bromochloroacetic-acid and Glomerulonephritis--Membranoproliferative

The detection of viable podocytes in the urine of patients with proteinuric diseases has been described as a non-invasive method to monitor disease activity. Most of the published studies use podocalyxin (PDX) as a podocyte specific marker.. We examined the excretion of viable PDX-positive cells in a random set of spot urine from patients with biopsy-proven focal segmental glomerulosclerosis (FSGS), membranous nephropathy (MGN) or membranoproliferative glomerulonephritis (MPGN) and characterized the excreted cells for podocyte and parietal epithelia markers as well as for proliferation activity.. We found that untreated patients with active disease excrete high numbers of PDX-positive cells in their urine. In contrast to that we were not able to detect significant amounts of PDX-positive cells in the urine of patients with active minimal change disease (MCD) and patients with FSGS or MGN in full remission. When we further characterized the cells we rarely detected expression of podocyte specific markers in the PDX-positive cells, but at least 50% of the PDX-positive cells were double positive for cytokeratin (CK8-18). Immunohistochemistry of the corresponding renal biopsies showed that 100% of podocytes and parietal cells stained positive for PDX. Semiquantitative analysis revealed that 45% of parietal cells were positive for CK8-18 and 100% of proximal tubular cells. No cells of the glomerular epithelial layer stained positive for CK8-18.. PDX-positive cells are lost in the urine in disease states that require podocyte regeneration and are a useful non-invasive marker for glomerular disease activity. These cells are possibly derived from the parietal epithelial layer.

Topics: Adolescent; Adult; Aged; Case-Control Studies; Child; Child, Preschool; Female; Glomerulonephritis, Membranoproliferative; Glomerulonephritis, Membranous; Glomerulosclerosis, Focal Segmental; Humans; Keratins; Kidney; Male; Middle Aged; Podocytes; Sialoglycoproteins; Staining and Labeling; Urine; Young Adult

The study attempted to define characteristics of renal podocytes in nephrotic syndrome glomerulopathies in children with and without glomerular immaturity based on the histochemical expression of cytokeratin 18 (CK 18) and vimentin. Material consisted of 29 renal biopsies performed in the Department of Pediatric Nephrology, Poznan University of Medical Sciences, between 1991 and 2000. The study group included 16 children with mesangial glomerulonephritis (MesGN) and signs of glomerular immaturity and 13 children with MesGN without signs of glomerular immaturity. The control tissue was derived from macroscopically normal renal cortex taken from kidneys resected for localised neoplasms ( n=3). In the control samples, the immunocytochemical expression of CK 18 was found only in epithelial cells of proximal and distal tubules. Vimentin was present in all podocytes, some mesangial cells and endothelium. In all cases of children with MesGN with signs of immaturity, both CK 18-positive and vimentin-positive podocytes were found. In all cases of MesGN without immaturity we revealed CK 18-negative podocytes but with distinct vimentin-positive expression. Reorganisation of cytoskeletal proteins within immature podocytes may be associated with the unfavourable clinical course of nephrotic syndrome in children. The application of antibodies against intermediate filaments may help to differentiate between mature and immature forms of MesGN.

Topics: Child, Preschool; Epithelium; Fluorescent Antibody Technique, Indirect; Glomerular Mesangium; Glomerulonephritis, Membranoproliferative; Humans; Immunoenzyme Techniques; Keratins; Kidney Glomerulus; Nephrotic Syndrome; Vimentin