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Zeng L, Ng JKC, Fung WWS, Chan GCK, Chow KM, Szeto CC. Urinary podocyte stress marker as a prognostic indicator for diabetic kidney disease. BMC Nephrol 2024; 25:32. [PMID: 38267859 PMCID: PMC10807208 DOI: 10.1186/s12882-024-03471-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/17/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Diabetic kidney diseases (DKD) is a the most common cause of end-stage kidney disease (ESKD) around the world. Previous studies suggest that urinary podocyte stress biomarker, e.g. podocin:nephrin mRNA ratio, is a surrogate marker of podocyte injury in non-diabetic kidney diseases. METHOD We studied 118 patients with biopsy-proved DKD and 13 non-diabetic controls. Their urinary mRNA levels of nephrin, podocin, and aquaporin-2 (AQP2) were quantified. Renal events, defined as death, dialysis, or 40% reduction in glomerular filtration rate, were determined at 12 months. RESULTS Urinary podocin:nephrin mRNA ratio of DKD was significantly higher than the control group (p = 0.0019), while urinary nephrin:AQP2 or podocin:AQP2 ratios were not different between groups. In DKD, urinary podocin:nephrin mRNA ratio correlated with the severity of tubulointerstitial fibrosis (r = 0.254, p = 0.006). and was associated with the renal event-free survival in 12 months (unadjusted hazard ratio [HR], 1.523; 95% confidence interval [CI] 1.157-2.006; p = 0.003). After adjusting for clinical and pathological factors, urinary podocin:nephrin mRNA ratio have a trend to predict renal event-free survival (adjusted HR, 1.327; 95%CI 0.980-1.797; p = 0.067), but the result did not reach statistical significance. CONCLUSION Urinary podocin:nephrin mRNA ratio has a marginal prognostic value in biopsy-proven DKD. Further validation is required for DKD patients without kidney biopsy.
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Affiliation(s)
- Lingfeng Zeng
- Department of General Medicine, The Xiangya Second Hospital of Central South University, Changsha, China
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, Randwick, Australia
| | - Jack Kit-Chung Ng
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, Randwick, Australia
- Li Ka Shing Institute of Health Sciences (LiHS), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Winston Wing-Shing Fung
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, Randwick, Australia
| | - Gordon Chun-Kau Chan
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, Randwick, Australia
| | - Kai-Ming Chow
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, Randwick, Australia
| | - Cheuk-Chun Szeto
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, Randwick, Australia.
- Li Ka Shing Institute of Health Sciences (LiHS), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
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Podocyturia: an earlier biomarker of cardiovascular outcomes. Sci Rep 2022; 12:21563. [PMID: 36513746 PMCID: PMC9747803 DOI: 10.1038/s41598-022-26162-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
Urinary podocin and nephrin mRNAs (podocyturia), as candidate biomarkers of endothelial/podocyte injury, were measured by quantitative PCR in Type II diabetics with normal albumin excretion rates (AER) at baseline, at 3-4 years, and at 7 years. Development of cardiovascular disease (CVD) was collected as outcome. Visit 1 podocyturia was significantly higher in subjects who subsequently developed CVD versus those who did not. Visit 1 AER terciles exhibited similar time to CVD, in contrast with stepwise and substantial increases in CVD events predicted by Visit 1 podocyturia terciles. Covariate-adjusted hazard ratios were highest for podocin, intermediate for nephrin mRNAs, and lowest for AER. Podocyturia was also measured in patients with and without significant coronary obstruction, and in 480 normoalbuminuric subjects at the enrolment visit to the Multi-Ethnic Study of Atherosclerosis (MESA). Podocyturia > 3 × 106 copies was associated with presence of obstructive coronary artery disease. In the MESA population, Visit 1 podocyturia was significantly higher in men, subjects with elevated BMI, and those with Type II DM. Conclusions: Podocyturia may be an earlier predictor of cardiovascular events than moderate albuminuria; it is significantly higher in patients with obstructive coronary artery disease, and in subjects with established risk factors for CVD.
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Müller-Deile J, Schiffer M. Podocytes from the diagnostic and therapeutic point of view. Pflugers Arch 2017; 469:1007-1015. [PMID: 28508947 DOI: 10.1007/s00424-017-1993-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/04/2017] [Indexed: 01/23/2023]
Abstract
The central role of podocytes in glomerular diseases makes this cell type an interesting diagnostic tool as well as a therapeutic target. In this review, we discuss the current literature on the use of podocytes and podocyte-specific markers as non-invasive diagnostic tools in different glomerulopathies. Furthermore, we highlight the direct effects of drugs currently used to treat primary glomerular diseases and describe their direct cellular effects on podocytes. A new therapeutic potential is seen in drugs targeting the podocytic actin cytoskeleton which is essential for podocyte foot process structure and function. Incubation of cultured human podocyte cell lines with sera from patients with active glomerular diseases is currently also used to identify novel circulating factors with pathophysiological relevance for the glomerular filtration barrier. In addition, treatment of detached urinary podocytes from patients with substances that restore their cytoskeleton might serve as a novel personalized tool to estimate their potential for podocyte recovery ex vivo.
