Excess levels of protein in urine (proteinuria) is a hallmark of kidney disease that typically occurs in conjunction with diabetes, hypertension, gene mutations, toxins or infections but may also be of unknown cause (idiopathic)1. Systemic soluble urokinase plasminogen activator receptor (suPAR) is a circulating factor implicated in the onset and progression of chronic kidney disease (CKD)2, such as focal segmental glomerulosclerosis (FSGS)3,4. The cellular source(s) of elevated suPAR associated with future and progressing kidney disease is unclear, but is likely extra-renal, as the pathological uPAR is circulating and FSGS can recur even after a damaged kidney is replaced with a healthy donor organ. Here we report that bone marrow (BM) Gr-1lo immature myeloid cells are responsible for the elevated, pathological levels of suPAR, as evidenced by BM chimera and BM ablation and cell transfer studies. A marked increase of Gr-1lo myeloid cells was commonly found in the BM of proteinuric animals having high suPAR, and these cells efficiently transmit proteinuria when transferred to healthy mice. In accordance with the results seen in suPAR-associated proteinuric animal models, in which kidney damage is caused not by local podocyte-selective injury but more likely by systemic insults, a humanized xenograft model of FSGS resulted in an expansion of Gr-1lo cells in the BM, leading to high plasma suPAR and proteinuric kidney disease. Together, these results identify suPAR as a functional connection between the BM and the kidney, and they implicate BM immature myeloid cells as a key contributor to glomerular dysfunction.

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We thank A.S. Shaw (Washington University School of Medicine) for the Rac1 transgenic mice; S. Shankland (University of Washington) for providing the nephrotoxic serum (NTS); A. Finnegan (Rush University Medical Center) for reagents and advice; B. Samelko (née Tryniszewska) (Rush University Medical Center) for technical assistance; and S. Mangos (Rush University Medical Center) for help with manuscript revisions. This research was supported by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) R01DK101350 (J.R.), R01DK106051 (J.R.), R01DK107984 (V.G.) and R01DK084195 (V.G.).

Author information


  1. Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA.

    • Eunsil Hahm
    • , Changli Wei
    • , Isabel Fernandez
    • , Jing Li
    • , Nicholas J Tardi
    • , Melissa Tracy
    • , Shikha Wadhwani
    • , Yanxia Cao
    • , Vasil Peev
    • , Andrew Zloza
    • , Jevgenijs Lusciks
    • , Vineet Gupta
    •  & Jochen Reiser
  2. Department of Immunology/Microbiology, Rush University Medical Center, Chicago, Illinois, USA.

    • Andrew Zloza
    •  & Jevgenijs Lusciks
  3. Division of Surgical Oncology Research, Section of Surgical Oncology, Rutgers Cancer Institute of New Jersey, and Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.

    • Andrew Zloza
  4. Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.

    • Salim S Hayek
  5. Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.

    • Christopher O'Connor
    •  & Markus Bitzer
  6. Division of Nephrology, Massachusetts General Hospital, Charlestown, Massachusetts, USA.

    • Sanja Sever
  7. Center for Regenerative Medicine, Massachusetts General Hospital, Harvard Stem Cell Institute and the Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, Massachusetts, USA.

    • David B Sykes
    •  & David T Scadden


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E.H. designed and performed experiments, and wrote the paper; I.F., J.L., and Y.C. performed animal experiments; N.J.T. generated electron micrographs; A.Z. and J.L. contributed to xenotransplantation experiment; C.W., M.T., S.W., V.P., S.S.H., C.O., M.B., V.G., S.S., D.B.S., and D.T.S. contributed to experiments; J.R. designed and supervised the study, and wrote the paper.

Competing interests

E.H., C.W., S.S., and J.R. are inventors on pending and issued patents related to anti-proteinuric therapies. They stand to gain royalties from present and future commercialization. J.R. and S.S. are also co-founders and advisors to TRISAQ, a biotechnology company. The remaining authors report no conflicts.

Corresponding author

Correspondence to Jochen Reiser.

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