В обзоре рассмотрены механизмы повреждения подоцитов, лежащие в основе развития протеинурии и прогрессирования гломерулосклероза при хроническом гломерулонефрите, представлены результаты экспериментальных и клинических исследований по данным вопросам. Описывается, как под действием различных иммунных и неиммунных факторов подоциты формируют стереотипный ответ на повреждение, заключающийся в перестройке актинового цитоскелета, сглаживании ножковых отростков, отщеплении подоцитов с гломерулярной базальной мембраны и появлении в моче специфических подоцитарных белков и/или целых клеток (подоцитурия). Массивная подоцитурия при ограниченной пролиферативной способности подоцитов способствует снижению их общей массы в клубочке (подоцитопении) и развитию гломерулосклероза. Авторами описан спектр маркеров подоцитарного повреждения, освещены методы их инвазивной и неинвазивной оценки, проанализирована взаимосвязь их уровня с выраженностью протеинурии и дисфункции почек, рассмотрены перспективы исследования подоцитарных белков в моче для оценки тяжести гломерулярного повреждения, риска развития гломерулосклероза.
In the review, the mechanisms of podocytes damage underlying the development of proteinuria and progression of glomerulosclerosis in chronic glomerulonephritis are discussed in detail. The results of experimental and clinical studies are presented. Under the different immune and non-immune factors the podocytes form a stereotyped response to damage consisting in the reorganization of the actin cytoskeleton, foot process effacement, the detachment of podocytes from the glomerular basement membrane, and the appearance of specific podocyte proteins and whole cells (podocyturia) in the urine. Massive podocyturia in a limited proliferative capacity of podocytes leads to reduce their total count in the glomerulus (podocytopenia) and the development of glomerulosclerosis. The authors describe the line of markers of the podocyte injury and invasive and non-invasive methods of their assessment. In addition, the relationship of podocyturia level with proteinuria and renal dysfunction are discussed, the prospects of assessment the podocyte proteins in urine for assessing of glomerular damage severity and glomerulosclerosis risk are examined.
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7. Neal CR. Podocytes: What’s under yours? (Podocytes and foot processes and how they change in nephropathy). Front Endocrinol. 23 February 2015. Available from: https://doi.org/10.3389/fendo.2015.00009
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9. Trimarchi H. Podocyturia: what is in a name? J Transl Int Med. 2015;3(2):51-6. doi: 10.1515/jtim-2015-0003
10. Barisoni L, Schnaper HW, Kopp JB. A Proposed Taxonomy for the Podocytopathies: A Reassessment of the Primary Nephrotic Diseases. Clin J Am Soc Nephrol. 2007;2:529-42. doi: 10.2215/CJN.04121206
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doi: 10.1038/ki.2008.128
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1. Shankland SJ. The podocyte’sresponse to injury: role in proteinuria and glomerulosclerosis. Kidney Int. 2006;69:2131-47. doi:10.1038/sj.ki. 5000410
2. Pavenstadt H, Kriz W, Kretzler M. Cell biology of the glomerular podocyte. Physiol Rev. 2003;83:253-307. doi: 10.1152/physrev.00020. 2002
3. Pollak MR. Inherited Podocytopathies: FSGS and Nephrotic Syndrome from a Genetic Viewpoint. J Am Soc Nephrol. 2002;13:3016-23.
doi: 10.1097/01.ASN.0000039569.34360.5E
4. Koop K, Eikmans M, Baelde HJ, Kawachi H, de Heer E, Paul LC, Bruijn JA. Expression of podocyte-associated molecules in acquired human kidney diseases. J Am Soc Nephrol. 2003;14:2063-71. doi: 10.1097/01. ASN.0000078803.53165.C9
5. Patrakka J, Tryggvason K. New insights into the role of podocytes in proteinuria. Nat Rev Nephrol. 2009;5:463-8. doi:10.1038/nrneph. 2009.108
6. Kriz W, Shirato I, Nagata M, Le Hir M, Lemley KV. The podocyte’s response to stress: The enigma of foot process effacement. Am J Physiol Renal Physiol. 2013;304:333-47. doi: 10.1152/ajprenal.00478.2012
7. Neal CR. Podocytes: What’s under yours? (Podocytes and foot processes and how they change in nephropathy). Front Endocrinol. 23 February 2015. Available from: https://doi.org/10.3389/fendo.2015.00009
8. Huber TB, Bensing T. The slit diaphragm: a signaling platform to regulate podocyte function. Curr Opin Nephrol Hypertens. 2005;14 (3):211-6.
9. Trimarchi H. Podocyturia: what is in a name? J Transl Int Med. 2015;3(2):51-6. doi: 10.1515/jtim-2015-0003
10. Barisoni L, Schnaper HW, Kopp JB. A Proposed Taxonomy for the Podocytopathies: A Reassessment of the Primary Nephrotic Diseases. Clin J Am Soc Nephrol. 2007;2:529-42. doi: 10.2215/CJN.04121206
11. Greka A, Mundel P. Cell biology and pathology of podocytes. Ann Rev Physiol. 2012;74:299-323. doi: 10.1146/annurev-physiol-020911-153238
12. Couser WG. Basic and translational concepts of immune-mediated glomerular diseases. J Am Soc Nephrol. 2012;23:381-99. doi: 10.1681/ ASN.2011030304
13. Jefferson JA, Shankland SJ, Pichler RH. Proteinuria in diabetic kidney disease: A mechanistic viewpoint. Kidney Int. 2008;74:22-36.
