Table 1.

Causes of podocyte injury resulting in foot process effacementa

Intrinsic Podocyte Stress: Genetic MutationsExtrinsic Podocyte Stress
Nucleus: WT1, PAX2, and LMX1B mutationsViral: infection or circulating viral protein
Cytoskeleton: ACTN4 mutationsToxic: medication (pamidronate, interferon), toxin (puromycin aminonucleoside, Adriamycin)
Slit diaphragm complex: NPHS1, NPHS2, and CD2AP mutationsLymphokine or other host protein: IFN-α, IFN-β, FSGS permeability factor
Plasma membrane: ITGB4 and TRPC6 mutationsMechanical: Podocyte stretch (glomerulomegaly)
Mitochondria: tRNA mutations, COQ2 mutationsAcute ischemia associated with thrombotic microangiopathy
Metabolic: Fabry diseaseImmunologic: Immune complex deposition or in situ formation(lupus, IgA nephropathy, membranous nephropathy)
Extracellular matrix: LAMB2Metabolic: Diabetes
  • a From the viewpoint of the podocyte, injury can arise from intrinsic stress (genetic mutations) or extrinsic stress (circulating protein or toxin, mechanical forces, ischemia or viral infection).