More on Renal Disease Progression: Is Interstitial Inflammation Truly Protective?

[摘要] Patients with a chronic glomerulopathy are at risk for progressively declining renal function that results in end-stage renal failure irrespective of etiology. The underlying pathophysiology is at least partly dependent on maladaptive functional changes that occur in the surviving nephrons upon destruction of a critical number of glomeruli. In proteinuric nephropathies, the dysfunction of the glomerular filtration barrier causes the abnormal passage of large amounts of potentially toxic plasma proteins and protein-bound molecules from the bloodstream into the tubular lumen. One widely accepted mechanism underlying the acceleration of progressive injury to the kidney is that the ensuing tubulointerstitial damage is induced by direct toxicity of filtered protein, because proteinuria has long been known to correlate with both the severity of glomerular barrier impairment and the rate of decline of renal function. An important question that has not yet been adequately addressed in this area is whether albumin in proteinuric ultrafiltrate may promote proximal tubule cell injury through enhanced endocytosis.

[学科分类] 泌尿医学

[关键词] Bone marrow necrosis;Sickle cell disease;Hyperhemolysis syndrome