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2017 ; 6
(5
): 221-228
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Podocyturia: Potential applications and current limitations
#MMPMID28948159
Trimarchi H
World J Nephrol
2017[Sep]; 6
(5
): 221-228
PMID28948159
show ga
Chronic kidney disease is a prevalent condition that affects millions of people
worldwide and is a major risk factor of cardiovascular morbidity and mortality.
The main diseases that lead to chronic kidney disease are frequent entities as
diabetes mellitus, hypertension and glomerulopathies. One of the clinical markers
of kidney disease progression is proteinuria. Moreover, the histological hallmark
of kidney disease is sclerosis, located both in the glomerular and in the
interstitial compartments. Glomerulosclerosis underscores an irreversible lesion
that is clinically accompanied by proteinuria. In this regard, proteinuria and
glomerular sclerosis are linked by the cell that has been conserved
phylogenetically not only to prevent the loss of proteins in the urine, but also
to maintain the health of the glomerular filtration barrier: The podocyte. It can
then be concluded that the link between proteinuria, kidney disease progression
and chronic kidney disease is mainly related to the podocyte. What is this
situation due to? The podocyte is unable to proliferate under normal conditions,
and a complex molecular machinery exists to avoid its detachment and eventual
loss. When the loss of podocytes in the urine, or podocyturia, is taking place
and its glomerular absolute number decreased, glomerulosclerosis is the
predominant histological feature in a kidney biopsy. Therefore, tissular podocyte
shortage is the cause of proteinuria and chronic kidney disease. In this regard,
podocyturia has been demonstrated to precede proteinuria, showing that the
clinical management of proteinuria cannot be considered an early intervention.
The identification of urinary podocytes could be an additional tool to be
considered by nephrologists to assess the activity of glomerulopathies, for
follow-up purposes and also to unravel the pathophysiology of podocyte detachment
in order to tailor the therapy of glomerular diseases more appropriately.
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