Liu Xiao-Jing, Zhang Yi-Miao, Wang Su-Xia, Liu Gang
Renal Division, Peking University First Hospital, Beijing, China; Institute of Nephrology, Peking University, Beijing, China; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China.
Nephrology (Carlton). 2014 Jul;19(7):392-7. doi: 10.1111/nep.12256.
The current study was designed to observe the ultrastructural changes of podocyte foot processes during the remission phase and its relationship with the amount of the proteinuria in patients with minimal change disease (MCD).
Electron micrographs of glomerular capillaries were taken from 33 adult cases with MCD, including 12 cases with nephrotic syndrome, 15 cases in partial remission and six cases in complete remission. The foot processes were classified into three grades by the ratio of the height to basal width: 0.5-1, 1-2 and ≥2. The foot process width (FPW) and the number of foot processes in different grades per 10 μm of glomerular basement membrane (GBM) were measured. Normal renal tissues from 12 nephrectomies for renal carcinoma were selected as controls.
There were statistical differences (P = 0.001) in the mean FPW among the nephrotic group (1566.4 ± 429.4 nm), partial remission group (1007.8 ± 234.9 nm), complete remission group (949.8 ± 168.2 nm) and normal controls (471.9 ± 51.8 nm). For the height-to-width ratio ≥2, the number of foot process per 10 μm GBM was significantly greater in the normal group than that in the complete remission group (0.84 ± 0.24 vs. 3.84 ± 1.80, P = 0.016). Taking all three groups of patients together, the mean FPW showed correlation with the level of proteinuria (r = 0.506, P = 0.003).
There may be no causal relationship between proteinuria and foot process effacement. In complete remission phase, both FPW and shape of foot process had not returned to normal while proteinuria disappeared.
本研究旨在观察微小病变病（MCD）患者缓解期足细胞足突的超微结构变化及其与蛋白尿程度的关系。
选取33例成年MCD患者的肾小球毛细血管电镜照片，其中肾病综合征患者12例，部分缓解患者15例，完全缓解患者6例。根据足突高度与基底宽度的比值将足突分为三级：0.5 - 1、1 - 2和≥2。测量每10μm肾小球基底膜（GBM）不同级别足突的宽度（FPW）和数量。选取12例因肾癌行肾切除术的正常肾组织作为对照。
肾病组（1566.4±429.4nm）、部分缓解组（1007.8±234.9nm）、完全缓解组（949.8±168.2nm）和正常对照组（471.9±51.8nm）的平均FPW存在统计学差异（P = 0.001）。对于高度与宽度比值≥2的情况，正常组每10μm GBM的足突数量显著多于完全缓解组（0.84±0.24对3.84±1.80，P = 0.016）。将三组患者合并分析，平均FPW与蛋白尿水平呈正相关（r = 0.506，P = 0.003）。
蛋白尿与足突融合之间可能不存在因果关系。在完全缓解期，虽然蛋白尿消失，但FPW和足突形态均未恢复正常。
