[Role of podocyte damage in the pathogenesis of glomerulosclerosis and tubulointerstitial lesions: findings in the growth hormone transgenic mouse model of progressive nephropathy].

The sequence of structural changes terminating in glomerulosclerosis, tubular atrophy and interstitial fibrosis was analyzed in the growth hormone (GH) transgenic mouse (TM) model of progressive renal disease. The investigation was performed in TM expressing the bovine GH gene under the control of the murine metallothionein-1-promoter and non-transgenic controls (CM) of different age groups. The kidneys were studied by light microscopy, transmission and scanning electron microscopy, and were analyzed with stereological methods. Early-stage renal lesions were characterized by glomerular hypertrophy and mesangial expansion. In 7-week-old TM the mean glomerular volume was twice that of age-matched CM. The number of endothelial and of mesangial cells per glomerulus was increased in TM vs. CM, while the number of podocytes did not change. The podocytes demonstrated hypertrophy and foot process effacement. Concomitant with an age-related further increase of glomerular size in TM, severe maladaptive podocyte lesions including detachment of podocytes were observed. The resultant denudation of the glomerular basement membrane was associated with severe proteinuria, glomerular hyalinosis, synechia formation and collapse of glomerular capillaries. These lesions progressed to glomerular obsolescence that was associated with atrophy of the adjacent tubule and interstitial fibrosis. The progressive kidney lesions in this model appear to be attributable to a considerable extent to podocyte damage resulting from the limited capacity of this cell type to keep up with progressing overall tuft growth. The findings provide further evidence that mature podocytes are unable for effective cell replication in vivo, and that podocyte damage plays a significant role in the pathogenesis of progressive glomerulosclerosis with tubular atrophy and interstitial fibrosis.