nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное обществоnid-605Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESЭкскреция с мочой маркеров подоцитарной дисфункции у больных хроническим гломерулонефритомUrinary excretion of podocyte dysfunction markers in patients with chronic glomerulonephritisБобковаИ. Н.BobkovaI. N.irbo.mma@mail.ruЧеботареваН. В.ChebotarevaN. V.noemail@neicon.ruЕськоваО. А.EskovaO. A.noemail@neicon.ruКозловскаяЛ. В.KozlovskayaL. V.noemail@neicon.ruГБОУ ВПО Первый МГМУ им. И.М. Сеченова Минздрава России, г. МоскваРоссияI.M. Sechenov First Moscow State Medical University, RussiaRussian Federation201320092024154263268Copyright © Бобкова И.Н., Чеботарева Н.В., Еськова О.А., Козловская Л.В., 20242024Бобкова И.Н., Чеботарева Н.В., Еськова О.А., Козловская Л.В.Bobkova I.N., Chebotareva N.V., Eskova O.A., Kozlovskaya L.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/605

В настоящее время предметом пристального внимания научных исследований в нефрологии является изучение роли подоцитарного повреждения в развитии протеинурии (ПУ) и прогрессировании хронического гломерулонефрита (ХГН). Цель исследования – у больных с разными формами ХГН оценить выраженность экскреции с мочой маркеров повреждения подоцитов - нефрина и сосудистого эндотелиального фактора роста (VEGF), уточнить их значение как показателей активности и прогноза. Материалы и методы: Обследовано 18 пациентов с неактивным ХГН (I группа), 18 – с выраженным мочевым синдромом (II группа), 38 – с нефротическим синдромом (НС) (III группа). Контрольную группу составили 10 здоровых лиц. Уровни нефрина и VEGF в моче определены методом ELISA. Результаты: При активном ХГН (II и III гр.) отмечалось значимое повышение уровней нефрина и VEGF в моче по сравнению со здоровыми и пациентами I гр. У больных ХГН с НС эти показатели были достоверно выше, чем у больных с меньшей ПУ. В III группе при одинаковой выраженности НС нефринурия (НУ) была значимо выше при наличии АГ и зависела от длительности НС. У больных с прогрессирующим течением ХГН ( с НС и ПН) отмечено резкое снижение мочевого показателя VEGF . У 23 больных с НС в зависимости от исходного уровня НУ (у 11 - с низкой НУ < 17нг/мл, у 12 – с высокой НУ > 17нг/мл) проаналировали ответ на последующую иммуносупрессивную терапию. Показано, что при высокой НУ шанс достичь ремиссии НС в ближайшие 6 месяцев в 7 раз ниже, чем у пациентов с низкой НУ. Заключение: Уровень мочевых маркеров подоцитарной дисфункции у больных ХГН может быть информативным тестом для мониторирования его активности, оценки прогноза.

Background. Recent studies have highlighted that podocyte (Pdc) injury leads to proteinuria (PU) and glomerulosclerosis. Urinary detection of Pdc injury markers is widely discussed as more sensitive indicators of chronic glomerulonephritis (СGN) activity and prognosis than PU. The aim of our study was to define nephrinuria (NU) and vascular endothelial growth factor (VEGF) excretion for an assessment of CGN activity and therapy efficiency. Methods. 74 CGN pts were studied: 18 – inactive CGN (I group), 18 – with PU 1-3 g/d (II), 38 – with nephrotic syndrome (NS) (III). 12 healthy subjects were studied as control. NU and urinary VEGF were measured by ELISA. Results: We revealed significantly increased NU and VEGF in active CGN (II, III group) compared to I group and control. These levels were greatly higher in NS than in pts with lower PU. NU depended on NS duration. Positive correlations were revealed between NU and PU value (r=0,27 p<0,05) and mean blood pressure (r=0,3 p=0,032). Urinary VEGF level was the highest in NS without renal failure. In pts with NS and impaired renal function we revealed significantly decreased urinary VEGF. 9 from 11 (82%) pts with low NU (<17ng/ml) had NS remission during 6 month of immunosuppressive therapy. On the other hand, 8 from 12 (67%) pts with high NU (>17ng/ml) had the immunosuppression resistance (9 month to 2 years). Conclusion: We suggest that estimation of NU and VEGF urinary levels may be useful for glomerular damage monitoring, CGN risk progression assessment and treatment efficiency prognosis.

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The authors declare that there are no conflicts of interest present.