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Li C, Szeto CC. Urinary podocyte markers in diabetic kidney disease. Kidney Res Clin Pract 2024; 43:274-286. [PMID: 38325865 PMCID: PMC11181047 DOI: 10.23876/j.krcp.23.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/30/2023] [Accepted: 10/30/2023] [Indexed: 02/09/2024] Open
Abstract
Podocytes are involved in maintaining kidney function and are a major focus of research on diabetic kidney disease (DKD). Urinary biomarkers derived from podocyte fragments and molecules have been proposed for the diagnosis and monitoring of DKD. Various methods have been used to detect intact podocytes and podocyte-derived microvesicles in urine, including centrifugation, visualization, and molecular quantification. Quantification of podocyte-specific protein targets and messenger RNA levels can be performed by Western blotting or enzyme-linked immunosorbent assay and quantitative polymerase chain reaction, respectively. At present, many of these techniques are expensive and labor-intensive, all limiting their widespread use in routine clinical tests. While the potential of urinary podocyte markers for monitoring and risk stratification of DKD has been explored, systematic studies and external validation are lacking in the current literature. Standardization and automation of laboratory methods should be a priority for future research, and the added value of these methods to routine clinical tests should be defined.
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Affiliation(s)
- Chuanlei Li
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Cheuk-Chun Szeto
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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2
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Kidney injury molecule-1 and podocalyxin dysregulation in an arginine vasopressin induced rodent model of preeclampsia. Eur J Obstet Gynecol Reprod Biol 2023; 284:58-65. [PMID: 36934678 DOI: 10.1016/j.ejogrb.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/07/2023] [Accepted: 03/12/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE To assess renal injury in an arginine vasopressin (AVP) rodent model of preeclampsia. STUDY DESIGN Urinary expression of kidney injury molecule-1 (KIM-1), urinary protein and creatinine was determined in rodents (n = 24; pregnant AVP, pregnant saline, non-pregnant AVP and non-pregnant saline), which received a continuous dose of either AVP or saline via subcutaneous mini osmotic pumps for 18 days, using a Multiplex kidney toxicity immunoassay. Renal morphology was assessed using haematoxylin and eosin staining and transmission electron microscopy. The immunolocalization of KIM-1 and podocalyxin was qualitatively evaluated using immunohistochemistry. RESULTS Urinary KIM-1 and urinary protein levels were significantly increased in treated vs. untreated rats on gestational days 8 (p < 0.05), 14 (p < 0.001) and 18 (p < 0.001). The pregnant rats displayed a lower trend of creatinine compared to the non-pregnant groups, albeit non-significantly. KIM-1 was immunolocalized in the proximal convoluted tubules in AVP treated vs. untreated groups. In contrast, podocalyxin was weakly immunostained within glomeruli of pregnant AVP treated vs. pregnant untreated rats. Histological evaluation revealed reduced Bowman's space, with some tubular and blood vessel necrosis in the pregnant treated group. Ultrastructural observations included effacement and fusion of podocyte foot processes, glomerular basement membrane abnormalities, podocyte nuclear crenations, mitochondrial oedema and cristae degeneration with cytoplasmic lysis within treated tissue. CONCLUSION Our findings demonstrate region-specific kidney injury particularly glomerular impairment and endothelial injury in AVP-treated rats. The findings highlight the utility of this model in studying the mechanisms driving renal damage in a rodent model of preeclampsia.
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3
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Noack D, Travar M, Mrdjen V, Voermans JJC, van de Vijver D, Molenkamp R, Koopmans MPG, Goeijenbier M, Rockx B. Serum Markers Associated with Disease Severity in a Bosnian Hemorrhagic Fever with Renal Syndrome Cohort. Viruses 2022; 14:v14071377. [PMID: 35891358 PMCID: PMC9316913 DOI: 10.3390/v14071377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/10/2022] [Accepted: 06/22/2022] [Indexed: 12/10/2022] Open
Abstract
Puumala orthohantavirus (PUUV) is endemic in Europe and can cause hemorrhagic fever with renal syndrome (nephropathia epidemica). Disease features include fever, thrombocytopenia, and acute kidney injury (AKI). This retrospective cohort study of forty PUUV patients aims to characterize associations of serum immunological, hemostatic or kidney injury markers to disease severity. While interleukin-18 (IL-18) was significantly increased in severely thrombocytopenic patients (<100 × 109 platelets/L) compared to patients with higher platelet counts, RANTES was significantly decreased in these patients. These data suggest that patients with significant thrombocytopenia might have experienced pronounced Th1 immune responses. When kidney dysfunction was used as the primary disease outcome, recently identified AKI biomarkers (Cystatin C, insulin-like growth factor-binding protein 7, Nephrin, and trefoil factor 3) were significantly upregulated in patients with severe PUUV infection, defined as the estimated glomerular filtration rate (eGFR) below 30 m/min/1.73 m2. The increased expression of these markers specifically indicates pathology in glomeruli and proximal tubuli. Furthermore, E-selectin was significantly higher while interferon gamma-induced protein 10 (IP-10) was significantly lower in PUUV patients with more severe kidney dysfunction compared to patients with higher eGFR-values. Increased E-selectin illustrates the central role of endothelial cell activation, whereas decreased IP-10 could indicate a less important role of this cytokine in the pathogenesis of kidney dysfunction.
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Affiliation(s)
- Danny Noack
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (D.N.); (J.J.C.V.); (D.v.d.V.); (R.M.); (M.P.G.K.); (M.G.)
| | - Maja Travar
- Department for Clinical Microbiology, University Clinical Center of Republika Srpska, 78000 Banja Luka, Bosnia and Herzegovina; (M.T.); (V.M.)
- Department for Microbiology and Immunology, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Republika Srpska, Bosnia and Herzegovina
| | - Visnja Mrdjen
- Department for Clinical Microbiology, University Clinical Center of Republika Srpska, 78000 Banja Luka, Bosnia and Herzegovina; (M.T.); (V.M.)
- Department for Microbiology and Immunology, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Republika Srpska, Bosnia and Herzegovina
| | - Jolanda J. C. Voermans
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (D.N.); (J.J.C.V.); (D.v.d.V.); (R.M.); (M.P.G.K.); (M.G.)
| | - David van de Vijver
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (D.N.); (J.J.C.V.); (D.v.d.V.); (R.M.); (M.P.G.K.); (M.G.)
| | - Richard Molenkamp
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (D.N.); (J.J.C.V.); (D.v.d.V.); (R.M.); (M.P.G.K.); (M.G.)
| | - Marion P. G. Koopmans
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (D.N.); (J.J.C.V.); (D.v.d.V.); (R.M.); (M.P.G.K.); (M.G.)
| | - Marco Goeijenbier
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (D.N.); (J.J.C.V.); (D.v.d.V.); (R.M.); (M.P.G.K.); (M.G.)
- Department of Intensive Care, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Barry Rockx
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (D.N.); (J.J.C.V.); (D.v.d.V.); (R.M.); (M.P.G.K.); (M.G.)