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Affiliation(s)
- Janina Müller-Deile
- Department of Nephrology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Mario Schiffer
- Department of Nephrology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Petrica L, Ursoniu S, Gadalean F, Vlad A, Gluhovschi G, Dumitrascu V, Vlad D, Gluhovschi C, Velciov S, Bob F, Matusz P, Milas O, Secara A, Simulescu A, Popescu R. Urinary podocyte-associated mRNA levels correlate with proximal tubule dysfunction in early diabetic nephropathy of type 2 diabetes mellitus. Diabetol Metab Syndr 2017; 9:31. [PMID: 28484521 PMCID: PMC5420400 DOI: 10.1186/s13098-017-0228-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 04/27/2017] [Indexed: 02/07/2023] Open
Abstract
AIM The study assessed mRNA expression of podocyte-associated molecules in urinary sediments of patients with type 2 diabetes mellitus (DM) in relation to urinary podocytes, biomarkers of podocyte injury and of proximal tubule (PT) dysfunction. METHODS A total of 76 patients with type 2 DM and 20 healthy subjects were enrolled in a cross-sectional study, and assessed concerning urinary podocytes, urinary mRNA of podocyte-associated genes, urinary biomarkers of podocyte damage and of PT dysfunction. RESULTS We found significant differences between urinary mRNA of podocyte-associated molecules in relation with albuminuria stage. In multivariable regression analysis, urinary mRNA of nephrin, podocin, alpha-actinin-4, CD2-associated protein, glomerular epithelial protein 1 (GLEPP1), ADAM 10, and NFκB correlated directly with urinary podocytes, albuminuria, urinary alpha1-microglobulin, urinary kidney-injury molecule-1, nephrinuria, urinary vascular endothelial growth factor, urinary advanced glycation end-products (AGE), and indirectly with eGFR (p < 0.0001, R2 = 0.808; p < 0.0001, R2 = 0.825; p < 0.0001, R2 = 0.805; p < 0.0001, R2 = 0.663; p < 0.0001, R2 = 0.726; p < 0.0001, R2 = 0.720; p < 0.0001, R2 = 0.724). CONCLUSIONS In patients with type 2 DM there is an association between urinary mRNA of podocyte-associated molecules, biomarkers of podocyte damage, and of PT dysfunction. GLEPP1, ADAM10, and NFκB may be considered additional candidate molecules indicative of early diabetic nephropathy. AGE could be involved in this association.
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Affiliation(s)
- Ligia Petrica
- Department of Nephrology, ‘Victor Babes’ University of Medicine and Pharmacy, Str. Iuliu Grozescu, No 6, Bl T27, Ap 10, Timisoara, Romania
- Centre for Translational Research and Systems Medicine, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Sorin Ursoniu
- Department of Public Health Medicine, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Florica Gadalean
- Department of Nephrology, ‘Victor Babes’ University of Medicine and Pharmacy, Str. Iuliu Grozescu, No 6, Bl T27, Ap 10, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Adrian Vlad
- Department of Diabetes and Metabolic Diseases, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Gheorghe Gluhovschi
- Department of Nephrology, ‘Victor Babes’ University of Medicine and Pharmacy, Str. Iuliu Grozescu, No 6, Bl T27, Ap 10, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Victor Dumitrascu
- Department of Pharmacology, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Daliborca Vlad
- Department of Pharmacology, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Cristina Gluhovschi
- Department of Nephrology, ‘Victor Babes’ University of Medicine and Pharmacy, Str. Iuliu Grozescu, No 6, Bl T27, Ap 10, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Silvia Velciov
- Department of Nephrology, ‘Victor Babes’ University of Medicine and Pharmacy, Str. Iuliu Grozescu, No 6, Bl T27, Ap 10, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Flaviu Bob
- Department of Nephrology, ‘Victor Babes’ University of Medicine and Pharmacy, Str. Iuliu Grozescu, No 6, Bl T27, Ap 10, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Petru Matusz
- Department of Anatomy and Embryology, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Oana Milas
- Department of Nephrology, ‘Victor Babes’ University of Medicine and Pharmacy, Str. Iuliu Grozescu, No 6, Bl T27, Ap 10, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Alina Secara
- Department of Nephrology, ‘Victor Babes’ University of Medicine and Pharmacy, Str. Iuliu Grozescu, No 6, Bl T27, Ap 10, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Anca Simulescu
