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2016 ; 31
(2
): 207-15
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The glomerular permeability factors in idiopathic nephrotic syndrome
#MMPMID25925039
Davin JC
Pediatr Nephrol
2016[Feb]; 31
(2
): 207-15
PMID25925039
show ga
It is currently postulated that steroid-sensitive idiopathic nephrotic syndrome
(SSNS) and steroid-resistant idiopathic nephrotic syndrome (SRNS), which are not
related to the mutation of a gene coding for podocyte structures or for
glomerular basement membrane proteins, result from a circulating factor affecting
podocyte shape and function. T lymphocytes have for a long time been suspected to
be involved in the pathophysiology of these diseases. The successful treatment of
steroid-dependant nephrotic syndrome with rituximab suggests a potential role for
B lymphocytes. Clinical and experimental data indicate roles for cytokines IL-13,
TNF?, circulating cardiotrophin-like cytokine factor 1 (member of the IL-6
family), circulating hemopexin, radical oxygen species, and the soluble
urokinase-type plasminogen activator receptor (suPAR) in the development of
nephrotic syndrome. Podocyte metabolism modifications-leading to the
overexpression of the podocyte B7-1antigen (CD 80), hypoactivity of the podocyte
enzyme sphingomyelin phosphodiesterase acid-like 3 b (SMPDL3b), and to the
podocyte production of a hyposialylated form of the angiopoietin-like 4
(Angptl4)-are mechanisms possibly involved in the changes in the podocyte
cytoskeleton leading to SSNS and or SRNS. Different multifactorial
pathophysiological mechanisms can be advocated for SSNS and SRNS. The present
paper reviews the experimental and clinical data upon which the different
hypotheses are based and reports their possible clinical applications.