- Correspondence:
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Kostovska I, Trajkovska KT, Topuzovska S, Cekovska S, Labudovic D, Kostovski O, Spasovski G. Nephrinuria and podocytopathies. Adv Clin Chem 2022; 108:1-36. [PMID: 35659057 DOI: 10.1016/bs.acc.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The discovery of nephrin in 1998 has launched a new era in glomerular diseases research, emphasizing its crucial role in the structure and function of the glomerular filtration barrier. In the past 20 years, substantial advances have been made in understanding podocyte structure and function as well as the discovery of several podocyte-related proteins including nephrin. The glomerular filtration barrier is comprised of podocytes, the glomerular basement membrane and endothelial cells. Podocytes, with their specialized slit diaphragm, form the essential backbone of the glomerular filtration barrier. Nephrin is a crucial structural and functional feature of the slit diaphragm that prevents plasma protein, blood cell and macromolecule leakage into the urine. Podocyte damage results in nephrin release. Podocytopathies are kidney diseases in which podocyte damage drives proteinuria, i.e., nephrotic syndrome. Many kidney diseases involve podocytopathy including congenital nephrotic syndrome of Finnish type, diffuse mesangial sclerosis, minimal change disease, focal segmental glomerulosclerosis, collapsing glomerulonephropathy, diabetic nephropathy, lupus nephropathy, hypertensive nephropathy and preeclampsia. Recently, urinary nephrin measurement has become important in the early detection of podocytopathies. In this chapter, we elaborate the main structural and functional features of nephrin as a podocyte-specific protein, pathomechanisms of podocytopathies which result in nephrinuria, highlight the most commonly used methods for detecting urinary nephrin and investigate the diagnostic, prognostic and potential therapeutic relevance of urinary nephrin in primary and secondary proteinuric kidney diseases.
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Affiliation(s)
- Irena Kostovska
- Department of Medical and Experimental Biochemistry, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia.
| | - Katerina Tosheska Trajkovska
- Department of Medical and Experimental Biochemistry, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Sonja Topuzovska
- Department of Medical and Experimental Biochemistry, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Svetlana Cekovska
- Department of Medical and Experimental Biochemistry, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Danica Labudovic
- Department of Medical and Experimental Biochemistry, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Ognen Kostovski
- University Clinic of Abdominal Surgery, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Goce Spasovski
- University Clinic of Nephrology, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
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5
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Urinary podocyte markers in kidney diseases. Clin Chim Acta 2021; 523:315-324. [PMID: 34666027 DOI: 10.1016/j.cca.2021.10.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/17/2021] [Accepted: 10/13/2021] [Indexed: 01/19/2023]
Abstract
Podocytes play an important role in the maintenance of kidney function, and they are the primary focus of many kidney diseases. Podocyte injury results in the shedding of podocyte-derived cellular fragments and podocyte-specific molecular targets into the urine, which may serve as biomarkers of kidney diseases. Intact podocytes, either viable or dead, and podocyte-derived microvesicles could be quantified in the urine by various centrifugation, visualization and culture methods. Podocyte-specific protein targets from the nucleus, cytoplasm, slit-diaphragm, glomerular capillary basement membrane, and cytoskeleton, as well as their corresponding messenger RNA (mRNA), in the urine could be quantified by western blotting, ELISA, or quantitative polymerase chain reaction. Although some of these techniques may be expensive or labor-intensive at present, they may become widely available in the future because of the improvement in technology and automation. The application of urinary podocyte markers for the diagnosis and monitoring of various kidney diseases have been explored but the published data in this area are not sufficiently systematic and lack external validation. Further research should focus on standardizing, comparing, and automizing laboratory methods, as well as defining their added value to the routine clinical tests.
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Zhang J, Li H, Fan B, Xu W, Zhang X. Extracellular vesicles in normal pregnancy and pregnancy-related diseases. J Cell Mol Med 2020; 24:4377-4388. [PMID: 32175696 PMCID: PMC7176865 DOI: 10.1111/jcmm.15144] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 12/11/2022] Open
Abstract
Extracellular vesicles (EVs) are nanosized, membranous vesicles released by almost all types of cells. Extracellular vesicles can be classified into distinct subtypes according to their sizes, origins and functions. Extracellular vesicles play important roles in intercellular communication through the transfer of a wide spectrum of bioactive molecules, contributing to the regulation of diverse physiological and pathological processes. Recently, it has been established that EVs mediate foetal‐maternal communication across gestation. Abnormal changes in EVs have been reported to be critically involved in pregnancy‐related diseases. Moreover, EVs have shown great potential to serve as biomarkers for the diagnosis of pregnancy‐related diseases. In this review, we discussed about the roles of EVs in normal pregnancy and how changes in EVs led to complicated pregnancy with an emphasis on their values in predicting and monitoring of pregnancy‐related diseases.
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Affiliation(s)
- Jiayin Zhang
- Jiangsu Key Laboratory of Medical Science and Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, China
| | - Haibo Li
- Department of Clinical Laboratory, Nantong Maternal and Child Health Care Hospital, Nantong, China
| | - Boyue Fan
- Jiangsu Key Laboratory of Medical Science and Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, China
| | - Wenrong Xu
- Jiangsu Key Laboratory of Medical Science and Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, China
| | - Xu Zhang
- Jiangsu Key Laboratory of Medical Science and Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, China
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Capriglione S, Plotti F, Terranova C, Gulino FA, Di Guardo F, Lopez S, Scaletta G, Angioli R. Preeclampsia and the challenge of early prediction: reality or utopia? State of art and critical review of literature. J Matern Fetal Neonatal Med 2018; 33:677-686. [PMID: 29954233 DOI: 10.1080/14767058.2018.1495191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: The challenge to obtain improved predictive tools, able to identify women destined to develop preeclampsia (PE), is raising the interest of researchers for the attractive chance to allow for timely initiation of prophylactic therapy, appropriate antenatal surveillance, and better-targeted research into preventive interventions. We aimed to gather all the evidence reported up to now in scientific literature relating to all prediction tests for PE.Materials and methods: We searched articles on conventional literature platforms from January 1952 to August 2016, using the terms "preeclampsia," "gestational preeclampsia," and "gestational hypertensive disorders" combined with "predictive test" and "risk assessment." Abstracts/titles identified by the search were screened by three investigators.Results: The search identified 203 citations, of which 154 potentially relevant after the initial evaluation. Among these studies, 20 full articles were excluded, therefore, 134 primary studies met the criteria for inclusion and were analyzed.Conclusions: Current evidence suggests that a combination of several features may provide the best predictive accuracy for the identification of PE. Large-scale, multicenter, multiethnic, prospective trials are required to propose an ideal combination of markers for routine screening.
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Affiliation(s)
- Stella Capriglione
- Department of Obstetrics and Gynaecology, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Francesco Plotti
- Department of Obstetrics and Gynaecology, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Corrado Terranova
- Department of Obstetrics and Gynaecology, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Ferdinando Antonio Gulino
- Center of Physiopathology of Human Reproduction, Department of Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Federica Di Guardo
- Center of Physiopathology of Human Reproduction, Department of Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Salvatore Lopez
- Department of Obstetrics and Gynaecology, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Giuseppe Scaletta
- Department of Obstetrics and Gynaecology, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Roberto Angioli
- Department of Obstetrics and Gynaecology, Campus Bio-Medico, University of Rome, Rome, Italy
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8
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Armaly Z, Jadaon JE, Jabbour A, Abassi ZA. Preeclampsia: Novel Mechanisms and Potential Therapeutic Approaches. Front Physiol 2018; 9:973. [PMID: 30090069 PMCID: PMC6068263 DOI: 10.3389/fphys.2018.00973] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/02/2018] [Indexed: 01/04/2023] Open
Abstract
Preeclampsia is a serious complication of pregnancy where it affects 5–8% of all pregnancies. It increases the morbidity and mortality of both the fetus and pregnant woman, especially in developing countries. It deleteriously affects several vital organs, including the kidneys, liver, brain, and lung. Although, the pathogenesis of preeclampsia has not yet been fully understood, growing evidence suggests that aberrations in the angiogenic factors levels and coagulopathy are responsible for the clinical manifestations of the disease. The common nominator of tissue damage of all these target organs is endothelial injury, which impedes their normal function. At the renal level, glomerular endothelial injury leads to the development of maternal proteinuria. Actually, peripheral vasoconstriction secondary to maternal systemic inflammation and endothelial cell activation is sufficient for the development of preeclampsia-induced hypertension. Similarly, preeclampsia can cause hepatic and neurologic dysfunction due to vascular damage and/or hypertension. Obviously, preeclampsia adversely affects various organs, however it is not yet clear whether pre-eclampsia per se adversely affects various organs or whether it exposes underlying genetic predispositions to cardiovascular disease that manifest in later life. The current review summarizes recent development in the pathogenesis of preeclampsia with special focus on novel diagnostic biomarkers and their relevance to potential therapeutic options for this disease state. Specifically, the review highlights the renal manifestations of the disease with emphasis on the involvement of angiogenic factors in vascular injury and on how restoration of the angiogenic balance affects renal and cardiovascular outcome of Preeclamptic women.