- Department of Nephrology, ‘Victor Babes’ University of Medicine and Pharmacy, Str. Iuliu Grozescu, No 6, Bl T27, Ap 10, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Roxana Popescu
- Department of Cellular and Molecular Biology, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
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Peng XH, Liang PY, Ou SJ, Zu XB. Protective effect of pioglitazone on kidney injury in diabetic rats. ASIAN PAC J TROP MED 2014; 7:819-22. [DOI: 10.1016/s1995-7645(14)60143-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 08/15/2014] [Accepted: 09/15/2014] [Indexed: 10/24/2022] Open
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Liu S, Mei P, Shi W, Zhang B, Li S, Liang X, Ye Z, Xu L, Ma J, Li Z, Zhang L, Wang W, Wang L, Li R, Feng Z, Dong W, Tao Y. Urinary messenger RNA of the receptor activator of NF-kappaB could be used to differentiate between minimal change disease and membranous nephropathy. Biomarkers 2014; 19:597-603. [DOI: 10.3109/1354750x.2014.956148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Ping Mei
- Department of Pathology, Guangdong General Hospital, Guangdong Academy of Medical Sciences
Guangzhou, GuangdongChina
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Dai Y, Yang H, Gao P, Liu WD. NPHS2 variation in Chinese southern infants with late steroid-resistant nephrotic syndrome. Ren Fail 2014; 36:1395-8. [PMID: 25112471 DOI: 10.3109/0886022x.2014.947515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Abstract NPHS2 mutations are responsible for autosomal recessive familial steroid-resistant nephrotic syndrome (SRNS) with minor glomerular abnormalities or focal segmental glomerulosclerosis (FSGS), which is characterized by early childhood onset and rapid progression to chronic renal insufficiency. This gene mutation is also responsible for an adolescent onset form of autosomal recessive familial FSGS with heavy proteinuria. Many infants with late steroid-resistant nephrotic syndrome (late SRNS) are prone to an implicated clinical and therapeutic course. The etiopathogenesis and the long-term prognosis of late SRNS remain obscure. Considering the similar steroid resistance between late and initial SRNS, analysis of NPHS2 variation was performed in 70 sporadic Chinese infants with late SRNS and 70 controls in the present study to investigate the possible role of NPHS2 gene in late SRNS. The variation analysis revealed three polymorphisms (288C > T heterozygous in exon 2, 954T > C heterozygous and homozygous, and 1038A > G heterozygous in exon 8) in 22 out of 70 patients studied. In conclusion, NPHS2 gene mutations are not a major cause of chronic renal insufficiency caused by late SRNS in Chinese southern infants.
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Affiliation(s)
- Yiheng Dai
- Department of Neonatal, South Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan, Guang Dong , China
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A compendium of urinary biomarkers indicative of glomerular podocytopathy. PATHOLOGY RESEARCH INTERNATIONAL 2013; 2013:782395. [PMID: 24327929 PMCID: PMC3845336 DOI: 10.1155/2013/782395] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 09/10/2013] [Indexed: 12/18/2022]
Abstract
It is well known that glomerular podocyte injury and loss are present in numerous nephropathies and that the pathophysiologic consecution of disease hinges upon the fate of the podocyte. While multiple factors play a hand in glomerulopathy progression, basic logic lends that if one monitors the podocyte's status, that may reflect the status of disease. Recent investigations have focused on what one can elucidate from the noninvasive collection of urine, and have proven that certain, specific biomarkers of podocytes can be readily identified via varying techniques. This paper has brought together all described urinary biomarkers of podocyte injury and is made to provide a concise summary of their utility and testing in laboratory and clinical theatres. While promising in the potential that they hold as tools for clinicians and investigators, the described biomarkers require further comprehensive vetting in the form of larger clinical trials and studies that would give their value true weight. These urinary biomarkers are put forth as novel indicators of glomerular disease presence, disease progression, and therapeutic efficacy that in some cases may be more advantageous than the established parameters/measures currently used in practice.
