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      Detecção de podocitúria em pacientes com nefrite lúpica Translated title: Detection of podocyturia in patients with lupus nephritis

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          Abstract

          INTRODUÇÃO: A podocitúria tem sido detectada em doenças glomerulares, tais como em nefrite lúpica (NL), em que a proteinúria é uma manifestação importante, e sua ocorrência parece limitar-se à fase ativa da doença. OBJETIVO: Avaliar a podocitúria por imunofluorescência em pacientes portadores de NL e verificar possível associação com atividade clínica da doença. MÉTODOS: Foram avaliados 56 pacientes com NL. Os pacientes foram divididos em três grupos de acordo com o grau de atividade clínica: Grupo B, sem atividade (n = 17); Grupo C, com atividade discreta (n = 29) e Grupo D, moderada a grave (n = 10). Como grupo controle, foram incluídos 29 indivíduos saudáveis (Grupo A). A podocitúria foi estudada por meio de imunofluorescência indireta, usando-se anticorpos primários antipodocina, nefrina e sinaptopodina, e anticorpo secundário conjugado à FITC. Também foram avaliados os níveis de creatinina sérica e da relação proteína/creatinina (P/C) urinária, assim como a presença de hematúria e leucocitúria. RESULTADOS: A podocitúria com antipodocina e com antissinaptopodina correlacionou-se estatisticamente com a relação P/C (p = 0,001 e p = 0,013, respectivamente). Tanto a podocitúria com antipodocina, quanto a relação P/C, apresentaram correlação significante (p < 0,001) com a graduação de atividade da doença na NL, diferentemente do que se observou com os outros dois anticorpos, antinefrina e antissinaptopodina. CONCLUSÃO: Nossos achados sugerem que a pesquisa de podocitúria com anticorpos antipodocina poderia ser útil no acompanhamento de pacientes com NL, fornecendo dados relevantes quanto à atividade da doença.

          Translated abstract

          INTRODUCTION: The podocyturia has been detected in glomerular diseases, such as lupus nephritis (LN), in which proteinuria is an important manifestation, and its occurrence seems to be limited to the active phase of the disease. OBJECTIVE: To evaluate podocyturia in LN patients, and the possible association with clinical disease activity. METHODS: We evaluated 56 patients with LN, that were classified in three groups according to the degree of clinical activity: Group B, no activity (n = 17), Group C with mild (n = 29) and Group D, moderate to severe activity (n = 10). The control group was composed by 29 healthy subjects (Group A). The podocyturia was studied by indirect immunofluorescence using primary antibodies to podocyte: anti-podocin, nephrin and synaptopodin, and a secondary antibody conjugated with FITC. We also evaluated serum creatinine levels, urinary protein/creatinine (P/C) ratio, hematuria and leucocituria. RESULTS: The podocyturia with anti-podocin and anti-sinaptopodin correlated statistically with the P/C ratio (p = 0.001 and p = 0.013, respectively). The podocyturia with anti-podocin, as well as the P/C ratio showed significant correlation (p < 0.001) with the degree of lupus disease activity, unlike the other two antibodies, anti-nephrin and anti-synaptopodin. CONCLUSION: Our findings show that podocyturia with anti-podocin could be useful in monitoring disease activity in LN patients.

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          Most cited references 20

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          Podocyte Damage Resulting in Podocyturia: A Potential Diagnostic Marker to Assess Glomerular Disease Activity

          A decrease in podocyte number contributes to the development of glomerulosclerosis in most forms of glomerular disease [ 1 , 2 , 3 , 4 , 5 ]. Traditionally, it has been argued that this decrease may be caused by the inability of podocytes to proliferate and replace those lost following immune, metabolic, toxic or hemodynamic injury. These data contrast with recent studies showing that podocytes are able to enter the cell cycle after injury, to progress through the different phases of the cell cycle and even enter mitosis. However, experimental and human data suggest that entry of podocytes into the cell cycle may result in reduced adhesion to the glomerular basement membrane with subsequent loss of podocytes into the urine and excretion of both viable and apoptotic podocytes. Viable urinary podocytes can be cultivated ex vivo for up to 2–3 weeks and in experimental models precede the onset of proteinuria. More importantly, podocyturia can decrease despite persistent proteinuria. The latter observation suggests that podocyturia may serve as the first non-invasive marker of ‘active’ glomerular damage and might thus drive therapeutic interventions in the future. However, at present technical issues still prevent a broad clinical application of podocyturia detection in clinical practice.
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            Urinary detection of podocyte injury.

            Glomerular epithelial cell (podocyte) biology has been focused on in the last few years. The emerging understanding in podocyte biology has improved the molecular mechanism knowledge in many glomerular diseases. Urinary podocyte count and measurement of urinary podocyte specific markers (nephrin and podocalyxin) have been developed to detect podocyte injury. We discuss the emerging clinical importance of the urinary podocyte count in experimental and human glomerular disease, as well as measurement of urinary podocyte specific marker.
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              Effect of the antiplatelet drug dilazep dihydrochloride on urinary podocytes in patients in the early stage of diabetic nephropathy

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                jbn
                Jornal Brasileiro de Nefrologia
                J. Bras. Nefrol.
                Sociedade Brasileira de Nefrologia (São Paulo )
                2175-8239
                December 2013
                : 35
                : 4
                : 252-258
                Affiliations
                [1 ] Universidade Federal de São Paulo Brazil
                Article
                S0101-28002013000400004
                10.5935/0101-2800.20130043

                http://creativecommons.org/licenses/by/4.0/

                Product
                Product Information: website
                Categories
                UROLOGY & NEPHROLOGY

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