Chebotareva N V, Bobkova I N, Lysenko L V
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow, Russia.
Ter Arkh. 2018 Jun 20;90(6):92-97. doi: 10.26442/terarkh201890692-97.
In the review, the mechanisms of podocytes damage underlying the development of proteinuria and progression of glomerulosclerosis in chronic glomerulonephritis are discussed in detail. The results of experimental and clinical studies are presented. Under the different immune and non-immune factors the podocytes form a stereotyped response to damage consisting in the reorganization of the actin cytoskeleton, foot process effacement, the detachment of podocytes from the glomerular basement membrane, and the appearance of specific podocyte proteins and whole cells (podocyturia) in the urine. Massive podocyturia in a limited proliferative capacity of podocytes leads to reduce their total count in the glomerulus (podocytopenia) and the development of glomerulosclerosis. The authors describe the line of markers of the podocyte injury and invasive and non-invasive methods of their assessment. In addition, the relationship of podocyturia level with proteinuria and renal dysfunction are discussed, the prospects of assessment the podocyte proteins in urine for assessing of glomerular damage severity and glomerulosclerosis risk are examined.
在这篇综述中，详细讨论了慢性肾小球肾炎中蛋白尿发生及肾小球硬化进展过程中足细胞损伤的机制。文中呈现了实验研究和临床研究的结果。在不同的免疫和非免疫因素作用下，足细胞对损伤形成一种刻板反应，包括肌动蛋白细胞骨架重组、足突消失、足细胞从肾小球基底膜脱离，以及尿液中出现特定的足细胞蛋白和完整细胞（足细胞尿）。足细胞有限的增殖能力下出现大量足细胞尿，导致肾小球中足细胞总数减少（足细胞减少症）以及肾小球硬化的发生。作者描述了足细胞损伤的一系列标志物及其评估的侵入性和非侵入性方法。此外，还讨论了足细胞尿水平与蛋白尿和肾功能不全的关系，探讨了检测尿液中足细胞蛋白以评估肾小球损伤严重程度和肾小球硬化风险的前景。
