Viggiano Davide, Nigro Michelangelo, Sessa Francesco, Vignolini Graziano, Campi Riccardo, Serni Sergio, Pollastro Rosa Maria, Vallone Gianfranco, Gigliotti Giuseppe, Capasso Giovambattista
Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy.
UOC of Nephrology and dialysis, Eboli Hospital "Maria SS Addolorata", Eboli, Italy.
PeerJ. 2019 Sep 4;7:e7640. doi: 10.7717/peerj.7640. eCollection 2019.
The total number of nephrons has been measured mainly from post-mortem studies and only in selected populations. Data from living subjects are scanty, and direct comparisons among different glomerular diseases are lacking. The present work exploits modern methodology to estimate the total nephron number in glomerulopathies with prevalent proteinuria/nephrotic syndrome versus glomerulopathies with nephritic syndrome (IgA nephropathy (IgAN), lupus nephritis), thus extending previous observations about the number and function of glomeruli in different physiological and pathological states.
This is a retrospective study based on one hundred and seven patients who have undergone renal biopsy. The glomerular density has been estimated from the biopsy specimens and the total cortical volume has been obtained from ultrasound recordings. Stereological methods have been applied to calculate the total number of nephrons and their volume. The correlation between clinical parameters and quantitative morphological data have studied using the Pearson correlation coefficient ().
The total number of nephrons inversely correlated with the systolic blood pressure ( = -0.4, < 0.05). In proteinuric diseases, such as focal segmental glomerulo-sclerosis (FSGS), membranous nephropathy (MN) and diabetes, the change in estimated GFR (eGFR) directly correlated with the total number of non-sclerotic glomeruli (NSG) ( = 0.62, < 0.01), whereas in nephritic syndrome no significant correlation was observed. The alterations in eGFR occurring in nephritic syndromes such as IgAN cannot be explained on the basis of the number of NSG.
The fusion of the podocyte foot-processes that typically occurs in purely proteinuric diseases does not modify the glomerular filtration rate: therefore in these situations, the change in eGFR depends mainly on the number of available glomeruli. On the other side, the eGFR decrease occurring in nephritic syndromes, such as IgAN, cannot be explained simply on the basis of the number of NSG and likely depends on the substantial involvement of the mesangial axis. Future studies should verify whether these changes are reversible with appropriate therapy, thus reversing eGFR decrease.
肾单位总数主要是通过尸检研究测量的，且仅在特定人群中进行。来自活体受试者的数据很少，并且缺乏不同肾小球疾病之间的直接比较。本研究采用现代方法来估计蛋白尿/肾病综合征为主的肾小球疾病与肾炎综合征（IgA肾病（IgAN）、狼疮性肾炎）的肾小球疾病中的肾单位总数，从而扩展了先前关于不同生理和病理状态下肾小球数量和功能的观察。
这是一项基于107例接受肾活检患者的回顾性研究。从活检标本中估计肾小球密度，并从超声记录中获得总皮质体积。应用体视学方法计算肾单位总数及其体积。使用Pearson相关系数研究临床参数与定量形态学数据之间的相关性。
肾单位总数与收缩压呈负相关（r = -0.4，P < 0.05）。在蛋白尿性疾病中，如局灶节段性肾小球硬化（FSGS）、膜性肾病（MN）和糖尿病，估计肾小球滤过率（eGFR）的变化与非硬化性肾小球（NSG）总数直接相关（r = 0.62，P < 0.01），而在肾炎综合征中未观察到显著相关性。IgAN等肾炎综合征中发生的eGFR改变不能基于NSG的数量来解释。
典型地发生在单纯蛋白尿性疾病中的足细胞足突融合不会改变肾小球滤过率：因此在这些情况下，eGFR的变化主要取决于可用肾小球的数量。另一方面，IgAN等肾炎综合征中发生的eGFR降低不能简单地基于NSG的数量来解释，并且可能取决于系膜轴的大量受累。未来的研究应验证这些变化是否可通过适当治疗逆转，从而逆转eGFR降低。
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