Cell and Tissue Research

, Volume 379, Issue 2, pp 231–243 | Cite as

Idiopathic nephrotic syndrome and serum permeability factors: a molecular jigsaw puzzle

  • Jean-Jacques Candelier
  • Hans-Kristian LorenzoEmail author


Nephrotic syndrome is traditionally defined using the triad of edema, hypoalbuminemia, and proteinuria, but this syndrome is very heterogeneous and difficult to clarify. Its idiopathic form (INS) is probably the most harmful and essentially comprises two entities: minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS). We will consider some hypotheses regarding the mechanisms underlying INS: (i) the presence of several glomerular permeability factors in the sera of patients that alter the morphology and function of podocytes leading to proteinuria, (ii) the putative role of immune cells. Thanks to recent data, our understanding of these disorders is evolving towards a more multifactorial origin. In this context, circulating factors may be associated according to sequential kinetic mechanisms or micro-environmental changes that need to be determined. In addition, the resulting proteinuria may trigger more proteinuria enhancing the glomerular destabilization.


Nephrotic syndrome Permeability factors Minimal change disease Focal segmental glomerulosclerosis Proteinuria 



Serum circulating factor


Idiopathic nephrotic syndrome


Focal segmental glomerulosclerosis


Recurrent focal segmental glomerulosclerosis


Minimal change disease


Cardiotrophin-like cytokine-1


Soluble urokinase plasminogen activator receptor


Apolipoprotein A-I


Funding information

Hans K. Lorenzo was supported by the “ Fondation du Rein”/“Fondation pour la Recherche Médicale”, grant number R16099LL.

Compliance with ethical statements

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Authors and Affiliations

  1. 1.INSERM U1197, Hôpital Paul Brousse14 Avenue Paul Vaillant CouturierVillejuifFrance
  2. 2.Université Paris-SaclayCampus Universitaire d’OrsayOrsayFrance
  3. 3.Service de Néphrologie, Hôpital BicêtreFaculté de Médecine Paris-SaclayLe Kremlin-BicêtreFrance

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