Mechanisms of tissue injury in renal artery stenosis: ischemia and beyond.
Mechanisms of tissue injury in renal artery stenosis: ischemia and beyond.
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DOI：
10.1016/j.pcad.2009.09.002
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发表时间：
2009-11
影响因子：
9.1
通讯作者：
Grande, Joseph P.
中科院分区：
文献类型：
--
作者：
Lerman, Lilach O.;Textor, Stephen C.;Grande, Joseph P.
动脉粥样硬化性肾血管阻塞远端的肾损伤反映了多种导致实质组织损伤的内在因素。叠加在肾动脉阻塞之上的动脉粥样硬化疾病通路可能会加重对肾脏和其他靶器官的损害，并且一些由肾动脉狭窄激活的因素可能反过来加速动脉粥样硬化的进展。这种相互作用是通过肾素 - 血管紧张素系统的放大激活、氧化应激、炎症和纤维化介导的，这些通路众所周知地参与了肾脏疾病的进展。脂质氧化还通过放大促纤维化机制和破坏组织重塑，加速狭窄肾脏中纤维化的发展。实际缺血在多大程度上调节狭窄肾脏中的损伤一直存在争议，部分原因是肾氧消耗的减少通常与肾血流量的减少平行，以及受累肾脏的肾静脉氧分压没有降低。然而，最近使用新方法的数据表明，肾内氧合在肾脏的不同区域受到不同的影响。肾脏内这种局部损伤的激活可能导致肾功能障碍和结构损伤，并最终导致不良且不可逆的肾脏结局。识别导致进行性肾损伤的特定通路可能有助于开发针对性的干预措施来阻断这些通路并保护狭窄的肾脏。
Renal injury distal to an atherosclerotic renovascular obstruction reflects multiple intrinsic factors producing parenchymal tissue injury. Atherosclerotic disease pathways superimposed on renal arterial obstruction may aggravate damage to the kidney and other target organs, and some of the factors activated by renal artery stenosis may in turn accelerate the progression of atherosclerosis. This cross talk is mediated through amplified activation of renin-angiotensin system, oxidative stress, inflammation, and fibrosis, pathways notoriously involved in renal disease progression. Oxidation of lipids also accelerates the development of fibrosis in the stenotic kidney by amplifying profibrotic mechanisms and disrupting tissue remodeling. The extent to which actual ischemia modulates injury in the stenotic kidney has been controversial, partly because the decrease in renal oxygen consumption usually parallels a decrease in renal blood flow, and because renal vein oxygen pressure in the affected kidney is not decreased. However, recent data using novel methodologies demonstrate that intra-renal oxygenation is heterogeneously affected in different regions of the kidney. Activation of such local injury within the kidney may lead to renal dysfunction and structural injury, and ultimately unfavorable and irreversible renal outcomes. Identification of specific pathways producing progressive renal injury may enable development of targeted interventions to block these pathways and preserve the stenotic kidney.
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影响因子：
13.6
作者：
Chade, AR;Herrmann, J;Lerman, LO
通讯作者：
Lerman, LO
影响因子：
37.8
作者：
Chade, AR;Rodriguez-Porcel, M;Lerman, LO
通讯作者：
Lerman, LO
DOI：
10.1161/01.atv.0000077477.40824.52
发表时间：
2003-07-01
影响因子：
8.7
作者：
Chade, AR;Rodriguez-Porcel, M;Lerman, LO
通讯作者：
Lerman, LO
影响因子：
8.3
作者：
Chade, AR;Mushin, OP;Lerman, LO
通讯作者：
Lerman, LO
影响因子：
15.9
作者：
Daemen, MARC;van't Veer, C;Buurman, WA
通讯作者：
Buurman, WA