| Objective: Minimal change disease (MCD) is the most common type ofnephrotic syndrome in children and accounts for approximately90%of allcases and10-15%of cases in adult primary nephrotic syndrome. Although thedisease is considered a disorder of T cell function, its exact mechanism isunknown. Another common type of nephrotic syndrome is focal segmentalglomerulosclerosis (FSGS), whose early pathologic is the lesion of podocytesthe same as MCD. These two diseases are all manifested by proteinuria inclinical. The relationship between MCD and primary FSGS has remainedcontroversial, as some experts have considered the two entities to represent acontinuum of one disease whereas others consider them separate entities. Dueto the limitation of renal biopsy, some patients who on initial renal biopsyhave been considered to have MCD, but who undergo a repeat biopsy due tosteroid dependence or resistance and are found to have a lesion that resemblesFSGS. B7-1, also termed CD80, is a transmembrane protein normallyexpressed on the surface of B cells and other APCs. In a series of experimentspodocytes could acquire dendritic cell–like functions, in which they can beinduced to express CD80. The present study uncovered an unanticipated novelrole for costimulatory molecule B7-1in podocytes as an inducible modifier ofglomerular permselectivity. B7-1may contribute to the pathogenesis ofproteinuria by decreasing the expression of nephrin and podocin, which arecritical to maintain the glomerular capillary barrier to protein, down regulationof nephrin and podocin protein, disrupting the SD complex. we tested the levelof urinary CD80in adult patients with minimal change disease to explorewhether it could be relevant to both diagnosis between MCD and focalsegmental glomerulosclerosis and pathogenesis.Methods: A total of53subjects who were diagnosed in Second Hospital of Hebei Medical University, Department of Nephrology from January2013toAugust2013were collected35cases were minimal change disease, in which9cases were in primary treatment (who were completely remission in the followup,and also were included in the remission group),10were in relapse, the restMCD cases were in remission after treatment. Meanwhile,35cases of focalsegmental glomerulosclerosis were also included. Collecting fresh urine10mlin the morning, packing in two clean EP tubes for the test of urinary CD80andurinary creatine.3ml fasting blood were alse collected in the morining,centrifuged immediately upon blood coagulation (3000g,10min), thesupernatant was used to measure serum concentration of IL-13. Specimenswere collected before the use of corticosteroids or immunosuppressive inpatients with primary MCD and FSGS. Demographics, laboratory tests andphysical examination were done by a specially-assigned person. UrinaryCD80was measured using a commercially available ELISA kit (BenderMedSystems, Burlingame, CA, USA) and results adjusted for urinarycreatinine excretion. Urinary creatinine and protein and serum albumin weremeasured by an autoanalyzer.Clinical indicators and experimental data were expressed as x±s, groupswere compared using analysis of variance and non-parametric test, furthercomparisons among groups using SNK analysis. We determined differencesbetween means with the Mann-Whitney U test or the Wilcoxon signed ranktest when applicable. We calculated the correlation between urinary sCD80and urinary protein using Spearman’s correlation coefficient test. SPSS13.0statistical software was used to analyze the above mentioned data, in whichprocess the significance was set at P＜0.05.Results: Finally53cases were included in our study,29of them weremale (54.7%), and24subjects were female (45.3%), with the age of rangingfrom19to75years at the time of analysis. A significant increase in urinaryCD80, normalized to urinary creatinine, was found in patients with MCD withnephrotic syndrome compared to those in remission (P<0.05) or those withFSGS (P<0.05). No significant differences of urinary CD80were seen between MCD patients in remission and those with FSGS (P=0.079), neitherbetween primary MCD patients and those in relapse (P=0.121). In pairedstudy,the level of urinary CD80in patients with MCD in remission wasstatistically lower than that in primary MCD patients (Z=2.666P=0.008), Nosignificant differences of serum IL-13were seen in these two groups (Z=0.847P=0.397). There was no difference of Serum concentrations of IL-13amongthose three groups (P>0.05). In patients of MCD with nephrotic syndrome,there was no correlation between urinary CD80and proteinuria (r=-0.219P=0.369)，neither between urinary CD80and serum IL-13(r=0.303P=0.205).Conclusion: Urinary CD80is elevated in MCD patients with nephroticsyndrome, indicating it might contribute to the development of MCD. UrinaryCD80excretion may be a useful marker to differentiate between MCD andFSGS. |
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