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Affiliation(s)
- Zaher Armaly
- Department of Nephrology, EMMS Nazareth Hospital, Galilee Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | - Jimmy E Jadaon
- Department of Obstetrics and Gynecology, EMMS Nazareth Hospital, Galilee Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel.,Laboratory Medicine, EMMS Nazareth Hospital, Galilee Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | - Adel Jabbour
- Laboratory Medicine, EMMS Nazareth Hospital, Galilee Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | - Zaid A Abassi
- Department of Physiology, The Ruth and Burce Rappaport Faculty of Medicine, Technion-IIT, Haifa, Israel.,Department of Laboratory Medicine, Rambam Health Campus, Haifa, Israel
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Kerley RN, McCarthy C. Biomarkers of glomerular dysfunction in pre-eclampsia - A systematic review. Pregnancy Hypertens 2018; 14:265-272. [PMID: 29567337 DOI: 10.1016/j.preghy.2018.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/09/2018] [Accepted: 03/09/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Early detection of pre-eclampsia remains one of the major focuses of antenatal obstetric care. There is often a delay in the diagnosis, mainly due to the non-specific nature of the condition. Podocytes which play a pivotal role in glomerular function become injured in pre-eclampsia leading to subsequent proteinuria. Our aim was to review available studies to determine the clinical utility of biomarkers of podocyte injury in pre-eclampsia. METHODS We used QUADAS (Quality Assessment of Diagnostic Accuracy Studies) criteria to perform a systematic review of the literature to determine the clinical utility of podocyte injury biomarkers in predicting pre-eclampsia. RESULTS This study identified five potential renal biomarkers including podocytes, nephrin, synaptopodin, podocin and podocalyxin. The pooled sensitivity of all biomarkers was 0.78 (95% CI 0.74-0.82) with a specificity of 0.82 (95% CI 0.79-0.85). The area under the Summary of Receiver Operating Characteristics Curve (SROC) was 0.926 (SE 0.30). Urinary nephrin achieved the highest diagnostic values with a sensitivity of 0.81 (95% CI 0.72-0.88) and specificity of 0.84 (95% CI 0.79-0.84). CONCLUSION Biomarkers of glomerular injury show promise as diagnostic aids in pre-eclampsia. A large-scale prospective cohort study is warranted before these biomarkers can be recommended for routine clinical care.
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Affiliation(s)
- Robert N Kerley
- Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital, Cork, Ireland.
| | - Cathal McCarthy
- Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital, Cork, Ireland
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10
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Martinez-Fierro ML, Castruita-De La Rosa C, Garza-Veloz I, Cardiel-Hernandez RM, Espinoza-Juarez MA, Delgado-Enciso I, Castañeda-Lopez ME, Cardenas-Vargas E, Trejo-Vázquez F, Sotelo-Ham EI, Castañeda-Miranda R, Cid-Baez MA, Ortiz-Rodriguez JM, Solis-Sanchez LO, Aviles AG, Ortiz-Castro Y. Early pregnancy protein multiplex screening reflects circulating and urinary divergences associated with the development of preeclampsia. Hypertens Pregnancy 2018; 37:37-50. [PMID: 29308696 DOI: 10.1080/10641955.2017.1411946] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Preeclampsia, a pregnancy disorder characterized by hypertension and proteinuria, represents the leading cause of fetal and maternal morbidity and mortality in developing countries. The identification of novel and accurate biomarkers that are predictive of preeclampsia is necessary to improve the prognosis of patients with preeclampsia. OBJECTIVE To evaluate the preeclampsia predictive value of 34 angiogenic-related proteins. METHODS We performed a nested cohort case-control study of pregnant women. The profile of the 34 proteins was evaluated at 12, 16, and 20 gestational weeks (GWs), using urine/plasma from 16 women who developed preeclampsia and 20 normotensive pregnant controls by Bio-Plex ProTM Human Cancer Biomarker Panels 1 and 2. RESULTS The urine concentration of soluble epidermal growth factor receptor (sEGFR), hepatocyte growth factor (HGF), angiopoietin-2 (ANG-2), endoglin (ENG), soluble fas ligand (sFASL), interleukin 6 (IL-6), placental growth factor (PLGF), and vascular endothelial growth factor A (VEGF-A) at 12 GW, prolactin (PRL), ANG-2, transforming growth factor alpha (TGF-α), and VEGF-A at 16 GW, and soluble IL-6 receptor alpha (sIL-6Rα), ANG-2 and sFASL at 20 GW, were different between groups (p < 0.05). The concentration cut-off values calculated in this study for the mentioned proteins, predicted an increased risk to developing preeclampsia in a range of 3.8-29.8 times in the study population. CONCLUSION The proteins sEGFR, HGF, ANG-2, sFASL, IL-6, PLGF, VEGF-A, PRL, TGF-α FGF-b, sHER2/Neu sIL-6Rα, ENG, uPA, and insulin-like growth factor binding protein 1 (IGFBP-1), were predictive of the development of preeclampsia and their use as markers for this disease should be considered.
