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Serum suPAR levels help differentiate steroid resistance from steroid-sensitive nephrotic syndrome in children. Pediatr Nephrol 2015; 30:301-7. [PMID: 25034499 DOI: 10.1007/s00467-014-2892-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 05/27/2014] [Accepted: 06/16/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Soluble urokinase plasminogen activator receptor (suPAR) has been regarded as a permeability factor in proteinuria, though its role in primary nephrotic syndrome remains to be elucidated further. METHODS Plasma samples and clinical information from 176 children with primary nephrotic syndrome were collected and concentrations of suPAR were measured. We evaluated the correlation between suPAR concentrations and clinical features, and the value of the plasma suPAR level in predicting steroid-resistant nephrotic syndrome (SRNS). RESULTS There is a significant difference in plasma suPAR concentration between SRNS and steroid-sensitive nephrotic syndrome (SSNS) groups (3,744.1 ± 2,226.0 vs. 2,153.5 ± 1,167.0, p < 0.05). The area under the curve (AUC) was 0.80, with p < 0.001 for the receiver operating characteristic (ROC) curve analysis using suPAR to predict SRNS. The suspicious range for predicting SRNS was estimated to be 1,907.0 pg/ml to 3,043.5 pg/ml (χ(2) = 14.775, p = 0.001). CONCLUSIONS From ROC curve analysis, we demonstrated the significance of the suPAR level in predicting SRNS with a high specificity but low sensitivity. However, the clinical value of suPAR to predict steroid resistance and guide therapy remains to be investigated further.
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Circulating suPAR levels are affected by glomerular filtration rate and proteinuria in primary and secondary glomerulonephritis. J Nephrol 2014; 28:299-305. [PMID: 25185729 DOI: 10.1007/s40620-014-0137-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 08/27/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND Circulating levels of soluble urokinase-like plasminogen activator receptor (suPAR) have been associated with proteinuria and renal function in focal segmental glomerulosclerosis (FSGS). This study aimed to evaluate if circulating suPAR levels are independently associated with proteinuria in patients with non-FSGS glomerulonephritis. METHODS This is a cross-sectional analysis of suPAR levels on 42 patients with primary non-FSGS glomerulonephritis (group GN) and 140 patients with secondary glomerulonephritis within an autoimmune disease (group AID). RESULTS suPAR serum levels were significantly higher in AID patients (4,733 ± 3,073 pg/ml) than in healthy controls (1,908 ± 1,685 pg/ml; p < 0.001), whereas GN patients displayed intermediate levels (3,670 ± 2,435 pg/ml; p = 0.021). Multivariate analysis for elevated serum suPAR (>3,000 pg/ml) showed an independent association with estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2) [odds ratio (OR) = 4.19, 95% confidence interval (CI): 1.67-10.54, p = 0.002], proteinuria >0.5 g/day (OR = 2.97; 95% CI: 1.32-6.70; p = 0.009) and presence of secondary vs. primary GN (OR = 2.87, 95% CI: 1.25-6.23; p = 0.013). A general linear model confirmed that suPAR levels were significantly affected by proteinuria >0.50 g/day (coefficient +1,477 pg/ml), eGFR (-38 pg/ml per 1 ml/min/1.73 m(2) increase) and presence of secondary vs. primary GN (+1,368 pg/ml). CONCLUSIONS This study shows that elevated serum suPAR levels are associated with reduced eGFR and presence of proteinuria in both primary and secondary GN, suggesting that circulating suPAR may represent a common biomarker of renal involvement in a wide spectrum of GN.
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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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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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Trimarchi H. Primary focal and segmental glomerulosclerosis and soluble factor urokinase-type plasminogen activator receptor. World J Nephrol 2013; 2:103-110. [PMID: 24255893 PMCID: PMC3832866 DOI: 10.5527/wjn.v2.i4.103] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 09/24/2013] [Accepted: 10/20/2013] [Indexed: 02/06/2023] Open
Abstract
Primary focal and segmental glomerulosclerosis (FSGS) may be due to genetic or acquired etiologies and is a common cause of nephrotic syndrome with high morbidity that often leads to end-stage renal failure. The different available therapeutic approaches are unsuccessful, in part due to partially deciphered heterogeneous and complex pathophysiological mechanisms. Moreover, the term FSGS, even in its primary form, comprises a histological description shared by a number of different causes with completely different molecular pathways of disease. This review focuses on the latest developments regarding the pathophysiology of primary acquired FSGS caused by soluble factor urokinase type plasminogen activator receptor, a circulating permeability factor involved in proteinuria and edema formation, and describes recent advances with potential success in therapy.
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