title: Tubulointerstitial injury and the progression of chronic kidney disease.
abstract: In chronic kidney disease (CKD), once injury from any number of disease processes reaches a threshold, there follows an apparently irreversible course toward decline in kidney function. The tubulointerstitium may play a key role in this common progression pathway. Direct injury, high metabolic demands, or stimuli from various other forms of renal dysfunction activate tubular cells. These, in turn, interact with interstitial tissue elements and inflammatory cells, causing further pathologic changes in the renal parenchyma. The tissue response to these changes thus generates a feed-forward loop of kidney injury and progressive loss of function. This article reviews the mechanisms of this negative cycle mediating CKD.
authors.affiliation: Division of Kidney Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine and Children's Memorial Hospital, Chicago, IL, USA. khodgkins@childrensmemorial.org
authors.forename: Kavita S
authors.initials: KS
authors.lastname: Hodgkins
authors.forename: H William
authors.initials: HW
authors.lastname: Schnaper
mesh_terms: D002450:Cell Communication; D002908:Chronic Disease; D018450:Disease Progression; D025461:Feedback, Physiological; D005355:