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Affiliation(s)
- Margarita L Martinez-Fierro
- a Molecular Medicine Laboratory, Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas , Zacatecas , Mexico.,b Centro de Innovacion Tecnologica e Industrial, Unidad Academica de Ingenieria Electrica. Universidad Autonoma de Zacatecas , Zacatecas , Mexico
| | - Claudia Castruita-De La Rosa
- a Molecular Medicine Laboratory, Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas , Zacatecas , Mexico
| | - Idalia Garza-Veloz
- a Molecular Medicine Laboratory, Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas , Zacatecas , Mexico.,b Centro de Innovacion Tecnologica e Industrial, Unidad Academica de Ingenieria Electrica. Universidad Autonoma de Zacatecas , Zacatecas , Mexico
| | - Rosa M Cardiel-Hernandez
- a Molecular Medicine Laboratory, Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas , Zacatecas , Mexico
| | - Marcela A Espinoza-Juarez
- a Molecular Medicine Laboratory, Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas , Zacatecas , Mexico
| | - Ivan Delgado-Enciso
- c School of Medicine , University of Colima , Colima , Mexico.,d Instituto Estatal de Cancerologia, Servicios de Salud del Estado de Colima , Colima , Mexico
| | - Maria E Castañeda-Lopez
- a Molecular Medicine Laboratory, Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas , Zacatecas , Mexico
| | - Edith Cardenas-Vargas
- a Molecular Medicine Laboratory, Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas , Zacatecas , Mexico.,e Hospital General Zacatecas "Luz González Cosío", Servicios de Salud de Zacatecas , Zacatecas , México
| | - Fabiola Trejo-Vázquez
- a Molecular Medicine Laboratory, Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas , Zacatecas , Mexico
| | - Elma I Sotelo-Ham
- f Coordinacion de Investigacion Estatal de la Secretaría de Salud de Zacatecas, Servicios de Salud de Zacatecas , Zacatecas , Mexico
| | - Rodrigo Castañeda-Miranda
- b Centro de Innovacion Tecnologica e Industrial, Unidad Academica de Ingenieria Electrica. Universidad Autonoma de Zacatecas , Zacatecas , Mexico
| | - Miguel A Cid-Baez
- a Molecular Medicine Laboratory, Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas , Zacatecas , Mexico.,b Centro de Innovacion Tecnologica e Industrial, Unidad Academica de Ingenieria Electrica. Universidad Autonoma de Zacatecas , Zacatecas , Mexico
| | - Jose M Ortiz-Rodriguez
- b Centro de Innovacion Tecnologica e Industrial, Unidad Academica de Ingenieria Electrica. Universidad Autonoma de Zacatecas , Zacatecas , Mexico
| | - Luis O Solis-Sanchez
- b Centro de Innovacion Tecnologica e Industrial, Unidad Academica de Ingenieria Electrica. Universidad Autonoma de Zacatecas , Zacatecas , Mexico
| | - Angelica Garcia Aviles
- e Hospital General Zacatecas "Luz González Cosío", Servicios de Salud de Zacatecas , Zacatecas , México
| | - Yolanda Ortiz-Castro
- a Molecular Medicine Laboratory, Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas , Zacatecas , Mexico
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11
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Phipps EA, Khankin EV. Extracellular Vesicles in Preeclampsia: Evolving Contributors to Proteinuria. J Am Soc Nephrol 2017; 28:3135-3137. [PMID: 28928135 DOI: 10.1681/asn.2017070789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Elizabeth A Phipps
- Renal Division, Brigham and Women's Hospital and.,Harvard Medical School, Boston, Massachusetts; and.,Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
| | - Eliyahu V Khankin
- Harvard Medical School, Boston, Massachusetts; and .,Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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12
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Kostovska I, Trajkovska KT, Cekovska S, Spasovski G, Labudovic D. Nephrin and Podocalyxin - New Podocyte Proteins for Early Detection of Secondary Nephropathies. BANTAO JOURNAL 2017. [DOI: 10.1515/bj-2016-0003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Abstract
In the last two decades a great progress was observed in understanding of podocytes, their specific structure and function identifying many specific podocyte proteins, such as nephrin and podocalyxin. Podocytes form the final barrier to plasma proteins leakage. Nephrin as a main component of the filtration diaphragm forms a physical barrier while podocalyxin as sialoglycoprotein forms an electrostatic barrier. Podocyte damage, i.e. podocytopathies and their loss through urine-podocyturia, are crucial in pathogenesis and progression of nephropathies with proteinuria as main clinical manifestation. In podocytopathies, nephrin and podocalyxin appear in the urine before proteinuria and microalbuminuria which were previously considered as earliest markers of nephropathies. Nephrinuria and podocalyxuria indicate damage of the podocytes on glomerular level and/or presence of apoptotic and necrotic podocytes in urine. These urinary markers are also important in early diagnosis of secondary nephropathies such as diabetic, lupus and hypertensive nephropathy as the most common causes of end-stage renal failure (ESRF). These markers are also important in the prediction of preeclampsia, which is the most common complication in pregnancy. In this review we elaborate in dept the main structural and functional features of podocytes and their specific proteins, nephrin and podocalyxin, summarizing the recent literature data on their importance in the early diagnosis of the most common secondary nephropathies.
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Affiliation(s)
- Irena Kostovska
- Department of Medical and Experimental Biochemistry, Skopje , Republic of Macedonia
| | | | - Svetlana Cekovska
- Department of Medical and Experimental Biochemistry, Skopje , Republic of Macedonia
| | - Goce Spasovski
- Department of Nephrology, Medical Faculty, Skopje, University "Ss Cyril and Methodius", Skopje , Republic of Macedonia
| | - Danica Labudovic
- Department of Medical and Experimental Biochemistry, Skopje , Republic of Macedonia
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13
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Gilani SI, Anderson UD, Jayachandran M, Weissgerber TL, Zand L, White WM, Milic N, Suarez MLG, Vallapureddy RR, Nääv Å, Erlandsson L, Lieske JC, Grande JP, Nath KA, Hansson SR, Garovic VD. Urinary Extracellular Vesicles of Podocyte Origin and Renal Injury in Preeclampsia. J Am Soc Nephrol 2017; 28:3363-3372. [PMID: 28729288 DOI: 10.1681/asn.2016111202] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 05/15/2017] [Indexed: 12/12/2022] Open
Abstract
Renal histologic expression of the podocyte-specific protein, nephrin, but not podocin, is reduced in preeclamptic compared with normotensive pregnancies. We hypothesized that renal expression of podocyte-specific proteins would be reflected in urinary extracellular vesicles (EVs) of podocyte origin and accompanied by increased urinary soluble nephrin levels (nephrinuria) in preeclampsia. We further postulated that podocyte injury and attendant formation of EVs are related mechanistically to cellfree fetal hemoglobin (HbF) in maternal plasma. Our study population included preeclamptic (n=49) and normotensive (n=42) pregnant women recruited at delivery. Plasma measurements included HbF concentrations and concentrations of the endogenous chelators haptoglobin, hemopexin, and α1- microglobulin. We assessed concentrations of urinary EVs containing immunologically detectable podocyte-specific proteins by digital flow cytometry and measured nephrinuria by ELISA. The mechanistic role of HbF in podocyte injury was studied in pregnant rabbits. Compared with urine from women with normotensive pregnancies, urine from women with preeclamptic pregnancies contained a high ratio of podocin-positive to nephrin-positive urinary EVs (podocin+ EVs-to-nephrin+ EVs ratio) and increased nephrinuria, both of which correlated with proteinuria. Plasma levels of hemopexin, which were decreased in women with preeclampsia, negatively correlated with proteinuria, urinary podocin+ EVs-to-nephrin+ EVs ratio, and nephrinuria. Administration of HbF to pregnant rabbits increased the number of urinary EVs of podocyte origin. These findings provide evidence that urinary EVs are reflective of preeclampsia-related altered podocyte protein expression. Furthermore, renal injury in preeclampsia associated with an elevated urinary podocin+ EVs-to-nephrin+ EVs ratio and may be mediated by prolonged exposure to cellfree HbF.
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Affiliation(s)
| | - Ulrik Dolberg Anderson
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences Lund, Lund University, Skåne University Hospital, Malmö, Sweden; and
| | | | | | | | - Wendy M White
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Natasa Milic
- Division of Nephrology and Hypertension.,Department of Biostatistics, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | | | | | - Åsa Nääv
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences Lund, Lund University, Skåne University Hospital, Malmö, Sweden; and
| | - Lena Erlandsson
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences Lund, Lund University, Skåne University Hospital, Malmö, Sweden; and
| | | | | | | | - Stefan R Hansson
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences Lund, Lund University, Skåne University Hospital, Malmö, Sweden; and
| | - Vesna D Garovic
- Division of Nephrology and Hypertension, .,Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
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14
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Müller-Deile J, Schiffer M. Podocytes from the diagnostic and therapeutic point of view. Pflugers Arch 2017; 469:1007-1015. [PMID: 28508947 DOI: 10.1007/s00424-017-1993-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/04/2017] [Indexed: 01/23/2023]
Abstract
The central role of podocytes in glomerular diseases makes this cell type an interesting diagnostic tool as well as a therapeutic target. In this review, we discuss the current literature on the use of podocytes and podocyte-specific markers as non-invasive diagnostic tools in different glomerulopathies. Furthermore, we highlight the direct effects of drugs currently used to treat primary glomerular diseases and describe their direct cellular effects on podocytes. A new therapeutic potential is seen in drugs targeting the podocytic actin cytoskeleton which is essential for podocyte foot process structure and function. Incubation of cultured human podocyte cell lines with sera from patients with active glomerular diseases is currently also used to identify novel circulating factors with pathophysiological relevance for the glomerular filtration barrier. In addition, treatment of detached urinary podocytes from patients with substances that restore their cytoskeleton might serve as a novel personalized tool to estimate their potential for podocyte recovery ex vivo.
