Podocyte Injury in Lupus Nephritis

Abstract

Systemic lupus erythematosus (SLE) is characterized by a broad spectrum of renal lesions. In lupus glomerulonephritis, histological classifications are based on immune-complex (IC) deposits and hypercellularity lesions (mesangial and/or endocapillary) in the glomeruli. However, there is compelling evidence to suggest that glomerular epithelial cells, and podocytes in particular, are also involved in glomerular injury in patients with SLE. Podocytes now appear to be not only subject to collateral damage due to glomerular capillary lesions secondary to IC and inflammatory processes, but they are also a potential direct target in lupus nephritis. Improvements in our understanding of podocyte injury could improve the classification of lupus glomerulonephritis. Indeed, podocyte injury may be prominent in two major presentations: lupus podocytopathy and glomerular crescent formation, in which glomerular parietal epithelial cells play also a key role. We review here the contribution of podocyte impairment to different presentations of lupus nephritis, focusing on the podocyte signaling pathways involved in these lesions.

Calcineurin and Systemic Lupus Erythematosus: The Rationale for Using Calcineurin Inhibitors in the Treatment of Lupus Nephritis

“…Podocytes are epithelial cells with a well-developed cytoskeleton that are essential for the proper working of the glomerular filtration barrier in the kidneys [ 73 ]. Several alterations have been observed in the podocytes of lupus nephritis patients, which contribute to proteinuria and kidney damage [ 74 ]. Importantly, calcineurin acts on different podocyte signaling pathways, which contribute to kidney damage.…”

Podocytopathy as ‘stand-alone’ involvement in systemic lupus erythematosus: a case report

“…4 Although LP is not grouped in the classification of LN of the ISN/RPS 2003, 5 a review article in 2019 proposed grouping LP in the classification. 6 Here, we report a rare case of LP at the onset of SLE.…”

<p>Towards Precision Medicine in Systemic Lupus Erythematosus</p>

“…Several studies of podocyte injury in LN found that podocyte injury correlated with the degree of proteinuria, and renal outcome. 46 Morphologically these podocyte injuries are similar to minimal change disease or focal segmental glomerulosclerosis (FSGS). These biopsies show extensive podocyte injury, without evidence of IC deposition.…”