Ischemic renal diseases: New insights into old entities

Abstract

Vascular nephropathies are a steadily increasing cause of end-stage renal failure. Arterionephrosclerosis and arteriolonephrosclerosis are common features in the hypertensive patient. This is especially true for blacks of African descent, in whom hypertension and nephrovasculopathies are a major cause of renal insufficiency. That primary hypertension leads to renal vascular lesions, glomerular obsolescence and interstitial fibrosis has long been established. It should not, however, obscure the fact that renal vascular lesions can be observed in animal models as well as in some humans, especially young blacks, in the absence of, or anticipating the onset of hypertension. This leads to considering the hypothesis that nephroangiosclerosis might stem from a genetic defect in the renal vascular bed and that this defect is strongly associated with the hypertensive trait. Atherosclerotic renal disease is a major, potentially treatable cause of chronic renal disease is a major, potentially treatable cause of chronic renal failure, especially in whites. It leads to renal atrophy, but the ischemic kidney retains a vigorous potential for tubular cell regeneration, which pleads for early recognition and treatment. Recent data suggest that renal ischemia, be it due to renal artery stenosis or to cholesterol crystal embolism, ranks among the multiple causes of secondary focal segmental glomerulosclerosis. Irrespective of its initial mechanism, ischemia induces renal fibrosis, the pathophysiology of which is centered on increased generation of angiotensin II. Finally, renal vascular lesions are commonly observed in the course of various nephropathies, even in the absence of hypertension, and the relationship between these lesions and the unfavorable prognosis of glomerulopathies, especially primary focal-segmental glomerulosclerosis, membranous glomerulopathy and IgA glomerulonephritis, remains to be elucidated. Expanding knowledge of the spectrum of nephrovasculopathies opens perspectives for investigating, understanding and treating a major mechanism of progressive renal insufficiency.

Detection of acute renal ischemia in swine using blood oxygen level‐dependent magnetic resonance imaging

“…When renal ischemia is prolonged, loss of renal function occurs due to cellular injury and death (2)(3)(4). Patients with renal ischemia are asymptomatic initially until there has been enough parenchymal damage to cause an elevation in creatinine.…”

Renovascular Hypertension: A Unique Cause of Unilateral Focal Segmental Glomerulosclerosis

“…Two mechanisms have been proposed for the development of FSGS in patients with renovasculopathies. While hyperfiltration-induced FSGS is the most well-established mechanism, Meyrier et al (5) suggested that ischemia is another possible contributor to the development of FSGS. In our patient, the poststenotic kidney showed normal glomeruli, suggesting that ischemia per se and the local activation of renin-angiotensin were insufficient factors to cause FSGS, and that protection from hyperfiltration was provided by the presence of high-grade stenosis.…”

Renal Dysfunction in Liver Transplant Candidates: Evaluation, Classification and Management in Contemporary Practice

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