Urine podocyte mRNAs, proteinuria, and progression in human glomerular diseases.
Model systems demonstrate that progression to ESRD is driven by progressive podocyte depletion (the podocyte depletion hypothesis) and can be noninvasively monitored through measurement of urine pellet podocyte mRNAs. To test these concepts in humans, we analyzed urine pellet mRNAs from 358 adult and pediatric kidney clinic patients and 291 controls (n=1143 samples). Compared with controls, urine podocyte mRNAs increased 79-fold (P<0.001) in patients with biopsy-proven glomerular disease and a 50% decrease in kidney function or progression to ESRD. An independent cohort of patients with Alport syndrome had a 23-fold increase in urinary podocyte mRNAs (P<0.001 compared with controls). Urinary podocyte mRNAs increased during active disease but returned to baseline on disease remission. Furthermore, urine podocyte mRNAs increased in all categories of glomerular disease evaluated, but levels ranged from high to normal, consistent with individual patient variability in the risk for progression. In contrast, urine podocyte mRNAs did not increase in polycystic kidney disease. The association between proteinuria and podocyturia varied markedly by glomerular disease type: a high correlation in minimal-change disease and a low correlation in membranous nephropathy. These data support the podocyte depletion hypothesis as the mechanism driving progression in all human glomerular diseases, suggest that urine pellet podocyte mRNAs could be useful for monitoring risk for progression and response to treatment, and provide novel insights into glomerular disease pathophysiology.
Department of Pediatrics and Communicable Diseases.
Larysa
L
Wickman
Farsad
F
Afshinnia
Su Q
SQ
Wang
Yan
Y
Yang
Fei
F
Wang
Mahboob
M
Chowdhury
Delia
D
Graham
Jennifer
J
Hawkins
Ryuzoh
R
Nishizono
Marie
M
Tanzer
Jocelyn
J
Wiggins
Guillermo A
GA
Escobar
Bradley
B
Rovin
Peter
P
Song
Debbie
D
Gipson
David
D
Kershaw
Roger C
RC
Wiggins
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000652:urine; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000473:pathology / Q000503:physiopathology / Q000652:urine; D006801:Humans; D007678:Kidney Glomerulus / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009402:Nephrosis, Lipoid / Q000473:pathology / Q000503:physiopathology / Q000652:urine; D009404:Nephrotic Syndrome / Q000473:pathology / Q000503:physiopathology / Q000652:urine; D050199:Podocytes / Q000502:physiology*; D011507:Proteinuria / Q000473:pathology / Q000503:physiopathology / Q000652:urine; D012333:RNA, Messenger / Q000502:physiology; D055815:Young Adult
D015415:Biomarkers; D012333:RNA, Messenger