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      Podocyte Injury Predicts Prognosis in Patients with IgA Nephropathy Using a Small Amount of Renal Biopsy Tissue

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          To predict the progression in patients with IgA nephropathy, we analyzed glomerular lesions except for sclerosis, adhesion and/or crescents in 34 patients with this disease by morphometric analysis. Levels of urinary protein excretion (UP), creatinine clearance (Ccr), serum creatinine (sCr) and mean blood pressure (MBP) at the time of renal biopsy were used as the clinical parameters. The slope of 1/sCr was also used as a prognostic parameter. Renal specimens were obtained by echo-guided biopsy. In PAS-stained light microscopic renal sections, three midsections of open glomeruli were selected and photographed. Stereologic estimation was performed as follows: absolute values of glomerular volume (V<sub>G</sub>), glomerular surface area (S<sub>G</sub>), podocyte and nonpodocyte cell number per glomerulus (N<sub>G(pod)</sub> and N<sub>G(Non-pod)</sub>), glomerular surface area covered by one podocyte S<sub>G</sub>/N<sub>G(pod)</sub>) and glomerular volume occupied by one nonpodocyte cell (V<sub>G</sub>/N<sub>G(Non-pod)</sub>). There was a significant correlation between the levels of UP and the change of podocyte injury parameters (N<sub>G(pod)</sub> and S<sub>G</sub>/N<sub>G(pod)</sub>) or N<sub>G(Non-pod)</sub>. N<sub>G(pod)</sub> was negatively but S<sub>G</sub>/N<sub>G(pod)</sub> and N<sub>G(Non-pod)</sub> were positively correlated with UP. S<sub>G</sub>/N<sub>G(pod)</sub> or N<sub>G(Non-pod)</sub> was correlated with MBP. N<sub>G(pod)</sub>, S<sub>G</sub>/N<sub>G(pod)</sub>, N<sub>G(Non-pod)</sub>, UP or MBP was significantly correlated with the slope of 1/sCr. High specificity was observed for N<sub>G(pod)</sub>, S<sub>G</sub>/N<sub>G(pod)</sub> and MBP. High sensitivity was also observed for N<sub>G(Non-pod)</sub> and UP. It appears that podocyte injury might provide additional prognostic information in patients with IgA nephropathy.

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          Urinary Excretion of Podocytes Reflects Disease Activity in Children with Glomerulonephritis

          The significance of the presence of podocytes in the urine was studied in various renal diseases in children. The podocytes were detected by immunofluorescence using monoclonal antibodies against the podocalyxin that is present on the surface of podocytes which serves as a glycocalyx. They were scored according to the numbers per partitioned area on cytospun urine sediments. Urine podocytes were absent in normal control, nonglomerular diseases such as urinary tract infection and nonglomerular hematuria, and glomerular, noninflammatory diseases such as minimal change nephrotic syndrome and membranous nephropathy. Conversely, the excretion of podocytes in the urine were detected in various glomerular, inflammatory diseases. A significantly higher level of the podocyte score was found in the acute state of glomerular diseases which was defined as within 6 months after disease onset. Positive correlations were obtained between the presence of urinary podocytes and the histological features of active extracapillary changes and mesangial proliferation. Urinary podocytes were examined monthly for 12 months in 7 cases with IgA nephropathy and 2 cases with Henoch-Schönlein purpura nephritis, and a consistently higher urinary podocyte score was observed in the patients with histological progression. The scoring of urinary podocytes was found to be useful clinically, as a diagnostic tool for glomerular or nonglomerular diseases, inflammatory or noninflammatory diseases, a marker for the estimation of the severity of active glomerular injury and also as a predictor of disease progression.

            Author and article information

            Kidney Blood Press Res
            Kidney and Blood Pressure Research
            S. Karger AG
            29 June 2001
            : 24
            : 2
            : 99-104
            Division of Nephrology, Department of Medicine, Juntendo University School of Medicine, Tokyo, Japan
            54214 Kidney Blood Press Res 2001;24:99–104
            © 2001 S. Karger AG, Basel

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            Page count
            Figures: 3, Tables: 4, References: 19, Pages: 6
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            Original Paper

            Cardiovascular Medicine, Nephrology

            Podocyte injury, Morphometry, IgA nephropathy, Prognosis


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