JOURNAL ARTICLE
RESEARCH SUPPORT, N.I.H., EXTRAMURAL
REVIEW
Pathogenesis of renal injury in obstructive uropathy.
Current Opinion in Pediatrics 2006 April
PURPOSE OF REVIEW: This review focuses on recent advances in understanding the factors contributing to obstructive nephropathy, the most important cause of renal failure in children. The major focus is on renal cellular and molecular events, with emphasis on those affecting the developing kidney.
RECENT FINDINGS: Experiments in the fetal sheep or neonatal rat, mouse, or pig reveal dramatic effects of urinary tract obstruction on renal growth and development. Surgical relief of obstruction can reverse some of the structural and functional deficits, but cannot restore normalcy. Renal tubular apoptosis is a major factor leading to tubular atrophy following unilateral ureteral obstruction. Increased reactive oxygen species, and a renal environment favoring pro-apoptotic, over survival, signals, contribute to cell death. A variety of intrarenal factors lead to progressive interstitial fibrosis, including the newly described process of epithelial-mesenchymal transition, whereby tubular epithelial cells are transformed into activated fibroblasts. A number of endogenous antifibrotic counter-regulatory molecules have been identified, opening the possibility of enhancing the kidney's own defenses against progressive fibrosis.
SUMMARY: The renal response to urinary tract obstruction is complex and involves a wide array of interacting molecules. Elucidation of these interactions will lead to the identification of biomarkers that will allow a more precise prediction to the response to surgical intervention and, hopefully, to novel therapies to prevent renal deterioration.
RECENT FINDINGS: Experiments in the fetal sheep or neonatal rat, mouse, or pig reveal dramatic effects of urinary tract obstruction on renal growth and development. Surgical relief of obstruction can reverse some of the structural and functional deficits, but cannot restore normalcy. Renal tubular apoptosis is a major factor leading to tubular atrophy following unilateral ureteral obstruction. Increased reactive oxygen species, and a renal environment favoring pro-apoptotic, over survival, signals, contribute to cell death. A variety of intrarenal factors lead to progressive interstitial fibrosis, including the newly described process of epithelial-mesenchymal transition, whereby tubular epithelial cells are transformed into activated fibroblasts. A number of endogenous antifibrotic counter-regulatory molecules have been identified, opening the possibility of enhancing the kidney's own defenses against progressive fibrosis.
SUMMARY: The renal response to urinary tract obstruction is complex and involves a wide array of interacting molecules. Elucidation of these interactions will lead to the identification of biomarkers that will allow a more precise prediction to the response to surgical intervention and, hopefully, to novel therapies to prevent renal deterioration.
Full text links
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
Read by QxMD is copyright © 2021 QxMD Software Inc. All rights reserved. By using this service, you agree to our terms of use and privacy policy.
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app