Renal disorders account for a substantial fraction of the budget for health care in many countries. Proteinuria is a frequent manifestation in afflicted patients, but the origin of the proteins varies based on the nature of the disorder. The emerging field of urinary proteomics has the potential to replace kidney biopsy as the diagnostic procedure of choice for patients with some glomerular forms of renal disease. To fully realize this potential, it is vital to understand the basis for the urinary excretion of protein in physiological and pathological conditions. In this review, we discuss the structure of the nephron, the functional unit of the kidney, and the process by which proteins/peptides enter the urine. We discuss several aspects of proteinuria that impact the proteomic analysis of urine of patients with renal diseases.
KeywordsGlomerular Filtration; Nephron; Proteinuria; Proteomics; Renal Tubule Twenty-four hundred years ago, Hippocrates noted the association between bubbles on the surface of voided urine and kidney disease. This foamy appearance is due to proteinuria, an abnormality oftentimes discovered during routine evaluations in the primary-care setting. The clinical significance of this finding varies widely. Some individuals will be shown to have a benign cause, such as fever, intense activity, exercise, orthostatic proteinuria, or acute illness. Alternatively, serious conditions include a host of ailments intrinsic to the kidney (glomerulonephritis, tubular disorders, interstitial renal disease, and hypertensive renal damage) and various extra-renal disorders (plasma cell dyscrasia, inflammation of the urinary tract, and uroepithelial tumors). To ensure an accurate and timely diagnosis, a knowledgeable approach to the evaluation of proteinuria is critical.
Structure of the nephronThe functional unit of the kidney is the nephron and each normal human kidney contains about 1 × 10 6 such units. Its essential components are the glomerulus and the tubule (Figure 1). The glomerulus is the site of formation of the primary urine. It is composed of a capillary network Corresponding Author: Bruce A. Julian, M.D., Division of Nephrology THT 643, 1530 Third Avenue South, Birmingham, AL 35294, USA, Tel: 1-205-934-9045, Fax: 1-205-934-7742, bjulian@uab.edu.
Conflict of interest statementThe authors do not have any financial/commercial conflicts of interest to declare.
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Author ManuscriptProteomics Clin Appl. Author manuscript; available in PMC 2010 August 26.
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NIH-PA Author Manuscriptlined by a thin layer of endothelial cells separated from overlying epithelial cells (podocytes) by a basement membrane. Bowman's space is covered by epithelial cells and is the collection site for the primary urine. Upon exiting this space, the urine enters the tubule where its composition is drastically altered before leaving the kidney. The tubule can be divided into several functional segments that differ in their capacities to reabsorb solutes, prote...