Past and future in vitro and in vivo approaches toward circulating factors and biomarkers in idiopathic nephrotic syndrome

Autor(es)

Guaragna, Mara S. ; Casimiro, Fernanda M. S. ; Varela, Patricia ; de S. Feltran, Luciana ; Watanabe, Andreia ; Neves, Precil D. M. M. ; Pesquero, Joao B. ; Belangero, Vera M. S. ; Nogueira, Paulo C. K. ; Onuchic, Luiz F.

• Tipo de documento: Artigo Científico
• Fonte: Pediatric Nephrology; v. N/A, p. 17-pg., 2025-01-30.

Resumo

Predicting the risks of progression to chronic kidney disease (CKD) stage 5 in idiopathic nephrotic syndrome (NS) and recurrence of the disease (rNS) following kidney transplantation (KT) is a key assessment to provide essential management information. NS has been categorized etiologically as genetic and immune-based. A genetic cause can be identified in similar to 30% of children with steroid-resistant NS (SRNS), a finding associated with a very low risk of rNS following KT. In immune-based NS, clinical overlap is observed among steroid-sensitive NS, secondary-resistant NS, and SRNS not associated with disease-causing genetic variants (non-monogenic SRNS). While similar to 50% of SRNS patients with no identified monogenic disease respond to intensified immunosuppressive treatments, the ones that do not respond to this therapy have a high risk of progression to CKD stage 5 and post-KT rNS. Secondary-resistant patients who progress to CKD stage 5 display the highest risk of post-KT rNS. The proposed shared underlying mechanism of the immune-based NS associated with post-KT rNS is based on a systemic circulating factor (CF) that affects glomerular permeability by inducing foot process effacement and focal segmental glomerulosclerosis. However, identifying patients without a detected genetic form who will recur post-KT is a major challenge. Extensive efforts, therefore, have been made to identify CFs and biomarkers potentially capable of predicting the risk of progression to CKD stage 5 and post-KT rNS. This review discusses the in vitro and in vivo approaches employed to date to identify and characterize potential CFs and CF-induced biomarkers of recurrent NS and offers an assessment of their potential to improve outcomes of KT in this patient population. (AU)

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