Wu Liang, Chang Dong-Yuan, Zhang Lu-Xia, Chen Min, Zhao Ming-Hui
Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.
Institute of Nephrology, Peking University, Beijing, China.
Ann Transl Med. 2021 Feb;9(4):282. doi: 10.21037/atm-20-6528.
Diabetic kidney disease (DKD), the major cause of chronic kidney disease, is associated with progressive renal fibrosis. The expression of CD90 correlated with fibrogenesis. However, the association between urinary soluble CD90 and renal disease severity, and whether it predicts outcomes in patients with DKD are still unclear.
Urinary sCD90 was measured in 285 patients with DKD in a longitudinal cohort. The composite endpoint was defined as end-stage renal disease (ESRD) or 40% reduction of estimated glomerular filtration rate (eGFR). The associations between urinary sCD90/Cr and clinical parameters, as well as renal outcomes were evaluated. Moreover, we detected the intrarenal CD90 expression, and demonstrated the correlation of intrarenal CD90 with clinico-pathological parameters.
The urinary sCD90 level of DKD patients is significantly higher than diabetes patients without kidney injuries and healthy controls. We further showed urinary sCD90/Cr had significantly correlations with eGFR (r=-0.373, P<0.001), uACR (r=0.303, P<0.001), serum creatinine (r=0.344, P<0.001), and the eGFR slope (r=-0.27, P<0.001). Elevated urinary sCD90/Cr was an independent risk factor for the composite endpoint, adjustment for potential confounders in DKD patients (HR 1.20, 95% CI: 1.04-1.38, P=0.015). However, the CD90 expression in the renal tubulointerstitial compartment in DKD patients was significantly lower than healthy controls, and showed significant negative correlations with the interstitial fibrosis and tubular atrophy score (IFTA) (r=-0.3, P=0.047), and urinary sCD90/Cr (r=-0.399, P=0.029).
This study provided evidence that urinary sCD90 could reflect the disease severity and serve as a valuable factor for renal outcome prediction in patients with DKD.
糖尿病肾病（DKD）是慢性肾脏病的主要病因，与进行性肾纤维化相关。CD90的表达与纤维化形成相关。然而，尿可溶性CD90与肾脏疾病严重程度之间的关联，以及它是否能预测DKD患者的预后仍不清楚。
在一个纵向队列中对285例DKD患者测定尿sCD90。复合终点定义为终末期肾病（ESRD）或估计肾小球滤过率（eGFR）降低40%。评估尿sCD90/Cr与临床参数以及肾脏预后之间的关联。此外，我们检测了肾内CD90的表达，并证明了肾内CD90与临床病理参数的相关性。
DKD患者的尿sCD90水平显著高于无肾脏损伤的糖尿病患者和健康对照。我们进一步表明，尿sCD90/Cr与eGFR（r=-0.373，P<0.001）、尿白蛋白肌酐比值（uACR）（r=0.303，P<0.001）、血清肌酐（r=0.344，P<0.001）和eGFR斜率（r=-0.27，P<0.001）显著相关。尿sCD90/Cr升高是复合终点的独立危险因素，对DKD患者的潜在混杂因素进行校正后（HR 1.20，95%CI：1.04-1.38，P=0.015）。然而，DKD患者肾小管间质区的CD90表达显著低于健康对照，且与间质纤维化和肾小管萎缩评分（IFTA）（r=-0.3，P=0.047）以及尿sCD90/Cr（r=-0.399，P=0.029）呈显著负相关。
本研究提供了证据，表明尿sCD90可反映疾病严重程度，并可作为DKD患者肾脏预后预测的重要因素。
