Tuesday, October 26, 2010

IN THE NEWS- Permeability Factor and FSGS

Permeability factor in FSGS has been in debate all along. A recent CJASN review summarizes the role of permeability factors in many nephrotic syndromes. 
New things I learned:
1. Minimal Change disease :- there is some research that a there is a vascular permeability factor called VPF.
Injecting rats with this factor, increased urinary protease and hemopexin in active nephrotic syndrome rats.
2. FSGS disease:- increased glomerular permeability factor has been described in case reports and experimental animal models.  There is also another glomerular permeability factor called CLC-1 that decreases nephrin and apparently this factor is blocked by anti CLC-1.
A nice strategy is proposed by the authors on attacking different aspects of the podocyte.
1. Decreasing the circulating levels of this factor or factors:- could use cytotoxic agents, antibody blocking agents.
2. Protect the podocytes by immunosuppresive agents:- steoids, CNIS, Anti CD20 etc.
3. Protect the endothelium:- perhaps VEGF inhibitors
4. Protect the kidney from fibrosis:- ACEI, ARBS, Anti TGF , fibrates and lipid lowering agents.

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