Medyńska Anna, Chrzanowska Joanna, Kościelska-Kasprzak Katarzyna, Bartoszek Dorota, Żabińska Marcelina, Zwolińska Danuta
Department of Pediatric Nephrology, Wroclaw Medical University, 50-367 Wrocław, Poland.
Department of Pediatric Endocrinology and Diabetology, Wroclaw Medical University, 50-367 Wrocław, Poland.
J Clin Med. 2021 Sep 13;10(18):4129. doi: 10.3390/jcm10184129.
Obesity, which is a serious problem in children, has a negative impact on many organs, including kidneys, and obesity-related glomerulopathy (ORG) is an increasingly common cause of ESKD (end-stage kidney disease) in adults. Early-detected and -treated glomerular lesions are reversible, so it is important to find a useful marker of early damage. The study aimed to evaluate the albumin-to-creatinine ratio (ACR), urinary alpha-1-acid glycoprotein (α1-AGP), and mRNA of podocyte-specific proteins as indicators of glomerular injury and their relationship with the degree of obesity and metabolic disorders.
A total of 125 obese children and 33 healthy peers were enrolled. Patients were divided into two groups, depending on SDS BMI values. ACR, α1-AGP, mRNA expression of nephrin, synaptopodin, podocin, and C2AP protein in urine sediment were measured.
ACR values did not differ between groups and were within the normal range. α1-AGP and mRNA expression were significantly higher in obese children compared with controls. mRNA expression of the remaining podocyte proteins was similar in both groups. No significant differences concerning all examined parameters were found depending on the degree of obesity. There was a positive significant correlation between α1-AGP and ACR.
Increased α1-AGP before the onset of albuminuria suggests its usefulness as a biomarker of early glomerular damage in obese children. An increased podocin mRNA expression also indicates podocyte damage and may be linked to ORG development. The lack of increase in expression of other podocyte proteins suggests that podocin mRNA may be a more specific and sensitive biomarker. The degree of obesity has no impact on the tested parameters, but further studies are needed to confirm it.
肥胖在儿童中是一个严重问题，会对包括肾脏在内的许多器官产生负面影响，而肥胖相关肾小球病（ORG）是成人终末期肾病（ESKD）日益常见的病因。早期检测和治疗的肾小球病变是可逆的，因此找到一种有用的早期损伤标志物很重要。本研究旨在评估白蛋白与肌酐比值（ACR）、尿α1-酸性糖蛋白（α1-AGP）以及足细胞特异性蛋白的mRNA作为肾小球损伤指标及其与肥胖程度和代谢紊乱的关系。
共纳入125名肥胖儿童和33名健康同龄人。根据SDS BMI值将患者分为两组。测量ACR、α1-AGP、尿沉渣中nephrin、synaptopodin、podocin和C2AP蛋白的mRNA表达。
两组间ACR值无差异且在正常范围内。与对照组相比，肥胖儿童的α1-AGP和mRNA表达显著更高。两组中其余足细胞蛋白的mRNA表达相似。根据肥胖程度，在所有检测参数方面未发现显著差异。α1-AGP与ACR之间存在显著正相关。
在蛋白尿出现之前α1-AGP升高表明其可作为肥胖儿童早期肾小球损伤的生物标志物。podocin mRNA表达增加也表明足细胞损伤，可能与ORG的发展有关。其他足细胞蛋白表达未增加表明podocin mRNA可能是更特异和敏感的生物标志物。肥胖程度对所测试参数无影响，但需要进一步研究来证实。
