Idiopathic nephrotic syndrome and circulating factors The Arlesienne?

The renal filtration is ensured by the kidney glomeruli selective for filtering the blood. The main actor of the glomerular filter is the podocyte whose interlaced pedicels bear protein complexes (nephrin, podocin, etc.) creating a molecular sieve (slit diaphragm) to achieve the filtration. Alterations of these podocytes lead to massive proteinuria, which characterizes the nephrotic syndrome. The idiopathic form is one of the most malignant and essentially comprises two entities: minimal change disease and focal segmental glomerulosclerosis. Many observations indicated that (1) immune cells are involved and that (2) there are several permeability factors in the blood that affect the morphology and function of podocytes (slit diaphragm with fractional foot processes fusion/effacement). Evidence for a permeability factor was chiefly derived from remission of proteinuria observed after implantation of a kidney with FSGS in healthy recipients or with other kidney diseases. Today, we are moving towards a multifactorial conception of the nephrotic syndrome where all these barely known factors could be associated according to a sequential kinetic mechanism that needs to be determined. © 2019 Medecine/Sciences. All rights reserved.; La fonction d'excrétion du rein fait intervenir des glomérules chargés de filtrer sélectivement le sang. L'acteur principal du filtre glomérulaire est le podocyte dont les pédicelles entrelacés portent des complexes moléculaires (néphrine, podocine, etc.) qui sont responsables du fonctionnement de la barrière de filtration (diaphragme de fente). Des altérations de ces podocytes entraînent une protéinurie massive qui caractérise le syndrome néphrotique. Parmi les formes les plus malignes de cette pathologie, se trouve le syndrome néphrotique idiopathique dont la physiopathologie reste inconnue. Ce syndrome regroupe essentiellement deux entités : les lésions glomérulaires minimes et la hyalinose segmentaire et focale. Ces pathologies impliqueraient les cellules du système immunitaire et plusieurs facteurs de perméabilité circulants qui agiraient sur la morphologie et le fonctionnement des podocytes. © 2019 Medecine/Sciences. All rights reserved.