Document Detail

Pathogenesis of acute renal failure: new aspects.
MedLine Citation:
PMID:  9200403     Owner:  NLM     Status:  MEDLINE    
Based on 2 case presentations - acute renal failure (ARF) due to myeloma kidney and due to angiotensin-converting enzyme inhibitor administration in the presence of transplant artery stenosis - new aspects in the pathogenesis of ARF are presented and discussed. The multifactorial pathogenesis of ARF includes (a) a disturbance of glomerular microcirculation (afferent and perhaps mesangial constriction, inadequate efferent dilatation); (b) a disturbance of medullary microcirculation (medullary capillary congestion) attributed to a combination of endothelial damage and tubular dilatation; (c) tubular cell damage which, though rarely in humans justifying the term 'acute tubular necrosis', promotes both backleak of glomerular filtrate and shedding of brush border vesicles; (d) the latter promotes tubular obstruction by casts which consist of Tamm-Horsfall protein and brush border components. Once ARF is established, repair processes set in which appear to depend on growth factors such as epidermal growth factor and insulin-like growth factor 1, of which there is a relative shortage in established ARF. Experimental therapeutic approaches focus on the restitution of microcirculation (endothelin receptor antagonists, atriopeptins), interference with cast formation (integrin receptor blockers), and the promotion of recovery by growth factors.
H A Bock
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Nephron     Volume:  76     ISSN:  0028-2766     ISO Abbreviation:  Nephron     Publication Date:  1997  
Date Detail:
Created Date:  1997-08-22     Completed Date:  1997-08-22     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0331777     Medline TA:  Nephron     Country:  SWITZERLAND    
Other Details:
Languages:  eng     Pagination:  130-42     Citation Subset:  IM    
Division of Nephrology, Kantonsspital, Basel, Switzerland.
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MeSH Terms
Angioplasty, Balloon
Angiotensin-Converting Enzyme Inhibitors / adverse effects*
Antineoplastic Agents / therapeutic use
Arteriosclerosis / complications*,  therapy
Enalapril / adverse effects*
Glomerular Filtration Rate
Kidney / physiopathology
Kidney Failure, Acute / etiology*,  physiopathology*
Kidney Glomerulus / blood supply
Kidney Neoplasms / complications*,  drug therapy,  physiopathology
Kidney Transplantation*
Multiple Myeloma / complications*,  drug therapy,  physiopathology
Postoperative Complications
Renal Circulation
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Antineoplastic Agents; 75847-73-3/Enalapril

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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