Współczesne poglÄ dy na patogenezę idiopatycznego zespołu nerczycowego u dzieci w odniesieniu do potencjalnych nowych możliwości terapeutycznych

Nephrotic syndrome in children is represented by the complex family of disease variants, with variable clinical course and different underlying mechanisms. Those which are not related to genetic mutations (responsible for abnormal microstructure of podocytes) are currently regarded as the effect of different “protein permeability factors”, which after binding to specific targets (receptors) on podocytes, change their shape and function, causing clinically overt proteinuria. Different relevant cytokines are released by specific subpopulations of T and B cells; however, the podocytes by themselves may be also the source of disturbed local metabolism-related dysfunction, inducing feedback from other tissues and cells, driven by specific cytokines. Currently, there is a growing view on therapy as targeting the podocytes, not only (as previously believed) the immunologic system. The ongoing research on these interactions is aimed to find the innovative, targeted therapies of nephrotic syndrome, which might replace or at least modify current therapeutic protocols and decrease drug toxicities, present during long-term treatment of relapsing, drug-dependent or drug-resistant disease. This paper reviews current available data on pathogenesis of idiopathic nephrotic syndrome in regard to potential therapeutic interventions.