55 pg/μmol Cr, P = 0.017). The AP5 signal was strongly induced along the cell membrane when human differentiated podocytes were incubated with the urine of patients with FSGS at presentation, and the signal could be reduced by a blocking antibody specific to uPAR. CONCLUSIONS Urinary suPAR was specifically elevated in patients with primary FSGS and was associated with disease severity. The elevated urinary suPAR could activate β3 integrin on human podocytes.
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Affiliation(s)
| | | | | | | | | | | | | | - Ming-hui Zhao
- Renal Division, Peking University First Hospital, Beijing, PR China.
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Abstract
Primary focal segmental glomerulosclerosis (FSGS) accounts for nearly 10 % of patients who require renal replacement therapy. Elevated circulating levels of soluble urokinase receptor (suPAR) have been identified as a biomarker to discriminate primary FSGS from other glomerulopathies. Subsequent reports have questioned the diagnostic utility of this test. In a study in BMC Medicine, Huang et al. demonstrate that urinary soluble urokinase receptor (suPAR) excretion assists in distinguishing primary FSGS from other glomerular diseases, and that high plasma suPAR concentrations are not directly linked to a decline in glomerular filtration rate (GFR). This observation suggests that further investigation of suPAR is warranted in patients with FSGS. It should be interpreted in light of a recent report that B7-1 is expressed in the podocytes of a subset of patients with FSGS, and that blocking this molecule may represent the first successful targeted intervention for this disease. These advances highlight the rapid pace of scientific progress in the field of nephrology. Nephrologists should work together, share resources, and expedite the design of protocols to evaluate these novel biomarkers in a comprehensive and scientifically valid manner.
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Affiliation(s)
- Howard Trachtman
- NYU Langone Medical Center, Department of Pediatrics, Division of Nephrology, CTSI, 227 E 30th Street, Room #110, New York, NY, USA.
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Cathelin D, Placier S, Ploug M, Verpont MC, Vandermeersch S, Luque Y, Hertig A, Rondeau E, Mesnard L. Administration of recombinant soluble urokinase receptor per se is not sufficient to induce podocyte alterations and proteinuria in mice. J Am Soc Nephrol 2014; 25:1662-8. [PMID: 24790179 DOI: 10.1681/asn.2013040425] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Circulating levels of soluble forms of urokinase-type plasminogen activator receptor (suPAR) are generally elevated in sera from children and adults with FSGS compared with levels in healthy persons or those with other types of kidney disease. In mice lacking the gene encoding uPAR, forced increases in suPAR concentration result in FSGS-like glomerular lesions and proteinuria. However, whether overexpression of suPAR, per se, contributes to the pathogenesis of FSGS in humans remains controversial. We conducted an independent set of animal experiments in which two different and well characterized forms of recombinant suPAR produced by eukaryotic cells were administered over the short or long term to wild-type (WT) mice. In accordance with the previous study, the delivered suPARs are deposited in the glomeruli. However, such deposition of either form of suPAR in the kidney did not result in increased glomerular proteinuria or altered podocyte architecture. Our findings suggest that glomerular deposits of suPAR caused by elevated plasma levels are not sufficient to engender albuminuria.
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Affiliation(s)
- Dominique Cathelin
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1155 - "Rare and common kidney diseases, matrix remodeling and tissue repair," Paris, France; Institut National de la Santé et de la Recherche Médicale UMR_S 1155 - "Rare and common kidney diseases, matrix remodelling and tissue repair," and
| | - Sandrine Placier
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1155 - "Rare and common kidney diseases, matrix remodeling and tissue repair," Paris, France; Institut National de la Santé et de la Recherche Médicale UMR_S 1155 - "Rare and common kidney diseases, matrix remodelling and tissue repair," and
| | - Michael Ploug
- Finsen Laboratory and Bric, Rigshospitalet, Copenhagen, Denmark
| | - Marie-Christine Verpont
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1155 - "Rare and common kidney diseases, matrix remodeling and tissue repair," Paris, France; Institut National de la Santé et de la Recherche Médicale UMR_S 1155 - "Rare and common kidney diseases, matrix remodelling and tissue repair," and
| | - Sophie Vandermeersch
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1155 - "Rare and common kidney diseases, matrix remodeling and tissue repair," Paris, France; Institut National de la Santé et de la Recherche Médicale UMR_S 1155 - "Rare and common kidney diseases, matrix remodelling and tissue repair," and
| | - Yosu Luque
