Thierry H Le Jemtel1, Indranee Rajapreyar1, Michael G Selby2, Brian Payne1, David R Barnidge3, Natasa Milic4, Vesna D Garovic2. 1. Division of Cardiology, Tulane University, New Orleans, La., USA. 2. Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minn., USA. 3. Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minn., USA. 4. Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minn., USA ; Department of Medical Statistics and Informatics, University of Belgrade School of Medicine, Belgrade, Serbia.
Abstract
BACKGROUND: Renal structural alterations have been partially uncovered in cardiorenal syndrome (CRS). Patients with CRS may have evidence of tubular damage, but markers of glomerular damage other than proteinuria have not been thoroughly investigated. The nature of renal damage in CRS may have therapeutic implications, as glomerular damage requires tight blood pressure control and renin-angiotensin-aldosterone system (RAAS) inhibition. The present investigation evaluates patients with CRS type 2 (CRS-2) for direct evidence of glomerular damage as evidenced by the presence of urinary podocin. METHODS: The presence of glomerular damage was assessed in acutely decompensated patients with CRS-2 and healthy controls. Urinary podocin was determined by quantification of a tryptic peptide of podocin with high-performance liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS). Morning urine samples were collected for podocin, creatinine (Cr), and protein. Urinary podocin was expressed in femtomoles of podocin/milligram of Cr. RESULTS: The urinary podocin/Cr ratio was greater in patients than in controls (0.37 ± 0.77 vs. 0.06 ± 0.05 fmol podocin/mg Cr, p = 0.04). A total of 40% of the patients had a urinary podocin/Cr ratio greater than the upper limit of normal (>0.2 fmol podocin/mg Cr). Patients with an elevated podocin/Cr ratio were more likely to have received ≤50% of the maximum dose of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (p = 0.04) than patients with a podocin/Cr ratio in the normal range. CONCLUSIONS: CRS-2 may be associated with glomerular damage as evidenced by an elevated urinary podocin/Cr ratio. Modulators of RAAS may have a protective effect on urinary podocin loss.
BACKGROUND: Renal structural alterations have been partially uncovered in cardiorenal syndrome (CRS). Patients with CRS may have evidence of tubular damage, but markers of glomerular damage other than proteinuria have not been thoroughly investigated. The nature of renal damage in CRS may have therapeutic implications, as glomerular damage requires tight blood pressure control and renin-angiotensin-aldosterone system (RAAS) inhibition. The present investigation evaluates patients with CRS type 2 (CRS-2) for direct evidence of glomerular damage as evidenced by the presence of urinary podocin. METHODS: The presence of glomerular damage was assessed in acutely decompensated patients with CRS-2 and healthy controls. Urinary podocin was determined by quantification of a tryptic peptide of podocin with high-performance liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS). Morning urine samples were collected for podocin, creatinine (Cr), and protein. Urinary podocin was expressed in femtomoles of podocin/milligram of Cr. RESULTS: The urinary podocin/Cr ratio was greater in patients than in controls (0.37 ± 0.77 vs. 0.06 ± 0.05 fmol podocin/mg Cr, p = 0.04). A total of 40% of the patients had a urinary podocin/Cr ratio greater than the upper limit of normal (>0.2 fmol podocin/mg Cr). Patients with an elevated podocin/Cr ratio were more likely to have received ≤50% of the maximum dose of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (p = 0.04) than patients with a podocin/Cr ratio in the normal range. CONCLUSIONS:CRS-2 may be associated with glomerular damage as evidenced by an elevated urinary podocin/Cr ratio. Modulators of RAAS may have a protective effect on urinary podocin loss.
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: Sanjay Rajagopalan; George L Bakris; William T Abraham; Bertram Pitt; Robert D Brook Journal: Hypertension Date: 2013-07-22 Impact factor: 10.190
Authors: Mattia A E Valente; Kevin Damman; Peter H J M Dunselman; Hans L Hillege; Adriaan A Voors Journal: Prog Cardiovasc Dis Date: 2012 Jul-Aug Impact factor: 8.194
Authors: Kevin Damman; Adriaan A Voors; Gerjan Navis; Dirk J van Veldhuisen; Hans L Hillege Journal: Prog Cardiovasc Dis Date: 2011 Sep-Oct Impact factor: 8.194
Authors: Iasmina M Craici; Steven J Wagner; Kent R Bailey; Patrick D Fitz-Gibbon; Christina M Wood-Wentz; Stephen T Turner; Suzanne R Hayman; Wendy M White; Brian C Brost; Carl H Rose; Joseph P Grande; Vesna D Garovic Journal: Hypertension Date: 2013-03-25 Impact factor: 10.190
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