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Nephrol Dial Transplant (2001) 16: 879-882
© 2001 European Renal Association-European Dialysis and Transplant Association

Editorial Comments

Life and death in the kidney: prospects for future therapy

Jeremy Hughes

Phagocyte Laboratory, MRC Centre for Inflammation Research, University of Edinburgh Medical School, Teviot Place, Edinburgh, UK

Keywords: apoptosis; kidney; renal disease; renal therapy; survival/death signals

Introduction

Cells may die by two distinct mechanisms. In adverse biological circumstances, such as severe ischaemia, cells may undergo necrosis: an inherently pro-inflammatory form of cell death secondary to the spillage of phlogistic intracellular contents into the local microenvironment. In general, however, cells prefer to die by undergoing apoptosis. Apoptosis is characterized by stereotypical morphological and biochemical changes including the activation of intracellular proteolytic enzymes, termed caspases, which seal the fate of the cell by cleaving numerous nuclear and cytoplasmic targets [1]. Apoptosis results in specific cell surface changes, such as the exposure of phosphatidylserine, and leads to the rapid uptake and degradation of apoptotic cells by local resident or infiltrating phagocytes without the release of pro-inflammatory mediators [2]. Indeed, the ingestion of apoptotic cells by pro-inflammatory macrophages is a ‘deactivating’ stimulus and therefore the clearance of apoptotic ‘corpses’ by macrophages may well promote the downregulation of . . . [Full Text of this Article]

Apoptosis in the kidney

Beneficial apoptosis
Deleterious apoptosis
Life and death signals in the kidney

Survival signals
Death signals
Interventions to modulate renal cell apoptosis

Indirect inhibition of renal cell apoptosis

Anti-inflammatory treatment
Anti-proteinuria treatment
Anti-fibrotic treatment
Anti-ischaemia treatment
Direct inhibition of renal cell apoptosis

Inhibition of downstream caspase activation
Administration of growth factors that inhibit apoptosis by stimulation of intracellular survival pathways
Potential pitfalls

Conclusion

Acknowledgments

Notes

References


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