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1155 - "Rare and common kidney diseases, matrix remodeling and tissue repair," Paris, France; Institut National de la Santé et de la Recherche Médicale UMR_S 1155 - "Rare and common kidney diseases, matrix remodelling and tissue repair," and Assistance Publique-Hôpitaux de Paris, Nephrological Emergencies and Renal Transplantation, Tenon Hospital, Paris, France; and
| | - Alexandre Hertig
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1155 - "Rare and common kidney diseases, matrix remodeling and tissue repair," Paris, France; Institut National de la Santé et de la Recherche Médicale UMR_S 1155 - "Rare and common kidney diseases, matrix remodelling and tissue repair," and Assistance Publique-Hôpitaux de Paris, Nephrological Emergencies and Renal Transplantation, Tenon Hospital, Paris, France; and
| | - Eric Rondeau
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1155 - "Rare and common kidney diseases, matrix remodeling and tissue repair," Paris, France; Institut National de la Santé et de la Recherche Médicale UMR_S 1155 - "Rare and common kidney diseases, matrix remodelling and tissue repair," and Assistance Publique-Hôpitaux de Paris, Nephrological Emergencies and Renal Transplantation, Tenon Hospital, Paris, France; and
| | - Laurent Mesnard
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1155 - "Rare and common kidney diseases, matrix remodeling and tissue repair," Paris, France; Institut National de la Santé et de la Recherche Médicale UMR_S 1155 - "Rare and common kidney diseases, matrix remodelling and tissue repair," and Assistance Publique-Hôpitaux de Paris, Nephrological Emergencies and Renal Transplantation, Tenon Hospital, Paris, France; and
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Sethi S, Glassock RJ, Fervenza FC. Focal segmental glomerulosclerosis: towards a better understanding for the practicing nephrologist. Nephrol Dial Transplant 2014; 30:375-84. [PMID: 24589721 DOI: 10.1093/ndt/gfu035] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Focal and segmental glomerulosclerosis (FSGS) is a common histopathological lesion that can represent a primary podocytopathy, or occur as an adaptive phenomenon consequent to nephron mass reduction, a scar from a healing vasculitic lesion, direct drug toxicity or viral infection among other secondary causes. Thus, the presence of an FSGS lesion in a renal biopsy does not confer a disease diagnosis, but rather represents the beginning of an exploratory process, hopefully leading ultimately to identification of a specific etiology and its appropriate treatment. We define primary FSGS as a 'primary' podocytopathy characterized clinically by the presence of nephrotic syndrome in a patient with an FSGS lesion on light microscopy and widespread foot process effacement on electron microscopy (EM). Secondary FSGS is commonly characterized by the absence of nephrotic syndrome and the presence of segmental foot process effacement on EM. Failure to accurately differentiate between the primary and secondary forms of FSGS has resulted in many patients undergoing unnecessary immunosuppressive treatment. Here, we review some key points that may assist the practicing nephrologist to distinguish between primary and secondary FSGS.
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Affiliation(s)
- Sanjeev Sethi
- Division of Anatomic Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Fernando C Fervenza
- Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, Rochester, MN, USA
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61
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The soluble urokinase receptor is not a clinical marker for focal segmental glomerulosclerosis. Kidney Int 2014; 85:636-40. [PMID: 24402090 DOI: 10.1038/ki.2013.505] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 09/24/2013] [Accepted: 10/10/2013] [Indexed: 11/08/2022]
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Hildebrand AM, Huang SHS, Clark WF. Plasma exchange for kidney disease: what is the best evidence? Adv Chronic Kidney Dis 2014; 21:217-27. [PMID: 24602471 DOI: 10.1053/j.ackd.2014.01.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 01/14/2014] [Accepted: 01/15/2014] [Indexed: 11/11/2022]
Abstract
Therapeutic plasma exchange (TPE) has been used as adjunctive therapy for various kidney diseases dating back to the 1970s. In many cases, support for TPE was on mechanistic grounds given the potential to remove unwanted large molecular-weight substances such as autoantibodies, immune complexes, myeloma light chains, and cryoglobulins. More recently, growing evidence from randomized controlled trials, meta-analyses, and prospective studies has provided insights into more rational use of this therapy. This report describes the role of TPE for the 6 most common kidney indications in the 2013 Canadian Apheresis Group (CAG) registry and the evidence that underpins current recommendations and practice. These kidney indications include thrombotic microangiopathy, antiglomerular basement membrane disease, anti-neutrophil cytoplasmic antibody-associated vasculitis, cryoglobulinemia, recurrence of focal and segmental glomerulosclerosis in the kidney allograft, and kidney transplantation.