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Affiliation(s)
- Janina Müller-Deile
- Department of Nephrology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Mario Schiffer
- Department of Nephrology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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15
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Feng YL, Yin YX, Ding J, Yuan H, Yang L, Xu JJ, Hu LQ. Alpha-1-antitrypsin suppresses oxidative stress in preeclampsia by inhibiting the p38MAPK signaling pathway: An in vivo and in vitro study. PLoS One 2017; 12:e0173711. [PMID: 28358847 PMCID: PMC5373516 DOI: 10.1371/journal.pone.0173711] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 02/24/2017] [Indexed: 11/18/2022] Open
Abstract
This present study was designed to investigate the effects of alpha-1-antitrypsin (AAT) on oxidative stress in preeclampsia (PE) by regulating p38 mitogen-activated protein kinase (p38MAPK) signaling pathway. HTR8/SVneo cells were randomly assigned into normal, hypoxia/reoxygenation (H/R), HR + AAT and HR + siRNA-AAT groups. Quantitative real-time polymerase chain reaction (qRT-PCR) and Western blotting were used to detect the mRNA and protein expressions of p-p38MAPK, AAT, signal transducer and activator of transcription 1 (STAT1) and activating transcription factor2 (ATF2). Flow cytometry, scratch test, cell counting kit-8 (CCK-8) assay and the 3-(4,5)-dimethylthiazol (-z-y1)-3,5-di- phenyltetrazolium bromide (MTT) assay were conducted to detect reactive oxygen species (ROS) and cell apoptosis, cell migration, proliferation and cytotoxicity, respectively. Mouse models in PE were established, which were divided into normal pregnancy (NP), PE and PE + AAT groups with blood pressure and urine protein measured. Chromatin immunoprecipitation (ChIP) and enzyme-linked immunosorbent assay (ELISA) were conducted to detect the activity of oxidative stress-related kinases and expressions of inflammatory cytokines and coagulation-related factors in cells and mice placenta. Immunohistochemistry, Western blotting and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay were performed to detect AAT and p38MAPK expressions, apoptosis-related protein expressions, and apoptosis rate in mice placenta. Compared with the normal group, the H/R group had decreased expression of AAT, activity of superoxide dismutase (SOD) and GSH-Px, cell proliferation and migration, but increased p38MAPK, STAT1, ATF2, MDA, H2O2, inflammatory cytokines, coagulation-related factors, cell cytotoxicity, ROS, apoptotic factors and apoptosis rate. Compared with the H/R group, the HR + ATT group had increased expressions of AAT, activity of SOD and GSH-Px, cell proliferation and migration but decreased p38MAPK, STAT1, ATF2, malonyldialdehyde (MDA), H2O2, inflammatory cytokines and coagulation-related factors, cell cytotoxicity, ROS, apoptotic factors and apoptosis rate, while opposite results were observed in the HR + siRNA-ATT group. Compared with the NP group, the PE group had decreased activity of SOD and GSH-Px but increased MDA, H2O2, AAT, p38MAPK, inflammatory cytokines, coagulation-related factors and apoptosis rate. The indexes in the PE + AAT group were between the NP and PE groups. Thus, we concluded that AAT suppressed oxidative stress in PE by inhibiting p38MAPK signaling pathway.
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Affiliation(s)
- Ya-Ling Feng
- Department of Obstetrics and Gynecology, Wuxi Matemal and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, P.R. China
- * E-mail: (YLF); (LQH)
| | - Yong-Xiang Yin
- Department of Pathology, The Affiliated Maternity and Child Health Hospital of Nanjing Medical University, Wuxi, P.R. China
| | - Jian Ding
- Department of Obstetrics and Gynecology, Wuxi Matemal and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, P.R. China
| | - Hua Yuan
- Department of Obstetrics and Gynecology, Wuxi Matemal and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, P.R. China
| | - Lan Yang
- Department of Obstetrics and Gynecology, Wuxi Matemal and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, P.R. China
| | - Jian-Juan Xu
- Department of Obstetrics and Gynecology, Wuxi Matemal and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, P.R. China
| | - Ling-Qin Hu
- Department of Obstetrics and Gynecology, Wuxi Matemal and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, P.R. China
- * E-mail: (YLF); (LQH)
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16
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Jung YJ, Cho HY, Cho S, Kim YH, Jeon JD, Kim YJ, Lee S, Park J, Kim HY, Park YW, Kwon JY. The Level of Serum and Urinary Nephrin in Normal Pregnancy and Pregnancy with Subsequent Preeclampsia. Yonsei Med J 2017; 58:401-406. [PMID: 28120572 PMCID: PMC5290021 DOI: 10.3349/ymj.2017.58.2.401] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 07/21/2016] [Accepted: 09/02/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate serum and urinary nephrin levels of normal pregnancy to establish a standard reference value and to compare them with patients who subsequently developed preeclampsia (PE). MATERIALS AND METHODS In this prospective study, 117 healthy singleton pregnancies were enrolled between 6 to 20 weeks of gestation at 2 participating medical centers during October 2010 to March 2012. Urine and serum samples were collected at the time of enrollment, each trimester, and at 4 to 6 weeks postpartum. Enzyme-linked immunosorbent assay for nephrin was performed and samples from patients who subsequently developed PE were compared to the normal patients. RESULTS Of 117 patients initially enrolled, 99 patients delivered at the study centers and of those patients, 12 (12.1%) developed PE at a median gestational age of 34⁺⁴ weeks (range 29⁺⁵-36⁺⁶). In the normal patients (n=68), serum nephrin level decreased and urinary nephrin level increased during the latter of pregnancy. In 12 patients who subsequently developed PE, a significant rise in the 3rd trimester serum and urinary nephrin levels, compared to the controls, was observed (p<0.001), and this increase occurred 9 days prior to the onset of clinical disease. CONCLUSION As the onset of PE was preceded by the rise in the serum and urinary nephrin in comparison to normal pregnancy, serum and urinary nephrin may be a useful predictive marker of PE.
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Affiliation(s)
- Yun Ji Jung
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Young Cho
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sihyun Cho
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Young Han Kim
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Dong Jeon
- Department of Obstetrics and Gynecology, MizMedi Women's Hospital, Seoul, Korea
| | - Young Jin Kim
- Department of Bioanalysis, Seoul Medical Science Institute & Seoul Clinical Laboratories, Seoul, Korea
| | - Sanghoo Lee
- Department of Bioanalysis, Seoul Medical Science Institute & Seoul Clinical Laboratories, Seoul, Korea
| | - Jimyeong Park
- Department of Bioanalysis, Seoul Medical Science Institute & Seoul Clinical Laboratories, Seoul, Korea
| | - Ha Yan Kim
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Won Park
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Ja Young Kwon
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.
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17
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Martinez-Fierro ML, Perez-Favila A, Garza-Veloz I, Espinoza-Juarez MA, Avila-Carrasco L, Delgado-Enciso I, Ortiz-Castro Y, Cardenas-Vargas E, Cid-Baez MA, Ramirez-Santoyo RM, Cervantes-Kardasch VH, Rodriguez-Sanchez IP, Badillo-Almaraz JI, Castañeda-Miranda R, Solis-Sanchez LO, Ortiz-Rodriguez JM. Matrix metalloproteinase multiplex screening identifies increased MMP-2 urine concentrations in women predicted to develop preeclampsia. Biomarkers 2017; 23:18-24. [PMID: 28055277 DOI: 10.1080/1354750x.2017.1279214] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Preeclampsia, a pregnancy disorder characterized by hypertension and proteinuria, represents the leading cause of fetal and maternal morbidity and mortality in developing countries. The identification of novel and accurate biomarkers that are predictive of preeclampsia is necessary to improve the prognosis of patients with preeclampsia. OBJECTIVE The objective of this study is to evaluate the usefulness of nine urinary metalloproteinases to predict the risk of preeclampsia development. METHODS MMP-1, MMP-2, MMP-3, MMP-7, MMP-8, MMP-9, MMP-10, MMP-12 and MMP-13 were analyzed in urine (early-pregnancy) from 17 women predicted to develop preeclampsia and 48 controls using the Bio-Plex Pro-Human MMP panel (Bio-Rad, Hercules, CA). RESULTS Urinary MMP-2 showed differences between groups which allowed us to calculate an increased risk for PE development of up to 20 times among the study population. CONCLUSION Increased urinary concentration of MMP-2 at 12 and 16 weeks of gestation predicted an increased risk of developing preeclampsia in the study population.
