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Nephrol Dial Transplant (1999) 14: 2072-2074
© 1999 European Renal Association-European Dialysis and Transplant Association

Editorial Comments

Tubular epithelial cell activation and interstitial fibrosis. The role of glomerular ultrafiltration of growth factors in the nephrotic syndrome and diabetic nephropathy

Shi-Nong Wang and Raimund Hirschberg

Division of Nephrology & Hypertension, Harbor-UCLA Medical Center and UCLA, Torrance, California, USA

Correspondence and offprint requests to: Raimund Hirschberg, MD, Division of Nephrology & Hypertension, Harbor-UCLA Medical Center, Box 406, 1000 West Carson Street, Torrance, CA 90509, USA. E-mail: hirschberg@humc.edu.

Introduction

Chronic glomerular proteinuria or the nephrotic syndrome are associated with worsening tubulointerstitial injury and fibrosis in virtually all immunological or nonimmunological glomerular diseases [1]. Moreover, prospective, randomized clinical trials indicate that the degree of glomerular protein ultrafiltration is a major risk factor for onset and progression of both interstitial fibrosis and progressive renal failure [2].

Currently, therapeutic interventions are primarily aimed at reducing the rate of glomerular protein ultrafiltration such as with angiotensin I converting enzyme inhibitors. However, it is conceivable that additional treatment strategies may be developed that block pathophysiological, further downstream events, namely the interaction of ultrafiltered proteins with tubular cells and their activation.

Bioactive proteins in glomerular ultrafiltrate

In the nephrotic syndrome, the glomerular ultrafiltrate contains `bulk' plasma proteins such as serum albumin and globulins. Albumin is taken up by proximal tubular cells through megalin-assisted endocytosis. Albumin itself may not be harmful to tubular cells, but toxicity may . . . [Full Text of this Article]

Apical tubular membranes express specific growth factor receptors

Activation of tubular cells by ultrafiltered growth factors

Activated tubular cells initiate cell–cell interactions in the renal interstitium

References


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