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Sinha A, Bajpai J, Saini S, Bhatia D, Gupta A, Puraswani M, Dinda AK, Agarwal SK, Sopory S, Pandey RM, Hari P, Bagga A. Serum-soluble urokinase receptor levels do not distinguish focal segmental glomerulosclerosis from other causes of nephrotic syndrome in children. Kidney Int 2014; 85:649-58. [PMID: 24429405 DOI: 10.1038/ki.2013.546] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 11/16/2013] [Accepted: 11/26/2013] [Indexed: 12/31/2022]
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64
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Are serum suPAR determinations by current ELISA methodology reliable diagnostic biomarkers for FSGS? Kidney Int 2014; 85:499-501. [DOI: 10.1038/ki.2013.549] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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65
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Renal biopsy: use of biomarkers as a tool for the diagnosis of focal segmental glomerulosclerosis. DISEASE MARKERS 2014; 2014:192836. [PMID: 24719498 PMCID: PMC3955602 DOI: 10.1155/2014/192836] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/15/2014] [Accepted: 01/15/2014] [Indexed: 12/12/2022]
Abstract
Focal segmental glomerulosclerosis (FSGS) is a glomerulopathy associated with nephrotic syndrome and podocyte injury. FSGS occurs both in children and adults and it is considered the main idiopathic nephrotic syndrome nowadays. It is extremely difficult to establish a morphological diagnosis, since some biopsies lack a considerable quantifiable number of sclerotic glomeruli, given their focal aspect and the fact that FSGS occurs in less than half of the glomeruli. Therefore, many biological molecules have been evaluated as potential markers that would enhance the diagnosis of FSGS. Some of these molecules and receptors are associated with the pathogenesis of FSGS and have potential use in diagnosis.
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66
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A multicenter cross-sectional study of circulating soluble urokinase receptor in Japanese patients with glomerular disease. Kidney Int 2014; 85:641-8. [PMID: 24429394 DOI: 10.1038/ki.2013.544] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 10/21/2013] [Accepted: 11/14/2013] [Indexed: 12/27/2022]
Abstract
Elevated serum-soluble urokinase receptor (suPAR) levels have been described in patients with focal segmental glomerulosclerosis (FSGS) in several different cohorts. However, it remains unclear whether this is the case for Japanese patients and whether circulating suPAR can be clinically useful as a diagnostic marker. To determine this, we measured serum suPAR levels in 69 Japanese patients with biopsy-proven glomerular diseases in a cross-sectional manner. The serum suPAR levels showed a significant inverse correlation with renal function by univariate (R(2) of 0.242) and multivariate (β=0.226) analyses. Even after excluding patients with renal dysfunction, no significant difference in the suPAR levels was detected among the groups. Receiver operating characteristic analysis and measures of the diagnostic test performance showed that suPAR was not a useful parameter for differentiating FSGS from the other glomerular diseases (AUC-ROC: 0.621), although a small subgroup analysis showed that patients with FSGS, treated with steroids and/or immunosuppressants, had significantly lower suPAR levels. Patients with ANCA-associated glomerulonephritis had significantly higher levels of suPAR compared with the other disease groups, which may be owing to their lower renal function and systemic inflammation. Thus, suPAR levels are significantly affected by renal function and have little diagnostic value even in patients with normal renal function.
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67
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Sahali D, Sendeyo K, Mangier M, Audard V, Zhang SY, Lang P, Ollero M, Pawlak A. Immunopathogenesis of idiopathic nephrotic syndrome with relapse. Semin Immunopathol 2014; 36:421-9. [PMID: 24402710 DOI: 10.1007/s00281-013-0415-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 12/03/2013] [Indexed: 12/14/2022]
Abstract
Idiopathic change nephrotic syndrome (INS), the most frequent glomerular disease in children and young adults, is characterized by heavy proteinuria and a relapsing remitting course. Although the mechanisms underlying the pathophysiology of proteinuria remain unclear, clinical and experimental observations suggest that lymphocyte and podocyte disturbances are two sides of the disease. The current hypothesis suggests that immune cells release a putative factor, which alters podocyte function resulting in nephrotic proteinuria. Besides T-cell abnormalities, recent evidence of B-cell depletion efficacy in sustained remissions added a new challenge in understanding the immunological mechanisms of INS. In this review, we discuss recent insights related to podocyte disorders occurring in INS and their relevance in human diseases.
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Affiliation(s)
- Djillali Sahali
- Service de Néphrologie et Transplantation, AP-HP, CHU Henri Mondor, Creteil, 94010, France,
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Sever S, Trachtman H, Wei C, Reiser J. Is there clinical value in measuring suPAR levels in FSGS? Clin J Am Soc Nephrol 2013; 8:1273-5. [PMID: 23886567 DOI: 10.2215/cjn.06170613] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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