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Affiliation(s)
- Margarita L Martinez-Fierro
- a Molecular Medicine Laboratory , Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas , Zacatecas , Mexico.,b Centro de Investigacion e Innovacion Tecnologica Industrial, Unidad Academica de Ingenieria Electrica, Universidad Autonoma de Zacatecas , Zacatecas , Mexico.,c Grupo de Investigacion Regional Emergente (GIRE) , Zacatecas , Mexico
| | - Aurelio Perez-Favila
- a Molecular Medicine Laboratory , Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas , Zacatecas , Mexico
| | - Idalia Garza-Veloz
- a Molecular Medicine Laboratory , Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas , Zacatecas , Mexico.,b Centro de Investigacion e Innovacion Tecnologica Industrial, Unidad Academica de Ingenieria Electrica, Universidad Autonoma de Zacatecas , Zacatecas , Mexico.,c Grupo de Investigacion Regional Emergente (GIRE) , Zacatecas , Mexico
| | - Marcela A Espinoza-Juarez
- a Molecular Medicine Laboratory , Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas , Zacatecas , Mexico
| | - Lorena Avila-Carrasco
- a Molecular Medicine Laboratory , Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas , Zacatecas , Mexico
| | - Ivan Delgado-Enciso
- d School of Medicine, University of Colima , Colima , Mexico.,e Instituto Estatal de Cancerologia, Servicios de Salud del Estado de Colima , Colima , Mexico
| | - Yolanda Ortiz-Castro
- a Molecular Medicine Laboratory , Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas , Zacatecas , Mexico
| | - Edith Cardenas-Vargas
- a Molecular Medicine Laboratory , Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas , Zacatecas , Mexico
| | - Miguel A Cid-Baez
- a Molecular Medicine Laboratory , Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas , Zacatecas , Mexico
| | - Rosa M Ramirez-Santoyo
- f Unidad Academica de Ciencias Biologicas, Universidad Autonoma de Zacatecas , Zacatecas , Mexico
| | | | - Iram P Rodriguez-Sanchez
- g Departamento de Genética, Facultad de Medicina , Universidad Autónoma de Nuevo León , Monterrey , Nuevo León , México
| | - Jose I Badillo-Almaraz
- a Molecular Medicine Laboratory , Unidad Academica de Medicina Humana y Ciencias de la Salud, Universidad Autonoma de Zacatecas , Zacatecas , Mexico
| | - Rodrigo Castañeda-Miranda
- b Centro de Investigacion e Innovacion Tecnologica Industrial, Unidad Academica de Ingenieria Electrica, Universidad Autonoma de Zacatecas , Zacatecas , Mexico.,c Grupo de Investigacion Regional Emergente (GIRE) , Zacatecas , Mexico
| | - Luis O Solis-Sanchez
- b Centro de Investigacion e Innovacion Tecnologica Industrial, Unidad Academica de Ingenieria Electrica, Universidad Autonoma de Zacatecas , Zacatecas , Mexico.,c Grupo de Investigacion Regional Emergente (GIRE) , Zacatecas , Mexico
| | - Jose M Ortiz-Rodriguez
- b Centro de Investigacion e Innovacion Tecnologica Industrial, Unidad Academica de Ingenieria Electrica, Universidad Autonoma de Zacatecas , Zacatecas , Mexico.,c Grupo de Investigacion Regional Emergente (GIRE) , Zacatecas , Mexico
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18
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Second-trimester urine nephrin:creatinine ratio versus soluble fms-like tyrosine kinase-1:placental growth factor ratio for prediction of preeclampsia among asymptomatic women. Sci Rep 2016; 6:37442. [PMID: 27874074 PMCID: PMC5118691 DOI: 10.1038/srep37442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/28/2016] [Indexed: 12/27/2022] Open
Abstract
This prospective observational study compare urine nephrin:creatinine ratio (NCR, ng/mg) with serum soluble fms-like tyrosine kinase-1:placental growth factor ratio (FPR, pg/pg) for preeclampsia (PE) prediction among unselected asymptomatic pregnant women in 2nd trimester. NCR and FPR were determined in 254 paired urine/blood samples collected simultaneously from 254 women at median gestational week (GW) 24 (range, 22–27) without hypertension or significant proteinuria in pregnancy (SPIP). Fifteen (5.9%) developed SPIP and hypertension at GW 34.0 (26.0–38.6) and 35.3 (27.6–38.6), respectively, and were diagnosed with PE at GW 35.7 (27.6–38.6). The 90th percentile level determined in 239 women normotensive throughout pregnancy gave NCR (139) sensitivity and positive predictive values (PPV) of 60% (9/15) and 27% (9/33), while those for serum FPR (4.85) were 40% (6/15) and 20% (6/30), respectively. Relative risks (95%CI) of later PE were 10.0 (3.82–26.4; 27% [9/33] vs. 2.7% [6/221]) and 4.98 (1.91–13.0; 20% [6/30] vs. 4.0% [9/224]) for NCR-positive and FPR-positive women, respectively. Cut-offs suggested by ROC gave NCR (86.6) sensitivity and PPV of 87% (13/15) and 17% (13/79), and FPR (8.8) values of 40% (6/15) and 40% (6/15), respectively. Thus, 2nd trimester NCR was superior to FPR for PE prediction.
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19
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Furuta I, Zhai T, Ishikawa S, Umazume T, Nakagawa K, Yamada T, Morikawa M, Minakami H. Association between nephrinuria, podocyturia, and proteinuria in women with pre-eclampsia. J Obstet Gynaecol Res 2016; 43:34-41. [DOI: 10.1111/jog.13180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/26/2016] [Accepted: 08/21/2016] [Indexed: 01/06/2023]
Affiliation(s)
- Itsuko Furuta
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
| | - Tianyue Zhai
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
| | - Satoshi Ishikawa
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
| | - Takeshi Umazume
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
| | - Kinuko Nakagawa
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
| | - Takahiro Yamada
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
| | - Mamoru Morikawa
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
| | - Hisanori Minakami
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
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20
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Zhai T, Furuta I, Akaishi R, Kawabata K, Chiba K, Umazume T, Ishikawa S, Yamada T, Morikawa M, Minakami H. Feasibility of nephrinuria as a screening tool for the risk of pre-eclampsia: prospective observational study. BMJ Open 2016; 6:e011229. [PMID: 27486123 PMCID: PMC4985984 DOI: 10.1136/bmjopen-2016-011229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To investigate the possibility of nephrinuria as a screening tool for the risk of pre-eclampsia (PE). DESIGN Prospective observational study. SETTING A single university hospital. Changes in urinary nephrin:creatinine ratio (NCR, ng/mg) and protein:creatinine ratio (PCR, mg/mg) in pregnancy were determined. Significant proteinuria in pregnancy (SPIP) was defined as PCR>0.27. PE was diagnosed in women with both SPIP and hypertension. PARTICIPANTS 89 pregnant women in whom neither hypertension nor SPIP was present at enrolment, providing 31, 125 and 93 random urine samples during first, second and third trimesters, respectively. RESULTS PE developed in 14 of the 89 women. NCR increased with increasing PCR in 14 women with PE (correlation coefficient, 0.862; p<0.0001). In contrast, NCR did not change significantly despite significant increases in PCR in 75 women with normotensive pregnancies defined as neither SPIP nor hypertension, indicating that there was little increase in nephrinuria over the physiological range of proteinuria in pregnancy. Relative risk of later development of PE among asymptomatic second and third trimester women with NCR (ng/mg) >122 (95th centile value for 75 women with normotensive pregnancies) was 5.93 (95% CI 2.59 to 13.6; 60% (6/10) vs 10% (8/79)) and 13.5 (95% CI 3.31 to 55.0; 75% (6/8) vs 5.5% (2/36)), respectively, compared with women with NCR≤122 at that time. CONCLUSIONS Nephrinuria was unlikely to increase in normal pregnancy. A certain NCR cut-off may efficiently differentiate women at higher risk of PE.