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Lv LL, Cao YH, Pan MM, Liu H, Tang RN, Ma KL, Chen PS, Liu BC. CD2AP mRNA in urinary exosome as biomarker of kidney disease. Clin Chim Acta 2013; 428:26-31. [PMID: 24144866 DOI: 10.1016/j.cca.2013.10.003] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 10/03/2013] [Indexed: 12/12/2022]
Abstract
AIMS Podocyte injury plays an important role in the pathogenesis of kidney disease. Urinary exosomes are microvesicles released by tubular epithelial cells and podocytes containing information of their originated cells. This study investigated for the first time whether podocyte related mRNA in urinary exosome could serve as novel biomarkers for kidney disease. METHODS Urine samples were collected from 32 patients of kidney disease who underwent kidney biopsy and 7 controls. CD2AP, NPHS2 and synaptopodin were detected by real-time RT-PCR on RNA isolated from urinary exosome. RESULTS The pellet microvesicles were positively stained with exosome and podocyte marker, AQP2, CD9 and nephrin. CD2AP mRNA was lower (p=0.008) in kidney disease patients compared with controls and decreased with the increasing severity of proteinuria (p=0.06). CD2AP correlated with serum creatinine (r=-0.373, p=0.035), BUN (r=-0.445, p=0.009) and eGFR (r=0.351, p=0.046). Neither NPHS2 nor synaptopodin correlated with parameters of renal function. CD2AP mRNA correlated negatively with 24 hour urine protein (r=-0.403, p=0.022), severity of tubulointerstitial fibrosis (r=-0.394, p=0.026) and glomerulosclerosis (r=-0.389, p=0.031) and could discriminate kidney disease from controls with AUC of 0.821 (p=0.008). CONCLUSIONS Urinary exosome mRNA of CD2AP might be a non-invasive tool for detecting both renal function and fibrosis of kidney disease.
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Affiliation(s)
- Lin-Li Lv
- Institute of Nephrology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
| | - Yu-Han Cao
- Institute of Nephrology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Ming-Ming Pan
- Institute of Nephrology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Hong Liu
- Institute of Nephrology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Ri-Ning Tang
- Institute of Nephrology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Kun-Ling Ma
- Institute of Nephrology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Ping-Sheng Chen
- Institute of Nephrology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Bi-Cheng Liu
- Institute of Nephrology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
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Agrawal V, Prasad N, Jain M, Pandey R. Reduced podocin expression in minimal change disease and focal segmental glomerulosclerosis is related to the level of proteinuria. Clin Exp Nephrol 2013; 17:811-8. [PMID: 23377573 DOI: 10.1007/s10157-013-0775-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 01/14/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Glomerular podocyte molecules are involved in the pathogenesis of congenital nephrotic syndrome. However, their role in primary nephrotic syndrome is not clear. This study investigated the expression of nephrin, podocin and synaptopodin in primary nephrotic syndrome. METHODS Eighty-seven patients with primary nephrotic syndrome including minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), membranous nephropathy (MN) and membranoproliferative glomerulonephritis Type I (MPGN) were included in the study. Glomerular expression of nephrin, podocin and synaptopodin was studied in renal biopsies by immunofluorescence and immunohistochemistry. Correlation of expression with clinical and biochemical parameters was performed. RESULTS The pattern of expression for all podocyte proteins in controls was uniform fine granular along the capillary walls towards the visceral epithelial cell aspect. Glomerular expression of nephrin was present in all renal biopsies and was similar to that in controls. Glomerular synaptopodin expression was seen in all MN and MPGN patients, while it was seen in 74 % (17/23) MCD and 93.5 % (29/31) FSGS. Reduced synaptopodin expression showed no correlation with clinical and biochemical factors. Podocin expression was present in 5/23 MCD (22 %), 3/31 FSGS (9.6 %), 13/17 MN (76.4 %) and 13/16 MPGN (81 %) patients. The reduced expression of podocin significantly correlated with the degree of proteinuria (p = 0.032). No correlation with age, gender and serum creatinine level was observed. CONCLUSION Reduction of glomerular podocin expression found in MCD and FSGS is related to the amount of proteinuria. Our findings suggest that alteration in podocyte phenotype may not be a primary event and may reflect the degree of podocyte injury in primary nephrotic syndrome.
