目的:随着对补体失调研究的深入,以C3沉积为主的肾小球肾炎日益受到关注,其病理类型多样,且病理类型间症状及预后差异具有异质性。为避免误诊及漏诊,本研究分析不同病理类型C3沉积为主的肾小球肾炎的临床、病理及预后特点。方法:回顾性...目的:随着对补体失调研究的深入,以C3沉积为主的肾小球肾炎日益受到关注,其病理类型多样,且病理类型间症状及预后差异具有异质性。为避免误诊及漏诊,本研究分析不同病理类型C3沉积为主的肾小球肾炎的临床、病理及预后特点。方法:回顾性分析52例2013年6月至2022年10月行肾活检诊断为以C3沉积为主肾小球肾炎患者的临床、病理及随访资料。根据临床表现以及病理检查结果分为感染后肾小球肾炎(post-infectious glomerulonephritis,PIGN)组(n=15)和非感染后肾小球肾炎(non-post-infectious glomerulonephritis,N-PIGN)组(n=37)。进一步行N-PIGN亚组分析,分为C3独立沉积组(n=16)与C3复合沉积组(n=21),或C3肾病(C3 glomerulopathy,C3G)组(n=27)与非C3肾病(N-C3G)组(n=10)。结果:PIGN组相较于N-PIGN组,活检时血清肌酐值更低(84.60μmol/L vs 179.62μmol/L,P=0.001),补体C3值更低(0.36 g/L vs 0.74 g/L,P<0.001),病理慢性化病变程度更轻。在N-PIGN亚组分析中,C3复合沉积组较C3独立沉积组血清肌酐值更高(235.30μmol/L vs 106.70μmol/L,P=0.004),24 h尿蛋白值更高(4025.62 mg vs 1981.11 mg,P=0.037)。PIGN组的预后好于N-PIGN组(P=0.049),C3独立沉积组的预后好于C3复合沉积组(P=0.017),C3G组的预后好于N-C3G(P=0.018)。结论:C3沉积为主的肾小球肾炎涵盖多种病理类型,诊断C3G前需先排除PIGN,但对于非典型PIGN患者仍需要警惕C3G叠加或者相互转化;此外,荧光显微镜下经典补体C1q的沉积可能提示肾预后不良,应加强相关诊治与随访。展开更多
Objective:IgA nephropathy(IgAN)is the most common primary glomerular disease in China,but its pathogenesis remains unclear.This study aims to explore the regulatory role of the mammalian target of rapamycin(mTOR)signa...Objective:IgA nephropathy(IgAN)is the most common primary glomerular disease in China,but its pathogenesis remains unclear.This study aims to explore the regulatory role of the mammalian target of rapamycin(mTOR)signaling pathway in autophagy and mesangial proliferation during renal injury in IgA.Methods:The activity of mTOR and autophagy was evaluated in kidney samples from IgAN patients and in an IgAN mouse model induced by oral bovine serum albumin and carbon tetrachloride(CCl4)injection.mTOR inhibitors(rapamycin)and activators[bpV(phen)]were administered to the IgAN mouse model to observe the effects of mTOR on autophagy and renal lesions.In human mesangial cells treated with polymeric IgA1(p IgA1)and mTOR modulators,the expression and distribution of cell cycle proteins were assessed,along with the effects of mTOR on mesangial cell proliferation and autophagy.Results:Increased mTOR activity and decreased autophagy were observed in kidney tissues from IgAN patients and the mouse model,as evidenced by elevated phosphorylated mTOR(p-mTOR)levels and reduced LC3 expression.In the IgAN mouse model,rapamycin inhibited mTOR,restored autophagy,reduced mesangial IgA deposition,alleviated mesangial cell proliferation,and decreased proteinuria(all P<0.05).In contrast,bpV(phen)activated mTOR,further suppressed autophagy,exacerbated kidney damage,and increased proteinuria(all P<0.05).In vitro,p-IgA1 induced mesangial cell proliferation and inhibited autophagy,effects that were reversed by rapamycin and aggravated by bpV(phen)(all P<0.05).mTOR regulated mesangial cell proliferation by altering cell cycle distribution,with rapamycin inducing G1 phase arrest and bpV(phen)promoting cell cycle progression.Additionally,cyclinD1 expression in renal cortex was up-regulated in the IgAN mouse model,further increased by bpV(phen),and reduced by rapamycin(all P<0.05).Conclusion:Inhibition of the mTOR signaling pathway enhances renal autophagy,reduces mesangial cell proliferation,and improves renal injury in IgAN.展开更多
