Wang Y, Zhao S, Loyd S, Groome LJ. Increased urinary excretion of nephrin, podocalyxin, and ig-h3 in women with preeclampsia. Am J Physiol Renal Physiol 302: F1084 -F1089, 2012. First published February 1, 2012 doi:10.1152/ajprenal.00597.2011Emerging evidence has shown that podocyte injury and reduced specific podocyte protein expressions contribute to proteinuria in preeclampsia. We collected urine specimens from women with preeclampsia to study whether podocyte-specific protein shedding is associated with renal barrier dysfunction. Urine specimens from women with normal pregnancies and from pregnant women complicated by chronic hypertension were used for comparison. We determined soluble podocyte slit protein nephrin levels in the urine specimens. Podocalyxin, ig-h3, and VEGF concentrations were also measured. We found that nephrin and podocalyxin were barely detectable in the urine specimens from normal pregnant women and from women with chronic hypertension. In preeclampsia, urinary nephrin and podocalyxin concentrations were significantly increased and highly correlated to each other, r 2 ϭ 0.595. Nephrin and podocalyxin were also correlated with urine protein concentrations. ig-h3 was detected in the urine specimens from women with preeclampsia, and it is highly correlated with nephrin and podocalyxin concentrations in preeclampsia. ig-h3 was undetectable in normal pregnancy and pregnancy complicated by chronic hypertension. Elevated VEGF levels were also found in women with preeclampsia compared with those of normal pregnancy and pregnancy complicated by chronic hypertension. These results provide strong evidence that podocyte protein shedding occurs in preeclampsia, and their levels are associated with proteinuria. The finding of urinary ig-h3 excretion in preeclampsia suggests that increased transforming growth factor activity might also be involved in the kidney lesion in this pregnancy disorder. kidney lesion; glycoprotein shedding; TGF-; proteinuria; pregnancy complication NEWLY DEVELOPED HYPERTENSION and proteinuria after 20 wk of gestation are the two major clinical diagnostic criteria for preeclampsia, a hypertensive and multiple-system disorder unique to human pregnancy. Plasma protein leakage into the urine signifies renal/kidney lesions in this pregnancy disorder. Pathophysiologically, renal lesions are attributed to the glomerular endotheliosis characterized by glomerular endothelial cell swelling and subendothelial deposits of protein materials (5). Renal vasoconstriction is another contributing factor as part of the global systemic vasoconstriction in preeclampsia (9). Emerging evidence has revealed that other than glomerular endotheliosis, podocyte injury also plays a significant role in glomerular barrier dysfunction in preeclampsia (7,8,12,27,28). Supporting evidence includes 1) reduced podocyte-specific protein nephrin and synaptopodin expressions in kidney autopsy or biopsy specimens from women who had preeclampsia (7, 27); 2) detection of viable podocytes in the urine specimens ...