Podocyte is the major culprit accounting for the progression of chronic renal disease

The concept that the podocyte is the major culprit underlying development and progression of glomerular diseases leading to chronic renal failure is well established. The essential steps in this process are (1) the establishment of tuft adhesions to Bowman's capsule; (2) the formation by capillaries contained in a tuft adhesion of a filtrate that is delivered, instead into Bowman's space, towards the interstitium; and (3) the spreading of this filtrate on the outer aspect of the affected nephron leading to the degeneration of this nephron. The present review summarizes the pros and cons concerning the relevance of misdirected filtration for a nephron-to-nephron transfer of the disease at the level of the tubular interstitium. Surprisingly, the histopathology clearly shows that interstitial proliferation surrounding degenerating nephrons tends to encapsulate the degenerative process, confining it to the already affected nephron. No evidence is available that the disease, mediated by interstitial proliferation and matrix deposition, may jump to a neighboring, so far unaffected, nephron. It appears that the process that leads to the degeneration of a nephron in the context of "classic" FSGS always starts separately in the respective glomerulus by severe podocyte injury. (C) 2002 Wiley-Liss, Inc.