Remnant nephron physiology and the progression of chronic kidney disease.

Remnant nephron physiology and the progression of chronic kidney disease.
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DOI:
10.1007/s00467-013-2494-8
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发表时间:
2014-02
影响因子:
3
通讯作者:
Schnaper, H. William
Schnaper, H. William
中科院分区:
医学3区
文献类型:
--
作者:
Schnaper, H. William

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在慢性肾脏疾病中,个别肾单位的持续衰竭导致肾功能的进行性丧失。这一过程部分是由于细胞和分子对损伤的反应,这代表了试图维持体内平衡,但相反启动了损害肾单位的程序。当肾单位丢失时,剩余肾单位的代偿加重肾小球病理生理学。将过量的生物活性分子递送至远端肾单位和肾小管上皮细胞产生炎症和细胞去分化。功能亢进的肾单位的能量需求超过肾小管可用的代谢底物,并且局部血管供应不足促进缺氧/缺血以及随后的酸中毒和活性氧物质的产生。以这种方式,维持生物平衡的机制被激活,最终导致肾单位的死亡。
In chronic kidney disease, ongoing failure of individual nephrons leads to the progressive loss of renal function. This process results in part from a cellular and molecular response to injury that represents an attempt to maintain homeostasis but instead initiates a program that damages the nephron. As nephrons are lost, compensation by the remaining nephrons exacerbates glomerular pathophysiology. Delivery of excessive amounts of biologically active molecules to the distal nephron and tubulointerstitium generates inflammation and cellular dedifferentiation. Energy requirements of hyperfunctioning nephrons exceed the metabolic substrate available to the renal tubule, and inadequacy of the local vascular supply promotes hypoxia/ischemia and consequent acidosis and reactive oxygen species generation. In this way, mechanisms activated to maintain biological balance ultimately lead to demise of the nephron.
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