doi: 10.1038/ki.2008.128
14. George B, Verma R, Soofi A, Garg P, Zhang J, Park TJ, Giardino L, Ryzhova L, Johnstone D, Wong H, Nihalani D, Salant D, Hanks S, Curran T, Rastaldi M, Holzman L. Crk1/2-dependent signaling is necessary for podocyte foot process spreading in mouse models of glomerular disease. J Clin Invest. 2012;122:674-92. doi: 10.1172/ JCI60070
15. Reiser J, von Gersdorff G, Loos M, Oh J, Asanuma K, Giardino L, Rastaldi M, Calvaresi N, Watanabe H, Schwarz K, Faul C, Kretzler M, Davidson A, Sugimoto H, Kalluri R, Sharpe A, Kreidberg J, Mundel P. Induction of B7–1 in podocytes is associated with nephrotic syndrome. J Clin Invest. 2004;113:1390-7. doi: 10.1172/JCI20402
16. Shirato I. Podocyte process effacement in vivo. Micros Res Tech. 2002;57:241-6. doi: 10.1002/jemt.10082
17. Le Hir M, Keller C, Eschmann V, Hähnel B, Hosser H, Kriz W. Podocyte bridges between the tuft and Bowman’s capsule: an early event in experimental crescentic glomerulonephritis. J Am Soc Nephrol. 2001;12:2060-71.
18. Nagata M. Podocyte injury and its consequences. Kidney Int. 2016 Jun; 89(6):1221-30. doi: 10.1016/j.kint.2016.01.012
19. Neal C, Crook H, Bell E, Harper S, Bates D. Three-dimensional reconstruction of glomeruli by electron microscopy reveals a distinct restrictive urinary subpodocyte space. J Am Soc Nephrol. 2005;16:1223-35. doi: 10.1681/ASN.2004100822
20. Liapis H, Romagnani P, Anders HJ. New insights into the pathology of podocyte loss: mitotic catastrophe. Am J Pathol. 2013;183:1364-74. doi: 10.1016/j.ajpath.2013.06.033
21. Vogelmann SU, Nelson WJ, Myers BD, Lemley KV. Urinary excretion of viable podocytes in health and renal disease. Am J Physiol Renal Physiol. 2003;285(1):40-8. doi: 10.1152/ajprenal.00404.2002
22. Garovic VD, Wagner SJ, Petrovic LM, Gray CE, Hall P, Sugimoto H, Kalluri R, Grande JP. Glomerular expression of nephrin and synaptopodin but not podocin is decreased in kidney sections from women with preeclampsia. Nephrol Dial Transplant. 2007;22:1136-43.
doi: 10.1093/ndt/gfl711
23. Hara A, Wada T, Furuchi K, Sakai N, Kawachi H, Shimizu F, Shibuya M, Matsushima K, Yokoyama H, Egashira K, Kaneko S. Blokade of VEGF accelerates proteinuria via decrease in nephrin expression in rat crescentic glomerulonephritis. Kidney Int. 2006;69(11):1986-95.
doi: 10.1038/sj.ki.5000439
24. Liu Y. New insights into epithelial-mesenchymal transitition contribute in kidney fibrosis. J Am Soc Nephrol. 2010;21:212-22.
doi: 10.1681/ASN.2008121226
25. Kriz W, Lemley K. A potential role for mechanical forces in the detachment of podocytes and the progression of CKD. J Am Soc Nephrol. 2015;26:258-69. doi: 10.1681/ASN.2014030278
26. Hara M, Yanagihara T, Kihara I. Urinary podocytes in primary focal segmental glomerulosclerosis. Nephron. 2001;89:342-7. doi: 10.1159/ 000046097
27. Hara M, Yanagihara T, Kihara I, Higashi K, Fujimoto K, Kajita T. Apical cell membranes are shed into urine from injured podocytes: A novel phenomenon of podocyte injury. J Am Soc Nephrol. 2005;16:408-16. doi: 10.1681/ASN.2004070564
28. Hara M, Yanagihara T, Kihara I. Cumulative excretion of urinary podocytes reflects disease progression in IgA nephropathy and Schönlein-Henoch purpura nephritis. Clin J Am Soc Nephrol. 2007;2:231-8. doi: 10.2215/CJN.01470506
29. Sato Y, Wharram BL, Lee SK, Wickman L, Goyal M, Venkatareddy M, et al. Urine podocyte mRNAs mark progression of renal disease. J Am Soc Nephrol. 2009;20:1041-52. doi: 10.1681/ASN.2007121328
30. Nakamura T, Ushiyama C, Suzuki S, Hara M, Shimada N, Sekizuka K, et al. Urinary podocytes for the assessment of disease activity in lupus nephritis. Am J Med Sci. 2000;320:112-6. doi: 10.1097/00000441-200008000-00009
31. Mansur JB, Sabino AR, Nishida SK, Kirsztajn GM. Is there a role for urinary podocyte excretion assessment in lupus nephritis? Ren Fail. 2016;38(4):643-7. doi: 10.3109/0886022X.2016.1150099
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Авторы
N.V. Chebotareva, I.N. Bobkova, L.V. Lysenko
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow, Russia
________________________________________________
N.V. Chebotareva, I.N. Bobkova, L.V. Lysenko
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow, Russia