De Petris Laura, Patrick Jilma, Christen Erica, Trachtman Howard
Department of Pediatrics, Washington University, St. Louis, Missouri, USA.
Ren Fail. 2006;28(6):475-82. doi: 10.1080/08860220600778902.
Diarrhea-associated hemolytic uremic syndrome (D+HUS) causes acute renal failure and may lead to podocyte loss. Objective. To determine if the urinary mRNA excretion of podocyte proteins is detectable in children with D+HUS and if it is a biomarker of a poor long-term outcome.
Patients were randomly selected from participants in the SYNSORB Pk trial. Urine samples were collected daily during the first week of hospitalization. Specimens were also obtained in healthy volunteers. Synaptopodin and nephrin mRNA levels were measured using real-time PCR.
Fifteen children, aged 4.9+/-2.8 years, were studied. Patients were categorized based on urinary mRNA levels into normal (marker:GAPDH<or=mean + SD) or high (marker:GAPDH>mean + SD) in controls. Twelve patients (80%) had increased urinary podocyte mRNA excretion; 11 (73%) had high synaptopodin and 5 (33%) had high nephrin mRNA levels. Follow-up data were available in 13/15 patients, all of whom had normal blood pressure, urinalysis, and serum creatinine concentration.
The isolation of podocyte mRNA from routine urine samples is feasible in children with D+HUS. Most patients have podocyturia based on synaptopodin and nephrin mRNA excretion. Larger studies with extended follow-up are required to determine the relationship of these biomarkers to long-term renal prognosis in D+HUS.
腹泻相关性溶血尿毒综合征（D+HUS）可导致急性肾衰竭，并可能导致足细胞丢失。目的：确定在D+HUS患儿中是否可检测到尿中足细胞蛋白的mRNA排泄，以及它是否是长期预后不良的生物标志物。
从SYNSORB Pk试验的参与者中随机选取患者。在住院的第一周每天收集尿液样本。也从健康志愿者中获取样本。使用实时PCR测量突触素和nephrin mRNA水平。
研究了15名年龄为4.9±2.8岁的儿童。根据尿mRNA水平将患者分为对照组中正常（标志物：GAPDH≤平均值+标准差）或高（标志物：GAPDH＞平均值+标准差）。12名患者（80%）尿足细胞mRNA排泄增加；11名（73%）突触素水平高，5名（33%）nephrin mRNA水平高。13/15名患者有随访数据，所有患者血压、尿常规和血清肌酐浓度均正常。
从D+HUS患儿的常规尿液样本中分离足细胞mRNA是可行的。基于突触素和nephrin mRNA排泄，大多数患者存在足细胞尿。需要进行更大规模、更长随访期的研究来确定这些生物标志物与D+HUS长期肾脏预后的关系。
