Poster - #VH-39669 - Keywords: Proteinuria, Mesangium, Podocyte, Slit_diaphragm, Basement_membrane

Novel Molecular and Glomerular Models Expand Pore Theory

Robert L. Luke, III, MD
Maine Medical Center, Portland, Maine

ABSTRACT:
All models are wrong, but some are useful. Pore theory is of limited use because macromolecular representations conflict with glomerular anatomy. Partial draining macromolecular representations are useful because they conform with glomerular anatomy. Novel molecular and anatomic models are introduced with the permeability of acidglycoprotein, albumin, transferrin, IgG, macroglobulin, and IgM in new patients and completed using classic matrix and hydrodynamic relations combined with the permeability of dextran, Ficoll, albumin, IgG, and glomerular measurements obtained from the literature. Visceral epithelium leaks protein, more in disease, but much more protein moves from lamina rara externa back across lamina densa and through mesangium into capillaries unless channels are compromised by increased cells, matrix, or proteins such as immune complexes, aberrant IgA, or amyloid. Mesangium not only supports capillaries, but also unclogs basement membrane. Therapy must not only suppress immune cells, but must also rehabilitate epithelial and mesangial cells.