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Affiliation(s)
- Tianyue Zhai
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Itsuko Furuta
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Rina Akaishi
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Kosuke Kawabata
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Kentaro Chiba
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Takeshi Umazume
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Satoshi Ishikawa
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Takahiro Yamada
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Mamoru Morikawa
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Hisanori Minakami
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
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21
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Abstract
OBJECTIVES Nephrin is an integral part of podocytes that together with endothelial cells and the basement form the glomerular filtration barrier. Placental ischemia triggers a cascade of events that ultimately result in endothelial malfunction, hypertension, podocytopathy and fetal compromise. METHODS We review the literature to determine if urine nephrin measurements could serve as a useful biomarker to detect early podocyte injury in pre-eclampsia. RESULTS Our search identifies eight studies published to date. The findings of these studies demonstrate that urine nephrin excretion plays a critical role in the pathogenesis of proteinuria during pre-eclampsia and that this is a good indicator of glomerular injury. CONCLUSION There is thus an urgent need for a large multi-centre clinical study using standardized recruitment criteria to determine the full potential of this biomarker in clinical practice.
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Affiliation(s)
- Yogavijayan Kandasamy
- a Department of Neonatology , The Townsville Hospital , Douglas , Queensland , Australia .,b Mothers and Babies Research Centre, Hunter Medical Research Institute, John Hunter Hospital, The University of Newcastle , Callaghan , New South Wales , Australia .,c College of Public Health, Medical and Veterinary Sciences, The James Cook University , Townsville City , Queensland , Australia , and
| | - David Watson
- d Department of Obstetrics and Gynaecology , The Townsville Hospital , Douglas , Queensland , Australia
| | - Donna Rudd
- c College of Public Health, Medical and Veterinary Sciences, The James Cook University , Townsville City , Queensland , Australia , and
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Kac G, Mendes RH, Farias DR, Eshriqui I, Rebelo F, Benaim C, Vilela AAF, Lima NS, Peres WAF, Salles GF. Hepatic, renal and inflammatory biomarkers are positively associated with blood pressure changes in healthy pregnant women: a prospective cohort. Medicine (Baltimore) 2015; 94:e683. [PMID: 25997037 PMCID: PMC4602876 DOI: 10.1097/md.0000000000000683] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
This article evaluates the association of hepatic, renal, and inflammatory biomarkers with changes in systolic (SBP) and diastolic (DBP) blood pressure (BP) during healthy pregnancies.A prospective cohort study with 225 healthy pregnant women was conducted in Rio de Janeiro, Brazil. SBP and DBP were evaluated throughout pregnancy (5th-13th, 20th-26th, and 30th-36th gestational weeks) and were the outcomes. The following biomarkers were measured at the first trimester and analyzed according to tertiles of the sample distribution and were considered the main independent predictors: alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), uric acid (UA), creatinine (Cr), and C-reactive protein (CRP) concentrations. The statistical analysis included 3 stages of modeling with the longitudinal linear mixed-effects procedures: Model 1 was adjusted for gestational age and quadratic gestational age; Model 2 included interactions between the biomarkers and gestational age; and Model 3 was adjusted for self-reported skin color, education, parity, early-pregnancy body mass index (BMI) (under/normal <25; overweight/obese ≥25 kg/m), smoking habit, and leisure-time physical activity. Additional models were performed for CRP and UA with the inclusion of interaction terms between the biomarkers and BMI.Women classified in the third tertile of the ALP (≥61.1 U/L; βSBP = 3.474; 95% confidence interval [CI]: 0.955-5.992; βDBP = 3.291; 95% CI: 1.098-5.485), ALT (≥14.3 U/L; βSBP = 2.232; 95% CI: 0.221-4.242; βDBP = 2.355; 95% CI: 0.721-3.989), and Cr values (≥48.6 μmol/L; βDBP = 1.927; 95% CI: 0.347-3.508) presented higher BP levels during pregnancy compared to those in the first and second tertiles. Women in the highest tertile of the ALP concentration distribution presented a lower rate of change in SBP and DBP during pregnancy (interaction term with gestational age βSBP = -0.004; 95% CI: -0.007 to -0.001; P = 0.02; βDBP = -0.003; 95% CI: -0.006 to -0.001; P = 0.01). Higher UA concentrations were associated with higher SBP levels only in overweight/obese women (β = 3.878; 95% CI: 0.687-7.068), whereas higher CRP concentrations (≥2.6 mg/L) were associated with higher DBP in under/normal weight women (β =2.252; 95% CI: 0.267-4.236).ALP, ALT, and Cr concentrations were positively associated with BP levels, whereas ALP was associated with a lower rate of change in BP. The associations of UA and CRP with BP differ according to the early-pregnancy BMI.
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Affiliation(s)
- Gilberto Kac
- From the Nutritional Epidemiology Observatory (GK, DRF, IE, FR, CB, AAFV, NSL), Department of Social and Applied Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro; BRAIN Laboratory (Basic Research and Advanced Investigations in Neurosciences) (RHM), Hospital de Clínicas de Porto Alegre, Porto Alegre; Graduate Program in Nutrition (GK, DRF, IE, CB, AAFV, NSL), Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro; Graduate Program in Epidemiology in Public Health (FR), National School of Public Health, Oswaldo Cruz Foundation; Department of Nutrition and Dietetics (WAFP), Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro; and Department of Internal Medicine (GFS), University Hospital Clementino Fraga Filho, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Kandasamy Y, Smith R, Lumbers ER, Rudd D. Nephrin - a biomarker of early glomerular injury. Biomark Res 2014; 2:21. [PMID: 25789166 PMCID: PMC4363192 DOI: 10.1186/2050-7771-2-21] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 11/07/2014] [Indexed: 01/04/2023] Open
Abstract
Nephrin is a 180 KD trans-membrane protein expressed in glomerular podocytes. It was first identified in children with congenital nephrotic syndrome of the Finnish type (NPHS1). Nephrin forms an integral part of podocytes, which-together with endothelial cells and the basement-form the glomerular filtration barrier. Podocytopathies result in the detection of nephrin in the urine. We reviewed the literature to determine if urine nephrin measurements could become useful as a biomarker to detect early podocyte injury. Our search identified a total of 19 studies that have been published to date. The most common clinical conditions for which urine nephrin analyses were carried out included diabetic nephropathy, glomerulonephritis and pre-eclampsia. Nephrin measurement was carried out using commercially available ELISA kits, the messenger ribonucleic acid real-time polymerase chain Reaction, or electrophoresis. Nephrinuria showed positive correlation with proteinuria and severity of podocyte injury. In two studies, the level of nephrinuria declined in conjunction with clinical improvement in the patient following immunosuppressive treatment. Currently, there is no published data on the value of measuring urinary nephrin in pediatric patients.
