title: A hemodynamically mediated mechanism of renal disease progression in severe glomerulonephritides or nephrosis.
abstract: Glomerular endothelial cell (GEC) dysfunction due to oxidative stress and enhanced proinflammatory cytokines plays an important role in inducing proteinuria and procoagulant activity, namely blood hypercoagulability, hyperviscosity and local intravascular coagulation and altered hemorheology in NS. A dysfunctioning GEC releases fewer endothelium-dependent vasodilators but produces more vasoconstrictors. Severe intrarenal hemodynamic alteration associated with hemodynamic maladjustment with preferential constriction at the efferent arteriole has been uniquely implicated in severe GN and NS-FSGS. Such a constriction exerts three significant hemodynamic impacts. Proximal to the efferent arteriolar constriction, it induces (i) an overestimated GFR due to hyperfiltration and (ii) an elevated intraglomerular hydrostatic pressure. Distal to the efferent arteriolar constriction, it (iii) exaggeratedly reduces PTCF which correlates with the TIF.
authors.affiliation: Department of Pediatrics, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand. fmedpft@md.chula.ac.th
authors.forename: Prasit
authors.initials: P
authors.lastname: Futrakul
authors.forename: Prasong
authors.initials: P
authors.lastname: Siriviriyakul
authors.forename: Suthiluk
authors.initials: S
authors.lastname: Patumraj
authors.forename: Srichitra
authors.initials: S
authors.lastname: Bunnag
authors.forename: Ornanong
authors.initials: O
authors.lastname: Kulaputana
authors.forename: Narisa
authors.initials: N
authors.lastname: Futrakul
mesh_terms: D018450:Disease Progression; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005921:Glomerulonephritis / Q000188:drug therapy / Q000503:physiopathology*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007678:Kidney Glomerulus / Q000503:physiopathology / Q000648:ultrastructure; D008954:Models, Biological; D009399:Nephrons / Q000648:ultrastructure; D009401:Nephrosis / Q000188:drug therapy / Q000503:physiopathology*; D018384:Oxidative Stress; D014661:Vasoconstriction; D014664:Vasodilation; D014665:Vasodilator Agents / Q000627:therapeutic use; D014666:Vasomotor System / Q000503:physiopathology*
chemical_list: D014665:Vasodilator Agents