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Affiliation(s)
- Vinita Agrawal
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India,
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Aizawa K, Takeda S, Tashiro Y, Yorozu K, Hirata M, Kanada H, Moriguchi Y, Endo K. Renoprotection by continuous erythropoietin receptor activator in puromycin aminonucleoside-induced nephrotic syndrome. Am J Nephrol 2012; 36:419-26. [PMID: 23128049 DOI: 10.1159/000343493] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 09/15/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND/AIMS Recent studies have demonstrated that erythropoiesis-stimulating agents (ESAs) induce a tissue-protective effect in the kidney. In this study, we examined whether continuous erythropoietin receptor activator (CERA), a long-acting ESA, could prevent kidney injury, especially podocyte damage, in a rat model of nephrotic syndrome induced by puromycin aminonucleoside (PAN). METHODS Rats were injected with CERA (30 µg/kg) or vehicle 4 h before the injection of PAN (50 mg/kg). Renal function, kidney injury, and podocyte damage were assessed at 7 days. RESULTS The levels of proteinuria, BUN, and plasma creatinine significantly increased in rats with PAN-induced nephrosis. Treatment with CERA significantly prevented these deteriorations induced by PAN. Glomerular lesions, especially vacuolation of podocytes, and the increase of desmin expression in PAN-treated rats were significantly ameliorated by treatment with CERA. Treatment with CERA also significantly prevented the decrease in the protein productions of nephrin and podocin in the kidneys of PAN-treated rats. We found persistent activation of the Akt signaling pathway in the kidneys of CERA-treated rats. CONCLUSION CERA could ameliorate renal dysfunction in PAN-induced nephrosis, which might be due to the amelioration of podocyte injury. CERA inhibited the depletion of nephrin and podocin, key components of the glomerular filtration barrier, and alleviated proteinuria. Activation of the Akt signaling pathway might be involved in the renoprotective effect of CERA.
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Affiliation(s)
- Ken Aizawa
- Product Research Department, Chugai Pharmaceutical Co., Ltd, Gotemba, Japan
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Abstract
Podocyte loss is an important component of disease progression in glomerular diseases. To some extent, the loss of podocytes can predict the degree of damage and the advancement of renal disease. Detecting the loss of podocytes in the urine could be a valuable, noninvasive method for obtaining information about the activity of the disease or the disease type, allowing the early diagnosis of glomerular diseases. One of the most robust markers that has been successfully used for urinary podocyte diagnostics is podocalyxin (PDX). PDX is a sialoprotein that is expressed on podocytes and on a variety of nonrenal cells as well as on glomerular endothelial and parietal epithelial cells. Therefore, podocyte loss can be detected by the amount of PDX in the urine. The relationship between urinary podocytes and renal diseases is supported by the detection of podocytes in patients with immunoglobulin A (IgA) nephropathy, Henoch-Schönlein purpura nephritis, lupus nephritis, diabetic nephropathy, and focal segmental glomerulosclerosis. The use of technology for detecting podocytes in the urine would have broad implications for the evaluation of disease activity, the degree of dedifferentiation, and the possibility of regeneration.
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Affiliation(s)
- Dong Sun
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu, PR China.
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Urinary podocyte-associated mRNA profile in various stages of diabetic nephropathy. PLoS One 2011; 6:e20431. [PMID: 21655212 PMCID: PMC3105067 DOI: 10.1371/journal.pone.0020431] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 04/20/2011] [Indexed: 11/19/2022] Open
Abstract
Background Podocyte injury and subsequent excretion in urine play a crucial role in the pathogenesis and progression of diabetic nephropathy (DN). Quantification of messenger RNA (mRNA) expression in urinary sediment by real-time PCR is emerging as a noninvasive method of screening DN-associated biomarkers. We hypothesized that the urinary mRNA profile of podocyte-associated molecules may provide important clinical insight into the different stages of diabetic nephropathy. Methods DN patients (N = 51) and healthy controls (N = 13) were enrolled in this study. DN patients were divided into a normoalbuminuria group (UAE<30 mg/g, n = 17), a microalbuminuria group (UAE 30∼300 mg/g, n = 15), and a macroalbuminuria group (UAE>300 mg/g, n = 19), according to their urinary albumin excretion (UAE). Relative mRNA abundance of synaptopodin, podocalyxin, CD2-AP, α-actin4, and podocin were quantified, and correlations between target mRNAs and clinical parameters were examined. Results The urinary mRNA levels of all genes studied were significantly higher in the DN group compared with controls (p<0.05), and mRNA levels increased with DN progression. Urinary mRNA levels of all target genes positively correlated with both UAE and BUN. The expression of podocalyxin, CD2-AP, α-actin4, and podocin mRNA correlated with serum creatinine (r = 0.457, p = 0.001; r = 0.329, p = 0.01; r = 0.286, p = 0.021; r = 0.357, p = 0.006, respectively). Furthermore, podocalyxin mRNA was found to negatively correlate with eGFR (r = −0.349, p = 0.01). Conclusion The urinary mRNA profiles of synaptopodin, podocalyxin, CD2-AP, α-actin4, and podocin were found to increase with the progression of DN, which suggested that quantification of podocyte-associated molecules will be useful biomarkers of DN.
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