BACKGROUND: Podocyte injury and its subsequent loss in urine play an important role in the pathogenesis of diabetic nephropathy; blockade of the renin-angiotensin system may ameliorate the damage. METHODS: In a non-randomized setting, we studied 71 patients with diabetic nephropathy on a stable dose of angiotensin-converting enzyme inhibitor (ACEI). In 37 patients, angiotensin receptor blocker (ARB) was added (the combination group); ACEI alone was continued in the other 34 (the control group). The mRNA expressions of nephrin, podocin, and synaptopodin in urinary sediment were measured at 0 and 12 weeks. RESULTS: Baseline glomerular filtration rate (GFR) correlated with the urinary expression of nephrin (r=0.320, P=0.007), podocin (r=0.336, P=0.004), and synaptopodin (r=0.350, P=0.003). After adjusting for the baseline expression, the combination group had a significantly lower urinary synaptopodin expression (7.49 (95% confidence interval CI, 0.62-115.29) vs 14.83 (95% CI, 1.03-241.43), P=0.026) than the control group after 12 weeks of treatment. The percentage change in urinary podocin expression over 12 weeks of treatment had a modest correlation with the rate of GFR decline in 1 year (r=-0.243, P=0.041). CONCLUSION: In patients with diabetic nephropathy, urinary mRNA expression of podocyte markers correlated with baseline renal function. Urinary expression of synaptopodin was lower after 12 weeks of ACEI and ARB combination therapy. Our result suggests that serial measurement of urinary podocyte markers may have a value for the monitoring of therapeutic response.
BACKGROUND: Podocyte injury and its subsequent loss in urine play an important role in the pathogenesis of diabetic nephropathy; blockade of the renin-angiotensin system may ameliorate the damage. METHODS: In a non-randomized setting, we studied 71 patients with diabetic nephropathy on a stable dose of angiotensin-converting enzyme inhibitor (ACEI). In 37 patients, angiotensin receptor blocker (ARB) was added (the combination group); ACEI alone was continued in the other 34 (the control group). The mRNA expressions of nephrin, podocin, and synaptopodin in urinary sediment were measured at 0 and 12 weeks. RESULTS: Baseline glomerular filtration rate (GFR) correlated with the urinary expression of nephrin (r=0.320, P=0.007), podocin (r=0.336, P=0.004), and synaptopodin (r=0.350, P=0.003). After adjusting for the baseline expression, the combination group had a significantly lower urinary synaptopodin expression (7.49 (95% confidence interval CI, 0.62-115.29) vs 14.83 (95% CI, 1.03-241.43), P=0.026) than the control group after 12 weeks of treatment. The percentage change in urinary podocin expression over 12 weeks of treatment had a modest correlation with the rate of GFR decline in 1 year (r=-0.243, P=0.041). CONCLUSION: In patients with diabetic nephropathy, urinary mRNA expression of podocyte markers correlated with baseline renal function. Urinary expression of synaptopodin was lower after 12 weeks of ACEI and ARB combination therapy. Our result suggests that serial measurement of urinary podocyte markers may have a value for the monitoring of therapeutic response.
Authors: Akihiro Fukuda; Larysa T Wickman; Madhusudan P Venkatareddy; Yuji Sato; Mahboob A Chowdhury; Su Q Wang; Kerby A Shedden; Robert C Dysko; Jocelyn E Wiggins; Roger C Wiggins Journal: Kidney Int Date: 2011-09-21 Impact factor: 10.612
Authors: Larysa Wickman; Farsad Afshinnia; Su Q Wang; Yan Yang; Fei Wang; Mahboob Chowdhury; Delia Graham; Jennifer Hawkins; Ryuzoh Nishizono; Marie Tanzer; Jocelyn Wiggins; Guillermo A Escobar; Bradley Rovin; Peter Song; Debbie Gipson; David Kershaw; Roger C Wiggins Journal: J Am Soc Nephrol Date: 2013-09-19 Impact factor: 10.121
Authors: Toru Sakairi; Yoshifusa Abe; Hiroshi Kajiyama; Linda D Bartlett; Lilian V Howard; Parmijit S Jat; Jeffrey B Kopp Journal: Am J Physiol Renal Physiol Date: 2009-12-02
Authors: Patrícia Garcia Rodrigues; Rafael Nazário Bringhenti; Jonathan Frapporti do Nascimento; Gabriel Joelsons; Mariane dos Santos; Sane Pereira; Francisco Veríssimo Veronese Journal: Int J Clin Exp Pathol Date: 2014-04-15
Authors: Yuji Sato; Bryan L Wharram; Sang Koo Lee; Larysa Wickman; Meera Goyal; Madhusudan Venkatareddy; Jai Won Chang; Jocelyn E Wiggins; Chrysta Lienczewski; Matthias Kretzler; Roger C Wiggins Journal: J Am Soc Nephrol Date: 2009-04-23 Impact factor: 10.121
Authors: Akihiro Fukuda; Larysa T Wickman; Madhusudan P Venkatareddy; Su Q Wang; Mahboob A Chowdhury; Jocelyn E Wiggins; Kerby A Shedden; Roger C Wiggins Journal: Nephrol Dial Transplant Date: 2012-08-03 Impact factor: 5.992