Diagnostic roles of urinary kidney microvesicles in diabetic nephropathy.
Diagnostic roles of urinary kidney microvesicles in diabetic nephropathy.
复制标题
尿肾微泡在糖尿病肾病中的诊断作用。
DOI：
10.21037/atm-20-441
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发表时间：
2020-11
影响因子：
--
通讯作者：
Yang L
中科院分区：
文献类型：
--
作者：
Cai FH;Wu WY;Zhou XJ;Yu XJ;Lv JC;Wang SX;Liu G;Yang L
糖尿病肾病（DN）的病理过程涉及肾小球、肾小管和内皮细胞的损伤。当受到压力或损伤时，来自这些隔室的细胞可以释放更多数量的微泡（MV）到尿液中。目前这三个部位的尿MVs是否能帮助诊断DN并反映其病理特征尚不清楚。49例经组织学证实的DN患者和29例膜性肾病或微小病变的蛋白尿对照患者入选。通过流式细胞术定量尿足细胞、近端肾小管和内皮细胞衍生的MV。对肾小球、肾小管间质和血管病变进行半定量评分，并分析其与尿MV的相关性。与蛋白尿对照组相比，DN患者尿中足细胞、近端肾小管和内皮细胞的MV数量较多。足细胞nephrin+ MVs和糖尿病视网膜病变的组合最佳诊断DN，特异性为89.7%，敏感性为88.9%。尿中近端肾小管微血管数与肾小管损伤程度呈正相关，尿中内皮微血管数与血管损伤程度呈正相关。以尿近端肾小管MVs作为肾小管损伤的指标，在肾血管损伤程度相匹配或蛋白尿>8 g/24 h时，DN患者与蛋白尿对照组之间的差异减小。尿肾脏特异性细胞来源的MV可作为诊断糖尿病蛋白尿患者DN的无创性生物标志物。它们的升高可反映相应的肾脏病理改变，有助于临床医师了解DN的异质性。
The pathology of diabetic nephropathy (DN) broadly involves the injury of glomeruli, tubulointerstitium and endothelium. Cells from these compartments can release increased numbers of microvesicles (MVs) into urine when stressed or damaged. Currently whether urinary MVs from these three parts can help diagnose DN and reflect pathological features remain unclear. Forty-nine patients with histologically proven DN and 29 proteinuric controls with membranous nephropathy or minimal change disease were enrolled. Urinary podocyte, proximal tubular and endothelial cell-derived MVs were quantified by flow cytometry. Renal glomerular, tubulointerstitial and vascular lesions were semi-quantitatively scored and their relevance to urinary MVs were analyzed. DN patients had greater numbers of urinary MVs from podocytes, proximal tubular and endothelial cells compared with proteinuric controls. The combination of podocyte nephrin+ MVs and diabetic retinopathy optimally diagnose DN with 89.7% specificity and 88.9% sensitivity. Moreover, positive correlations were observed between urinary levels of proximal tubular MVs and the severity of tubular injury and between urinary levels of endothelial MVs and the degree of vascular injury. Using urinary proximal tubular MVs as the indicators for tubular injury, the differences between DN patients and proteinuric controls diminished after matching the degree of renal vascular injury or when proteinuria >8 g/24 h. Urinary kidney-specific cell-derived MVs might serve as noninvasive biomarkers for the diagnosis of DN in diabetic proteinuric patients. Their elevated levels could reflect corresponding renal pathological lesions, helping physicians look into the heterogeneity of DN.
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影响因子：
3.2
作者：
Maezawa Y;Takemoto M;Yokote K
通讯作者：
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作者：
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作者：
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