Abstract:

Objectice: To find out the association between endothelial dysfunction and the disease activity the markers of endothelial dysfuntion in patients with FSGS at different stages of the disease were assessed. Methodology: Sixty-three patients with FSGS (aged 10 to 59 years) and 32 sex- and age- macthed healthy volunteers were included in this longitudinal study. Among these patients, 11 cases had complicated with venous thromboembolism (VTE). The markers of endothelial dysfunction including circulating endothelial cells (CECs), von Willebrand factor (vWF), soluble thrombomodulin (sTM), vascular cell adhesion molecule (VCAM) and E-selectin (ES) were assessed at baseline. Markers except CECs were rechecked after 2, 6, and 12 months’ treatment. Results: Patients with FSGS had significantly higher plasma levels of CECs, vWF, sTM, VCAM and ES compared to controls. The levels of CECs and vWF were higher in patients with VTE than those without VTE. In patients without VTE, both sTM and VCAM were positively related to serum creatinine. VCAM as well as vWF was also correlated significantly with urine NAG and RBP. After 2 months therapy, 8 cases were lost to follow up, 15 achieved complete remission (CR), 13 got partial remission（PR）and 15 had no response (NR), 1 was withdrawn as she went into peritoneal dialysis. The plasma levels of all the markers studied before and after treatment were not significantly different in NR group, but in PR group, the level of sTM decreased significantly, while the other three markers had no obvious change. Patients who achieved CR had significently decreased plasma levels of sTM and VCAM, but the levels of vWF and ES did not change significantly. There were 11 patients who obtained continuous complete remission (CCR) during the one year follow up, and the markers of endothelial dysfuntion in these patients decreased systematically to normal levels except vWF and VCAM, the levels of which remained higher than those of controls. Conclusion: The patients with FSGS had endothelial dysfuction which is related to the disease activity and VTE complications. Endothelial dysfunction is reversible. To improve endothelial function may offer a novel strategy to reduce renal insult and complications.

Key words: endothelial dysfuntion, , FSGS, disease activity, venous thromboemb-olism