Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Transplantation. 2013 Aug 27;96(4):394-9. doi: 10.1097/TP.0b013e3182977ab1.
Recently, serum soluble urokinase receptor (suPAR) has been proposed as a cause of two thirds of cases of focal segmental glomerulosclerosis (FSGS). It was noted to be uniquely elevated in cases of primary FSGS, with higher levels noted in cases that recurred after transplantation. It is also suggested as a possible target and marker of therapy.
We studied serum and urine suPAR from pretransplantation banked samples from 86 well-characterized kidney transplant recipients and 10 healthy controls to determine its prognostic utility. Causes of native kidney disease were primary FSGS, diabetic nephropathy, membranous nephropathy, immunoglobulin A nephropathy, and autosomal dominant polycystic kidney disease. suPAR was measured using a commercially available enzyme-linked immunosorbent assay kit. Urinary suPAR was indexed to creatinine.
Both serum and urine suPAR correlated with proteinuria and albuminuria. Serum suPAR was found to be elevated in all transplant candidates with advanced renal disease compared with healthy controls and could not differentiate disease diagnosis. Urine suPAR was elevated in cases of recurrent FSGS compared with all other causes of end-stage renal disease. Recurrent FSGS cases had substantially higher proteinuria compared with all other cases. However, elevated urinary suPAR showed a trend in providing additional prognostic information beyond proteinuria in the small cohort of recurrent FSGS cases.
In advanced renal disease, elevated serum suPAR is not unique to FSGS cases. Urinary suPAR appears to be higher in cases of FSGS destined for recurrence and merits further evaluation.
最近，血清可溶性尿激酶受体（suPAR）被认为是三分之二局灶节段性肾小球硬化症（FSGS）病例的病因。它在原发性 FSGS 病例中被发现明显升高，在移植后复发的病例中水平更高。它也被认为是一种可能的治疗靶点和标志物。
我们研究了 86 例经充分特征描述的肾移植受者的移植前储存样本的血清和尿液 suPAR，以确定其预后价值。原发性 FSGS、糖尿病肾病、膜性肾病、免疫球蛋白 A 肾病和常染色体显性多囊肾病是导致患者原发病的原因。使用商业上可获得的酶联免疫吸附测定试剂盒来测量 suPAR。尿 suPAR 与肌酐进行指数化。
血清和尿液 suPAR 均与蛋白尿和白蛋白尿相关。与健康对照组相比，所有患有晚期肾病的移植候选者的血清 suPAR 均升高，并且不能区分疾病诊断。与所有其他终末期肾病的原因相比，复发性 FSGS 病例的尿液 suPAR 升高。复发性 FSGS 病例的蛋白尿显著高于所有其他病例。然而，在复发性 FSGS 病例的小队列中，升高的尿 suPAR 在提供蛋白尿以外的额外预后信息方面显示出趋势。
在晚期肾病中，升高的血清 suPAR 并非 FSGS 病例所特有。尿液 suPAR 似乎在复发性 FSGS 病例中更高，值得进一步评估。
