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Podocyte and endothelial cell injury lead to nephrotic syndrome in proliferative lupus nephritis
Author(s) -
Nawata Aya,
Hisano Satoshi,
Shimajiri Shohei,
Wang KeYong,
Tanaka Yoshiya,
Nakayama Toshiyuki
Publication year - 2018
Publication title -
histopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.626
H-Index - 124
eISSN - 1365-2559
pISSN - 0309-0167
DOI - 10.1111/his.13454
Subject(s) - synaptopodin , nephrin , podocyte , lupus nephritis , podocalyxin , nephrotic syndrome , membranous nephropathy , glomerular basement membrane , medicine , pathology , nephropathy , glomerulonephritis , mesangial proliferative glomerulonephritis , endocrinology , proteinuria , kidney , disease , diabetes mellitus
Aims Nephrotic syndrome ( NS ) is a major manifestation of lupus nephritis ( LN ). The dysregulation of podocytes, the glomerular basement membrane ( GBM ) and endothelial cells ( EC s) results in proteinuria in glomerular diseases. The aim of our study was to clarify whether the dysregulation of these barriers is associated with NS in proliferative LN and membranous LN . Methods and results Fifty‐six patients with NS , including minimal change NS in 15, primary membranous nephropathy ( PMN ) in 13, class III / IV LN in 15, and class V LN in 13, were enrolled in this study. Subjects with idiopathic haematuria were assigned as controls. Glomerular expression of Wilms tumour protein 1 ( WT 1), nephrin, synaptopodin and podocalyxin was evaluated by immunohistochemistry ( IHC ) and real‐time quantitative reverse transcription polymerase chain reaction. EC injury was evaluated by CD 31 immunostaining and electron microscopy ( EM ). Reduced expression of WT 1, nephrin and synaptopodin was found in PMN , class III / IV LN and class V LN as compared with controls by IHC and mRNA analysis. Reduced expression of these molecules was not different between class III / IV LN and class V LN . Reduced numbers of CD 31‐positive EC s were found in class III / IV LN as compared with class V LN . EC injury showing subendothelial widening on EM was apparent in class III / IV LN as compared with class V LN . Foot process effacement was found only along the GBM showing EC injury in class III / IV LN . Conclusions Our study suggests that coexistence of podocyte and EC injury may lead to NS in proliferative LN . Podocyte damage alone leads to NS in membranous LN .