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Extrarenal determinants of kidney filter function

机译：肾脏过滤功能的外辐射决定因素

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The kidney is an organ involved in cross talk with many human organs. The link between the immune system and the kidney has been studied in some detail, although data precisely elucidating their interaction are sparse, in particular with regard to the function of the kidney filter apparatus. Current research suggests that an understanding of the impairment of this cross talk between the bone marrow, as a fundament of the immune system and the kidney will provide meaningful insights into the pathophysiological mechanisms of impaired kidney filter function. Circulating factors have long been implicated in the pathogenesis of idiopathic nephrotic syndrome, particularly focal segmental glomerulosclerosis (FSGS) and its recurrence. Soluble urokinase receptor (suPAR) has emerged as a circulating factor responsible for FSGS and also as an early predictive marker for the development of various renal diseases. The bone marrow has recently been revealed as a predominant source of suPAR with deleterious effects on the kidney filter. These new findings have led to bone marrow or hematopoietic stem cell transplants being considered as potential therapeutic options for preventing the post-transplantation recurrence of FSGS or even as a treatment for the original disease associated with high suPAR levels. Whereas bone marrow transplantation for patients with pre-existing chronic kidney disease is challenging, recent clinical trials have demonstrated the promising outcome of combined bone marrow and kidney transplantation in patients with kidney failure. In this review, with its brief update on suPAR, we describe the critical new role of the bone marrow in the pathogenesis of the kidney disease process and the functional connection between these two organs through the soluble mediator, suPAR. We also comment on the feasibility of bone marrow transplants for the treatment of patients with chronic renal failure arising from recurrent FSGS.
机译：肾脏是一个与许多人体器官相互作用的器官。免疫系统和肾脏之间的联系已经得到了一些详细的研究，尽管精确阐明它们相互作用的数据很少，尤其是关于肾脏过滤装置的功能。目前的研究表明，了解作为免疫系统和肾脏基础的骨髓之间这种相互作用的损害，将有助于深入了解肾滤过功能受损的病理生理机制。长期以来，循环因素一直与特发性肾病综合征的发病机制有关，尤其是局灶性节段性肾小球硬化症（FSGS）及其复发。可溶性尿激酶受体（suPAR）已成为FSGS的循环因子，也是各种肾脏疾病发展的早期预测标志物。最近发现，骨髓是suPAR的主要来源，对肾脏滤过器有有害影响。这些新发现导致骨髓或造血干细胞移植被认为是预防FSGS移植后复发的潜在治疗选择，甚至是与高suPAR水平相关的原始疾病的治疗方法。虽然骨髓移植对已有慢性肾脏疾病的患者具有挑战性，但最近的临床试验表明，骨髓和肾脏联合移植对肾衰竭患者的治疗效果良好。在这篇综述中，我们简要介绍了suPAR的最新进展，描述了骨髓在肾脏疾病发病过程中的重要新作用，以及通过可溶性介质suPAR这两个器官之间的功能联系。我们还评论了骨髓移植治疗复发性FSGS引起的慢性肾功能衰竭患者的可行性。

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