Hemodynamic Correction and Early Detection of Tubulointerstitial Fibrosis Prevent Disease Progression in Chronic Kidney Disease

Futrakul, Narisa; Siriviriyakul, Prasong; Futrakul, Prasit

doi:10.1081/jdi-120038523

Cited by 1 publication

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“…Enhanced expression of vasoconstrictors induces hemodynamic maladjustment characterized by a preferential constriction at the efferent arteriole and thus a corresponding reduction in peritubular capillary flow supplying the tubulointerstitial structure (Figure 1). This phenomenon is well documented in CKD [14][15][16][17] . It is interesting to observe that an intact tubulointerstitial structure is usually associated with normal level of peritubular capillary flow.…”

Section: Renal Microvascular Injury and Tubulointerstitial Fibrosismentioning

confidence: 98%

Urgent call for reconsideration of chronic kidney disease

Futrakul

Futrakul²

2012

WJN

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Circulating toxins namely: free radicals, cytokines and metabolic products induce glomerular endothelial dysfunction, hemodynamic maladjustment and chronic ischemic state;this leads to tubulointerstitial fibrosis in chronic kidney disease (CKD). Altered vascular homeostasis observed in late stage CKD revealed defective angiogenesis and impaired nitric oxide production explaining therapeutic resistance to vasodilator treatment in late stage CKD. Under current practice, CKD patients are diagnosed and treated at a rather late stage due to the lack of sensitivity of the diagnostic markers available. This suggests the need for an alternative therapeutic strategy implementing the therapeutic approach at an early stage. This view is supported by the normal or mildly impaired vascular homeostasis observed in early stage CKD. Treatment at this early stage can potentially enhance renal perfusion, correct the renal ischemic state and restore renal function. Thus, this alternative therapeutic approach would effectively prevent end-stage renal disease.

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Section: Renal Microvascular Injury and Tubulointerstitial Fibrosismentioning

confidence: 98%