Increased endothelin 1 expression in adult-onset minimal change nephropathy with acute renal failure
Increased endothelin 1 expression in adult-onset minimal change nephropathy with acute renal failure
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DOI：
10.1053/j.ajkd.2005.02.007
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发表时间：
2005-05-01
影响因子：
13.2
通讯作者：
Wang, JS
中科院分区：
文献类型：
--
作者：
Chen, CL;Fang, HC;Wang, JS
背景。急性肾功能衰竭（ARF）发生在一些患有微小改变肾病（MCN）的成人患者中。为了探讨与ARF发生相关的临床和病理因素，我们比较了伴有和不伴有ARF的成人发病MCN患者内皮素1 （ET-1）表达的临床特征和肾脏病理特征。方法：患者群体包括53例在10年期间连续诊断为成人发病MCN的患者。根据肌酐清除率，25例患者被分配到ARF组，28例患者被分配到非ARF组。结果临床资料显示，与非ARF组相比，ARF组血压升高，血清胆固醇水平升高，血清白蛋白水平降低。病理资料显示，同一组足突消退、间质水肿和小管上皮变平更为严重。与非ARF组相比，ARF组的血管、小管和肾小球中ET-1的表达更高。ARF组类固醇反应率较低。然而，在获得缓解的患者中，类固醇治疗在缓解的稳定性方面没有显著差异。结论：与肾ET-1表达增强相关的ARF是MCN的一种可逆性并发症，常见于细胞外液明显扩大的患者。据推测，ARF可能是MCN潜在发病机制的一种放大，涉及ET-1表达增强，这可能与利尿剂治疗期间一过性循环功能不全叠加。
Background., Acute renal failure (ARF) occurs in some adult patients with minimal change nephropathy (MCN). To investigate clinical and pathological factors associated with developing ARF, we compared clinical features and kidney pathological characteristics of endothelin 1 (ET-1) expression in patients with adult-onset MCN with and without ARF. Methods: The patient population consisted of 53 patients consecutively diagnosed with adult-onset MCN during a 10-year period. Based on creatinine clearance, 25 patients were assigned to the ARF group and 28 patients were assigned to the non-ARF group. Results Clinical data show that the ARF group had a higher blood pressure, higher serum cholesterol level, and lower serum albumin level than the non-ARF group. Pathological data showed more severe foot-process effacement, interstitial edema, and flattened tubular epithelium in the same group. Greater ET-1 expression was detected in vessels, tubules, and glomeruli of the ARF compared with non-ARF group. The ARF group experienced a lower steroid response rate. However, there was no significant difference in stability of remission to steroid treatment in patients who achieved a remission. Conclusion: ARF associated with enhanced kidney ET-1 expression is a reversible complication of MCN that occurs frequently in patients with apparently expanded extracellular fluid. Presumptively, ARF may develop as an amplification of the underlying pathogenesis of MCN involved in enhanced ET-1 expression, which may be superimposed by a transient episode of circulatory insufficiency during diuretic treatment.