Circulating factor associated with increased glomerular permeability to albumin in recurrent focal segmental glomerulosclerosis
Circulating factor associated with increased glomerular permeability to albumin in recurrent focal segmental glomerulosclerosis
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DOI：
10.1056/nejm199604043341402
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发表时间：
1996-04-04
影响因子：
158.5
通讯作者：
Trachtman, H
中科院分区：
文献类型：
--
作者：
Savin, VJ;Sharma, R;Trachtman, H
背景：高达40%的特发性局灶节段性肾小球硬化引起的肾衰竭患者在移植后会复发大量蛋白尿和进行性肾损伤。一种循环因素可能是导致这种复发的原因。为了确定局灶节段性肾小球硬化患者是否存在一种能够引起肾小球损伤的循环因子，我们对100名患有该疾病的患者的血清样本进行了肾小球对白蛋白渗透性的体外测定。在56例接受肾移植的患者中，33例复发，64例患者（其中许多接受了移植）正在接受透析治疗。同时对31例其他肾脏疾病患者和9例正常人进行了研究。33例移植后复发局灶节段性肾小球硬化患者白蛋白通透性的平均（+/-SE）值（0.47+/-0.06）高于正常受试者（0.06+/-0.07）或未复发患者（0.14+/-0.06），6例复发患者经血浆分离后通透性降低（从0.79+/-0.06降至0.10+/-0.05，P=0.008），蛋白尿明显减少。皮质类固醇敏感性肾病综合征或移植后膜性肾病患者血清活性水平较低。循环因子与蛋白A和疏水相互作用柱结合，表观分子质量约为50kd。结论：在部分局灶节段性肾小球硬化患者中发现的一种循环因子与肾移植后疾病复发有关，可能是引发肾损伤的原因。
Background, Heavy proteinuria and progressive renal injury recur after transplantation in up to 40 percent of patients with renal failure caused by idiopathic focal segmental glomerulosclerosis. A circulating factor may be responsible for this recurrence.Methods. To determine whether patients with focal segmental glomerulosclerosis have a circulating factor capable of causing glomerular injury, we tested serum samples from 100 patients with the disorder in an in vitro assay of glomerular permeability to albumin. Of the 56 patients who had undergone renal transplantation, 33 had recurrences, Sixty-four patients, many of whom had undergone transplantation, were being treated with dialysis. Thirty-one patients with other renal diseases and nine normal subjects were also studied,Results. The 33 patients with recurrent focal segmental glomerulosclerosis after transplantation had a higher mean (+/-SE) value for permeability to albumin (0.47+/-0.06) than the normal subjects (0.06+/-0.07) or the patients who did not have recurrences (0.14+/-0.06), After plasmapheresis in six patients with recurrences, the permeability was reduced (from 0.79+/-0.06 to 0.10+/-0.05, P=0.008), and proteinuria was significantly decreased, Patients with corticosteroid-sensitive nephrotic syndrome or with membranous nephropathy after transplantation had low levels of serum activity. The circulating factor bound to protein A and hydrophobic-interaction columns and had an apparent molecular mass of about 50 kd.Conclusions, A circulating factor found in some patients with focal segmental glomerulosclerosis is associated with recurrent disease after renal transplantation and may be responsible for initiating the renal injury.