Proteinuria: An enzymatic disease of the podocyte

Peter Mundel, Jochen Reiser

Research output: Contribution to journalReview articlepeer-review

Abstract

Proteinuria is a major health-care problem that affects several hundred million people worldwide. Proteinuria is a cardinal sign and a prognostic marker of kidney disease, and also an independent risk factor for cardiovascular morbidity and mortality. Microalbuminuria is the earliest cue of renal complications of diabetes, obesity, and the metabolic syndrome. It can often progress to overt proteinuria that in 10-50% of patients is associated with the development of chronic kidney disease, ultimately requiring dialysis or transplantation. Therefore, reduction or prevention of proteinuria is highly desirable. Here we review recent novel insights into the pathogenesis and treatment of proteinuria, with a special emphasis on the emerging concept that proteinuria can result from enzymatic cleavage of essential regulators of podocyte actin dynamics by cytosolic cathepsin L (CatL), resulting in a motile podocyte phenotype. Finally, we describe signaling pathways controlling the podocyte actin cytoskeleton and motility and how these pathways can be manipulated for therapeutic benefit.

Original languageEnglish (US)
Pages (from-to)571-580
Number of pages10
JournalKidney International
Volume77
Issue number7
DOIs
StatePublished - Apr 2010
Externally publishedYes

Keywords

  • Albuminuria
  • Aldosterone
  • Cyclosporine
  • Podocyte

ASJC Scopus subject areas

  • Nephrology

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