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2014 ; 12
(ä): 81
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Urinary soluble urokinase receptor levels are elevated and pathogenic in patients
with primary focal segmental glomerulosclerosis
#MMPMID24884842
Huang J
; Liu G
; Zhang YM
; Cui Z
; Wang F
; Liu XJ
; Chu R
; Zhao MH
BMC Med
2014[May]; 12
(ä): 81
PMID24884842
show ga
BACKGROUND: Focal segmental glomerulosclerosis (FSGS) is a major cause of
end-stage renal disease. Recent studies have proposed that plasma soluble
urokinase receptor (suPAR) might be a causative circulating factor but this
proposal has caused controversy. This study aimed to measure urinary suPAR levels
in patients with primary FSGS and its significance in the pathogenesis of FSGS.
METHODS: Sixty-two patients with primary FSGS, diagnosed between January 2006 and
January 2012, with complete clinical and pathologic data were enrolled, together
with disease and normal controls. Urinary suPAR levels were measured using
commercial ELISA kits and were corrected by urinary creatinine (Cr). The
associations between urinary suPAR levels and clinical data at presentation and
during follow up were analyzed. Conditionally immortalized human podocytes were
used to study the effect of urinary suPAR on activating ?3 integrin detected by
AP5 staining. RESULTS: The urinary suPAR level of patients with primary FSGS
(500.56, IQR 262.78 to 1,059.44 pg/?mol Cr) was significantly higher than that of
patients with minimal change disease (307.86, IQR 216.54 to 480.18 pg/?mol Cr, P
= 0.033), membranous nephropathy (250.23, IQR 170.37 to 357.59 pg/?mol Cr, P
<0.001), secondary FSGS (220.45, IQR 149.38 to 335.54 pg/?mol Cr, P <0.001) and
normal subjects (183.59, IQR 103.92 to 228.78 pg/?mol Cr, P <0.001). The urinary
suPAR level of patients with cellular variant was significantly higher than that
of patients with tip variant. The urinary suPAR level in the patients with
primary FSGS was positively correlated with 24-hour urine protein (r = 0.287, P =
0.024). During follow up, the urinary suPAR level of patients with complete
remission decreased significantly (661.19, IQR 224.32 to 1,115.29 pg/?mol Cr
versus 217.68, IQR 121.77 to 415.55 pg/?mol Cr, P = 0.017). The AP5 signal was
strongly induced along the cell membrane when human differentiated podocytes were
incubated with the urine of patients with FSGS at presentation, and the signal
could be reduced by a blocking antibody specific to uPAR. CONCLUSIONS: Urinary
suPAR was specifically elevated in patients with primary FSGS and was associated
with disease severity. The elevated urinary suPAR could activate ?3 integrin on
human podocytes.