文摘目的:随着对补体失调研究的深入,以C3沉积为主的肾小球肾炎日益受到关注,其病理类型多样,且病理类型间症状及预后差异具有异质性。为避免误诊及漏诊,本研究分析不同病理类型C3沉积为主的肾小球肾炎的临床、病理及预后特点。方法:回顾性分析52例2013年6月至2022年10月行肾活检诊断为以C3沉积为主肾小球肾炎患者的临床、病理及随访资料。根据临床表现以及病理检查结果分为感染后肾小球肾炎(post-infectious glomerulonephritis,PIGN)组(n=15)和非感染后肾小球肾炎(non-post-infectious glomerulonephritis,N-PIGN)组(n=37)。进一步行N-PIGN亚组分析,分为C3独立沉积组(n=16)与C3复合沉积组(n=21),或C3肾病(C3 glomerulopathy,C3G)组(n=27)与非C3肾病(N-C3G)组(n=10)。结果:PIGN组相较于N-PIGN组,活检时血清肌酐值更低(84.60μmol/L vs 179.62μmol/L,P=0.001),补体C3值更低(0.36 g/L vs 0.74 g/L,P<0.001),病理慢性化病变程度更轻。在N-PIGN亚组分析中,C3复合沉积组较C3独立沉积组血清肌酐值更高(235.30μmol/L vs 106.70μmol/L,P=0.004),24 h尿蛋白值更高(4025.62 mg vs 1981.11 mg,P=0.037)。PIGN组的预后好于N-PIGN组(P=0.049),C3独立沉积组的预后好于C3复合沉积组(P=0.017),C3G组的预后好于N-C3G(P=0.018)。结论:C3沉积为主的肾小球肾炎涵盖多种病理类型,诊断C3G前需先排除PIGN,但对于非典型PIGN患者仍需要警惕C3G叠加或者相互转化;此外,荧光显微镜下经典补体C1q的沉积可能提示肾预后不良,应加强相关诊治与随访。
基金supported by the Key Funding Project of Hunan Provincial Health Commission(A202303057091)the Nephrology Medical Development Research Fund Project(20220316ZN),China.
文摘Objective:IgA nephropathy(IgAN)is the most common primary glomerular disease in China,but its pathogenesis remains unclear.This study aims to explore the regulatory role of the mammalian target of rapamycin(mTOR)signaling pathway in autophagy and mesangial proliferation during renal injury in IgA.Methods:The activity of mTOR and autophagy was evaluated in kidney samples from IgAN patients and in an IgAN mouse model induced by oral bovine serum albumin and carbon tetrachloride(CCl4)injection.mTOR inhibitors(rapamycin)and activators[bpV(phen)]were administered to the IgAN mouse model to observe the effects of mTOR on autophagy and renal lesions.In human mesangial cells treated with polymeric IgA1(p IgA1)and mTOR modulators,the expression and distribution of cell cycle proteins were assessed,along with the effects of mTOR on mesangial cell proliferation and autophagy.Results:Increased mTOR activity and decreased autophagy were observed in kidney tissues from IgAN patients and the mouse model,as evidenced by elevated phosphorylated mTOR(p-mTOR)levels and reduced LC3 expression.In the IgAN mouse model,rapamycin inhibited mTOR,restored autophagy,reduced mesangial IgA deposition,alleviated mesangial cell proliferation,and decreased proteinuria(all P<0.05).In contrast,bpV(phen)activated mTOR,further suppressed autophagy,exacerbated kidney damage,and increased proteinuria(all P<0.05).In vitro,p-IgA1 induced mesangial cell proliferation and inhibited autophagy,effects that were reversed by rapamycin and aggravated by bpV(phen)(all P<0.05).mTOR regulated mesangial cell proliferation by altering cell cycle distribution,with rapamycin inducing G1 phase arrest and bpV(phen)promoting cell cycle progression.Additionally,cyclinD1 expression in renal cortex was up-regulated in the IgAN mouse model,further increased by bpV(phen),and reduced by rapamycin(all P<0.05).Conclusion:Inhibition of the mTOR signaling pathway enhances renal autophagy,reduces mesangial cell proliferation,and improves renal injury in IgAN.
