Normal Glomerular Permeability and Its Modification by Minimal Change Nephrotic Syndrome

Robson, Alan M.; Giangiacomo, Joseph; Kienstra, Randy A.; Naqvi, Saiyid T.; Ingelfinger, Julie R.

doi:10.1172/jci107862

Cited by 94 publications

(30 citation statements)

References 28 publications

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“…Similar findings have also been obtained in adult patients with various forms of glomerulonephritis (6). The similarity of fractional clearances of macromolecules in these studies by others (6,7) to those in the present study suggests that a common mechanism of altered macromolecular transport might be involved in these disorders in man Fig. 2), then it is likely that alterations in glomerular capillary permselectivity also occurred in the patients studied.…”

supporting

confidence: 91%

Permselectivity of of the glomerular capillary wall. Studies of experimental glomerulonephritis in the rat using neutral dextran.

Chang¹,

Deen²,

Robertson³

et al. 1976

J. Clin. Invest.

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A B S T R A C T Polydisperse [3H]dextran was infused into eight Munich-Wistar rats in the early autologous phase of nephrotoxic serum nephritis (NSN), thereby permitting direct measurements of pressures and flows in surface glomeruli and fractional clearances for dextrans [(U/P)dextran/ (U/P)inuin] ranging in radius from 18 to 42 A. Despite glomerular injury, evidenced morphologically and by a marked reduction in the glomerular capillary ultrafiltration coefficient, the glomerular filtration rate remained normal because of a compensating increase in the mean net ultrafiltration pressure. In NSN rats, as in normal controls, inulin was found to permeate the glomerular capillary wall without measurable restriction, and dextrans were shown to be neither secreted nor reabsorbed. For dextran radii of 18, 22, 26, 30, 34, 38, and 42 A, (U/P)dextran/(U/P)inuli. in NSN and control rats,

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supporting

confidence: 91%

Permselectivity of of the glomerular capillary wall. Studies of experimental glomerulonephritis in the rat using neutral dextran.

Chang¹,

Deen²,

Robertson³

et al. 1976

J. Clin. Invest.

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“…Other reports also had shown prednisolone therapy improved the renal function. 6,[18][19][20][21][22] In the majority of reports, the prognosis for recovery of renal function had been good even in patients in whom dialysis was required. This study confirms renal function can recover completely in most of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…From the relationship of AKI category with serum albumin and acute tubular injury in our study, we also think the decrease of effective renal plasma flow is one of the important factors of AKI in adult idiopathic nephrotic syndrome patients, although several other factors may contribute to the decline of acute glomerular filtration in idiopathic nephrotic syndrome, such as high intratubular pressure, low filtration fraction caused by impaired glomerular permeability, tubular obstruction by protein casts, and interstitial edema of the kidney. 6,10,11,[19][20][21][22] We recognize several limitations of this study. As this is a retrospective and single-center study, it may not be representative of all adult idiopathic nephrotic syndrome patients with AKI.…”

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury in Adult Idiopathic Nephrotic Syndrome

Chen

Lin

et al. 2011

Renal Failure

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Objective: This study aims to investigate the epidemiology, clinical and histological features, and prognosis of acute kidney injury (AKI) according to RIFLE classification in adult patients with idiopathic nephrotic syndrome. Methods: In this retrospective study, 277 patients with idiopathic nephrotic syndrome were reviewed from June 2005 to June 2009. Results: Fifty-one (18%) patients entered RIFLE class Risk (AKI-R); 24 (9%) patients entered RIFLE class Injury (AKI-I); and 20 (7%) patients entered RIFLE class Failure (AKI-F). Logistic regression analysis showed that severe hypoalbuminemia, increase in age, and being male were risk factors of AKI. Cumulative recovery rates in 3 months for groups AKI-R, AKI-I, and AKI-F were 95%, 100%, and 94%, respectively (p = 0.21). The mean time to recovery for groups AKI-R, AKI-I, and AKI-F was 20 ± 3, 25 ± 4, and 30 ± 5 days, respectively. Cumulative complete remission rates in 3 months for groups AKI-R, AKI-I, and AKI-F were 92%, 86%, and 65%, respectively (p = 0.002). The mean time to remission for groups AKI-R, AKI-I, and AKI-F was 28 ± 3, 39 ± 6, and 62 ± 8 days, respectively. Conclusion: AKI is not uncommon in adult idiopathic nephrotic syndrome. More severe AKI was associated with longer time of nephrotic syndrome complete remission. Renal function can recover completely in most of the patients.

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“…For example, glomerular pore size distribution in minimal change nephropathy has been shown to be uniformly shifted to pores of smaller size than normal (14,49,50). The selective proteinuria typical of this disorder appears to be a consequence of a loss of glomerular polyanion.…”

Section: Discussionmentioning

confidence: 99%

Mechanisms of proteinuria in human glomerulonephritis.

Myers¹,

Okarma²,

Friedman³

et al. 1982

J. Clin. Invest.

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A B S T R A C T We evaluated glomerular barrier function in 28 patients with glomerulonephritis. Neutral dextrans of graded size were used to characterize the size-selective properties of the barrier. Charge selectivity was characterized by electrofocusing excreted urinary proteins. A fractional IgG clearance (relative to freely permeable inulin), smaller or greater than 100 X lo-was used to distinguish patients with minor (group I, n = 13) and major (group II, n = 15) urinary IgG leakage, respectively. Fractional clearances of smaller dextrans (radii 20-50 A) were similar, but those of larger dextrans (radii 52-60 A) were elevated in group II relative to group I patients. A model of solute transport through a bimodal pore size distribution revealed the values for pore radius in the lower mode to approximate 51-55 A in both group I and group II patients. Pore radius in the upper mode, by contrast, was much larger in group II than in group I patients, approximating 87-97 vs. 72-77 A, respectively. Electrofocusing of urinary protein from group I patients revealed mostly albumin (isoelectric point 5.2). In group II patients, however, immunoglobulin excretion was copious. Moreover, the distribution of anionic, neutral, and cationic species (isoelectric points 5.5-8.5) in urinary and plasma eluates of IgG2 and IgG4 was similar. We conclude that when glomerulonephritis is associated with selective albuminuria, as in group I, there is an isolated reduction of electrostatic retardation of relatively small anionic proteins. Major urinary IgG leakage (group II), however, appears to result from the development in the glomerular membrane of a subpopulation of enlarged pores that are highly permeable towards proteins of large size and varying charge.

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Normal Glomerular Permeability and Its Modification by Minimal Change Nephrotic Syndrome

Cited by 94 publications

References 28 publications

Permselectivity of of the glomerular capillary wall. Studies of experimental glomerulonephritis in the rat using neutral dextran.

Permselectivity of of the glomerular capillary wall. Studies of experimental glomerulonephritis in the rat using neutral dextran.

Acute Kidney Injury in Adult Idiopathic Nephrotic Syndrome

Mechanisms of proteinuria in human glomerulonephritis.

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