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Affiliation(s)
- Yogavijayan Kandasamy
- />Department of Neonatology, The Townsville Hospital, 100 Angus Smith Drive, Douglas, QLD 4814 Australia
- />Hunter Medical Research Institute, Mothers and Babies Research Centre, John Hunter Hospital, The University of Newcastle, Callaghan, NSW 2310 Australia
- />College of Public Health, Medical and Veterinary Sciences, The James Cook University, Townsville, QLD 4814 Australia
| | - Roger Smith
- />Hunter Medical Research Institute, Mothers and Babies Research Centre, John Hunter Hospital, The University of Newcastle, Callaghan, NSW 2310 Australia
| | - Eugenie R Lumbers
- />Hunter Medical Research Institute, Mothers and Babies Research Centre, John Hunter Hospital, The University of Newcastle, Callaghan, NSW 2310 Australia
| | - Donna Rudd
- />College of Public Health, Medical and Veterinary Sciences, The James Cook University, Townsville, QLD 4814 Australia
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Affiliation(s)
- Vesna D Garovic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
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White WM, Garrett AT, Craici IM, Wagner SJ, Fitz-Gibbon PD, Butters KA, Brost BC, Rose CH, Grande JP, Garovic VD. Persistent urinary podocyte loss following preeclampsia may reflect subclinical renal injury. PLoS One 2014; 9:e92693. [PMID: 24664365 PMCID: PMC3963957 DOI: 10.1371/journal.pone.0092693] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 02/24/2014] [Indexed: 01/08/2023] Open
Abstract
Objective Studies have shown that podocyturia, i.e., urinary loss of viable podocytes (glomerular epithelial cells), is associated with proteinuria in preeclampsia. We postulated that urinary podocyte loss may persist after preeclamptic pregnancies, thus resulting in renal injury. This may lead to future chronic renal injury. In addition, we compared the postpartum levels of the angiogenic factors, which previously have been associated with preeclampsia, between normotensive versus preeclamptic pregnancies. Study Design The diagnosis of preeclampsia was confirmed using standard clinical criteria. Random blood and urine samples were obtained within 24 hours prior to delivery and 5 to 8 weeks postpartum. Urine sediments were cultured for 24 hours to select for viable cells and staining for podocin was used to identify podocytes. Serum samples were analyzed for the levels of angiogenic markers using ELISA (enzyme-linked immunosorbent assay) methodology. Results At delivery, preeclamptic patients (n = 10) had significantly higher proteinuria (p = 0.006) and podocyturia (p<0.001) than normotensive pregnant patients (n = 18). Postpartum proteinuria was similar between these two groups (p = 0.37), while podocyturia was present in 3 of 10 women with preeclampsia and in none of the normotensive controls (p = 0.037). Angiogenic marker levels, including placental growth factor, soluble vascular endothelial growth factor receptor fms-like tyrosine kinase receptor-1 and endoglin, were not significantly different between women with preeclampsia and women with a normotensive pregnancy, either at delivery or postpartum. Conclusion Persistent urinary podocyte loss after preeclamptic pregnancies may constitute a marker of ongoing, subclinical renal injury.
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Affiliation(s)
- Wendy M. White
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Angelica T. Garrett
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Iasmina M. Craici
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Steven J. Wagner
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Patrick D. Fitz-Gibbon
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Kim A. Butters
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Brian C. Brost
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Carl H. Rose
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Joseph P. Grande
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Vesna D. Garovic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
- * E-mail:
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Agha FE, Youness ER, Selim MMH, Ahmed HH. Nephroprotective potential of selenium and taurine against mercuric chloride induced nephropathy in rats. Ren Fail 2014; 36:704-16. [DOI: 10.3109/0886022x.2014.890012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Craici IM, Wagner SJ, Weissgerber TL, Grande JP, Garovic VD. Advances in the pathophysiology of pre-eclampsia and related podocyte injury. Kidney Int 2014; 86:275-85. [PMID: 24573315 PMCID: PMC4117806 DOI: 10.1038/ki.2014.17] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 11/04/2013] [Accepted: 11/14/2013] [Indexed: 12/12/2022]
Abstract
Pre-eclampsia is a pregnancy-specific hypertensive disorder that may lead to serious maternal and fetal complications. It is a multisystem disease that is commonly, but not always, accompanied by proteinuria. Its cause(s) remain unknown, and delivery remains the only definitive treatment. It is increasingly recognized that many pathophysiological processes contribute to this syndrome, with different signaling pathways converging at the point of systemic endothelial dysfunction, hypertension, and proteinuria. Different animal models of pre-eclampsia have proven utility for specific aspects of pre-eclampsia research, and offer insights into pathophysiology and treatment possibilities. Therapeutic interventions that specifically target these pathways may optimize pre-eclampsia management and may improve fetal and maternal outcomes. In addition, recent findings regarding placental, endothelial, and podocyte pathophysiology in pre-eclampsia provide unique and exciting possibilities for improved diagnostic accuracy. Emerging evidence suggests that testing for urinary podocytes or their markers may facilitate the prediction and diagnosis of pre-eclampsia. In this review, we explore recent research regarding placental, endothelial, and podocyte pathophysiology. We further discuss new signaling and genetic pathways that may contribute to pre-eclampsia pathophysiology, emerging screening and diagnostic strategies, and potential targeted interventions.
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Affiliation(s)
- Iasmina M Craici
- Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Steven J Wagner
- Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Joseph P Grande
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Vesna D Garovic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
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A compendium of urinary biomarkers indicative of glomerular podocytopathy. PATHOLOGY RESEARCH INTERNATIONAL 2013; 2013:782395. [PMID: 24327929 PMCID: PMC3845336 DOI: 10.1155/2013/782395] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 09/10/2013] [Indexed: 12/18/2022]
Abstract
It is well known that glomerular podocyte injury and loss are present in numerous nephropathies and that the pathophysiologic consecution of disease hinges upon the fate of the podocyte. While multiple factors play a hand in glomerulopathy progression, basic logic lends that if one monitors the podocyte's status, that may reflect the status of disease. Recent investigations have focused on what one can elucidate from the noninvasive collection of urine, and have proven that certain, specific biomarkers of podocytes can be readily identified via varying techniques. This paper has brought together all described urinary biomarkers of podocyte injury and is made to provide a concise summary of their utility and testing in laboratory and clinical theatres. While promising in the potential that they hold as tools for clinicians and investigators, the described biomarkers require further comprehensive vetting in the form of larger clinical trials and studies that would give their value true weight. These urinary biomarkers are put forth as novel indicators of glomerular disease presence, disease progression, and therapeutic efficacy that in some cases may be more advantageous than the established parameters/measures currently used in practice.
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August P. Preeclampsia: a "nephrocentric" view. Adv Chronic Kidney Dis 2013; 20:280-6. [PMID: 23928394 DOI: 10.1053/j.ackd.2013.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Revised: 01/29/2013] [Accepted: 01/30/2013] [Indexed: 01/12/2023]
Abstract
To the obstetrician, preeclampsia is a placental syndrome becoming clinically apparent in later pregnancy and presenting with maternal hypertension, proteinuria, and in some cases liver and central nervous system dysfunction, which, if not addressed in a timely fashion can lead to significant maternal and fetal morbidity and mortality. As such, the only satisfactory cure is delivery of the fetus, after which most, if not all, of the manifestations disappear. The nephrologist, who often is consulted only when patients develop more serious manifestations such as accelerating hypertension, acute kidney injury, and microangiopathic features, often has a different perspective. She/he sees a woman with hypertension and proteinuric kidney disease with mildly reduced glomerular filtration rate. Exciting discoveries regarding the pathogenesis of this syndrome have helped to reconcile these two views; however, much remains unknown. This review focuses on the hypertension and kidney manifestations of the disease, acknowledging that complex placental pathogenic alterations are clearly an important, if not the most important, initiator of the later maternal signs and symptoms.
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