92 Proteinuria has previously been regarded as a marker of glomerular dysfunction and was seen as both associative and a central risk factor for progression of renal impairment. However, it is known that proteinuria can independently Carfilzomib concentration predict cardiovascular disease96 and the question arises as to whether reduction in proteinuria could influence this prospectively. From observational data, it is also known that 25-OHD status in the CKD population correlates negatively with urinary protein loss.97,98 Podocytes are known to exhibit various components of the vitamin D machinery (CYP27B1 enzyme and the VDR) and in the db/db animal model of type II diabetes

(induced with a leptin receptor anomaly), a failure to develop progressive diabetic nephropathy and albuminuria is associated with upregulation of these components, in addition to increased glomerular vitamin D binding protein concentrations and serum calcitriol.99 Other evidence of podocyte response to vitamin D was demonstrated by Piecha’s group, who used 1,25-OHD in subtotally nephrectomized rats and showed

a significant reduction in proteinuria which was associated with lower podocyte hypertrophy and foot process fusion compared with controls.100 GSK3235025 It should be noted that this result was reproducible with the use of the experimental calcimimetic R-568, independent of serum calcium concentrations, but both resulted in significant parathyroid hormone suppression.100 Xiao et al. studied the effect of 1,25-OHD on podocyte apoptosis, and after injection with a known apoptotic inducer (Puromycin Aminonucleoside) compared podocyte number and apoptosis between groups. Those treated with 1,25-OHD exhibited lower cellular apoptosis and increased cell number, which correlated with potentiated downstream phosphorylation of Akt following phosphatidylinositol 3 kinase (PI3K) activation, a critical signalling pathway Liothyronine Sodium for podocyte survival.101 Between podocytes there exists a slit-diaphragm composed of

specific proteins, that complex and act as an important macromolecule barrier. One of the first proteins identified in the slit diaphragm, nephrin, is thought to have a key regulatory role in its structure and function and in various animal and biological models, interruption of this protein is associated with heavy proteinuria.102 In a recent study by Yamauchi et al. the nephrin gene was fused to a detectable enzymatic marker and transfected into an experimental immortal podocyte cell line which was then exposed to various substances to try and establish factors that affected gene transcription. They found pro-inflammatory moieties IL-1β and TNFα caused downregulation whereas stimulation with 1,25-OHD caused an almost threefold increase in the expression of nephrin compared with control.