IntroductionTubular epithelial cells under adaptive state (aTEC) have been frequently reported in the injured kidney closely associated with disease progression. However, whether aTEC is present in the urine of Diabetic Kidney Disease (DKD) patients and its clinical implication have not been assessed. MethodsUrine samples from early and advanced DKD patients were collected and subjected to single cell RNA sequencing (scRNA-seq). Kidney single nucleus RNA-seq, spatial scRNA-seq and bulk RNA-seq datasets were employed to reconstruct their local environment and to delineate differences between shed cells and local residence. ResultsMost urinary TEC in DKD patients are under adaptive states. While the composition of urinary TEC is consistent in early and advanced DKD, higher ratio of aTEC under progenitor and fibrosis state is defined in early DKD. Trajectory inference reveals some aTEC are early derivatives of injured PT. Spatial mapping reveals proliferative and fibrosis aTEC reside close to glomerulus region. Systemic evaluation of different states of urinary aTEC in patients of diverse-cause kidney injury suggests that the ratio of progenitor/proliferative aTEC and fibrosis aTEC is of diagnostic value. ConclusionUrine is an underestimated source of aTEC providing us non-invasive manner to interrogate the injured state of tubule. The ratio of fibrosis aTEC and progenitor/proliferative aTEC in urine features tubular injury state and may help improve DKD diagnosis.
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