Emergent players in renovascular disease

Abstract

Renovascular disease (RVD) remains a common etiology of secondary hypertension. Recent clinical trials revealed unsatisfactory therapeutic outcomes of renal revascularization, leading to extensive investigation to unravel key pathophysiological mechanisms underlying irreversible functional loss and structural damage in the chronically ischemic kidney. Research studies identified complex interactions among various players, including inflammation, fibrosis, mitochondrial injury, cellular senescence, and microvascular remodeling. This interplay resulted in a shift of our understanding of RVD from a mere hemodynamic disorder to a pro-inflammatory and pro-fibrotic pathology strongly influenced by systemic diseases like metabolic syndrome (MetS), hypertension, diabetes mellitus, and hyperlipidemia. Novel diagnostic approaches have been tested for early detection and follow-up of RVD progression, using new imaging techniques and biochemical markers of renal injury and dysfunction. Therapies targeting some of the pathological pathways governing the development of RVD have shown promising results in animal models, and a few have moved from bench to clinical research. This review summarizes evolving understanding in chronic ischemic kidney injury.

IL-10 partly mediates the ability of MSC-derived extracellular vesicles to attenuate myocardial damage in experimental metabolic renovascular hypertension

“…Renal artery stenosis (RAS), mainly caused by atherosclerosis ( 1 ), is a common etiology of renovascular hypertension (RVH) ( 2 ). RAS not only results in hemodynamic disorders and deteriorating renal function, but is also exacerbated by systemic diseases including metabolic syndrome (MetS) and diabetes mellitus ( 3 ). Conversely, all of these risk factors are crucial contributors to atherosclerosis ( 4 ) and cardiovascular disease (CVD) ( 5 ), a leading cause of death in the U.S ( 6 , 7 ).…”

Unraveling the Multifaceted Roles of Extracellular Vesicles: Insights into Biology, Pharmacology, and Pharmaceutical Applications for Drug Delivery

“…In rats, circulating EVs have been shown to be able to suppress vasodilation [ 199 , 200 ] and thus play an important role in hypertension. Namely, it has been shown that hypertensive patients show an increase in EC-EVs in the plasma [ 201 ] and urine [ 202 ]. Thus, blocking the generation and release of EVs was found to reduce blood pressure in hypertensive rats [ 203 ].…”

Elevated Intrarenal Resistive Index Predicted Faster Renal Function Decline and Long-Term Mortality in Non-Proteinuric Chronic Kidney Disease

“…Renovascular disease usually presents in two different clinical forms: Renovascular Hypertension, characterized by renal artery stenosis, systemic hypertension, and normal renal function; Ischemic Nephropathy, characterized by renal artery stenosis, increased intrarenal vascular resistance, and a decrease in renal function with or without hypertension [ 3 ]. Renal failure because of ischemic nephropathy results from functional, hormonal, and anatomical alterations induced by chronic renal hypoperfusion and ischemia [ 4 ]. Currently, the hypothesis that an increased intraparenchymal vascular resistance without renal artery stenosis may cause glomerular hypoperfusion and a decline in glomerular filtration rate towards ESRD, not associated with glomerular damage, has not been well defined [ 5 ].…”