The podocyte's response to injury: role in proteinuria and glomerulosclerosis

Kidney Int. 2006 Jun;69(12):2131-47. doi: 10.1038/ Epub 2006 May 10.


The terminally differentiated podocyte, also called glomerular visceral epithelial cell, are highly specialized cells. They function as a critical size and charge barrier to prevent proteinuria. Podocytes are injured in diabetic and non-diabetic renal diseases. The clinical signature of podocyte injury is proteinuria, with or without loss of renal function owing to glomerulosclerosis. There is an exciting and expanding literature showing that hereditary, congenital, or acquired abnormalities in the molecular anatomy of podocytes leads to proteinuria, and at times, glomerulosclerosis. The change in podocyte shape, called effacement, is not simply a passive process following injury, but is owing to a complex interplay of proteins that comprise the molecular anatomy of the different protein domains of podocytes. These will be discussed in this review. Recent studies have also highlighted that a reduction in podocyte number directly causes proteinuria and glomerulosclerosis. This is owing to several factors, including the relative inability for these cells to proliferate, detachment, and apoptosis. The mechanisms of these events are being elucidated, and are discussed in this review. It is the hope that by delineating the events following injury to podocytes, therapies might be developed to reduce the burden of proteinuric renal diseases.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adrenal Cortex Hormones / pharmacology
  • Adrenal Cortex Hormones / therapeutic use
  • Angiotensin II Type 1 Receptor Blockers / pharmacology
  • Angiotensin II Type 1 Receptor Blockers / therapeutic use
  • Apoptosis / physiology
  • Cell Adhesion / physiology
  • Cell Count
  • Cell Cycle / physiology
  • Cell Proliferation
  • Cytoskeleton / pathology
  • Cytoskeleton / physiology
  • Cytoskeleton / ultrastructure
  • DNA Damage
  • Diabetic Nephropathies / drug therapy
  • Diabetic Nephropathies / pathology
  • Diabetic Nephropathies / physiopathology*
  • Endothelium / pathology
  • Endothelium / physiopathology
  • Glomerular Basement Membrane / pathology
  • Glomerular Basement Membrane / physiopathology
  • Glomerular Basement Membrane / ultrastructure
  • Glomerulosclerosis, Focal Segmental / drug therapy
  • Glomerulosclerosis, Focal Segmental / pathology
  • Glomerulosclerosis, Focal Segmental / physiopathology*
  • Humans
  • Hypertrophy / pathology
  • Hypertrophy / physiopathology
  • Podocytes / drug effects
  • Podocytes / pathology*
  • Podocytes / physiology*
  • Proteinuria / drug therapy
  • Proteinuria / pathology*
  • Proteinuria / physiopathology
  • Tretinoin / pharmacology
  • Tretinoin / therapeutic use


  • Adrenal Cortex Hormones
  • Angiotensin II Type 1 Receptor Blockers
  • Tretinoin