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Published ahead of print on April 23, 2009
J Am Soc Nephrol 20: 1041-1052, 2009
© 2009 American Society of Nephrology
doi: 10.1681/ASN.2007121328
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BASIC RESEARCH

Urine Podocyte mRNAs Mark Progression of Renal Disease

Yuji Sato, Bryan L. Wharram, Sang Koo Lee, Larysa Wickman, Meera Goyal, Madhusudan Venkatareddy, Jai Won Chang, Jocelyn E. Wiggins, Chrysta Lienczewski, Matthias Kretzler and Roger C. Wiggins

Nephrology Division, University of Michigan, Ann Arbor, Michigan

Correspondence: Dr. Roger C. Wiggins, University of Michigan Health System, Division of Nephrology, Department of Internal Medicine, 1570 MSRBII, Box 0676, Ann Arbor, MI 48109-0676. Phone: 734-936-4813; Fax: 734-763-0982; E-mail: rwiggins{at}umich.edu

Received for publication December 14, 2007. Accepted for publication December 29, 2008.

Because loss of podocytes associates with glomerulosclerosis, monitoring podocyte loss by measuring podocyte products in urine may be clinically useful. To determine whether a single episode of podocyte injury would cause persistent podocyte loss, we induced limited podocyte depletion using a diphtheria toxin receptor (hDTR) transgenic rat. We monitored podocyte loss by detecting nephrin and podocin mRNA in urine particulates with quantitative reverse transcriptase–PCR. Aquaporin 2 mRNA served as a kidney reference gene to account for variable kidney contribution to RNA amount and quality. We found that a single injection of diphtheria toxin resulted in an initial peak of proteinuria and podocyte mRNAs (podocin and nephrin) followed 8 d later by a second peak of proteinuria and podocyte mRNAs that were podocin positive but nephrin negative. Proteinuria that persisted for months correlated with podocin-positive, nephrin-negative mRNAs in urine. Animals with persistent podocyte mRNA in urine progressed to ESRD with global podocyte depletion and interstitial scarring. Podocytes in ectatic tubules expressed podocalyxin and podocin proteins but not nephrin, compatible with detached podocytes’ having an altered phenotype. Parallel human studies showed that biopsy-proven glomerular injury associated with increased urinary podocin:aquaporin 2 and nephrin:aquaporin 2 molar ratios. We conclude that a single episode of podocyte injury can trigger glomerular destabilization, resulting in persistent podocyte loss and an altered phenotype of podocytes recovered from urine. Podocyte mRNAs in urine may be a useful clinical tool for the diagnosis and monitoring of glomerular diseases.




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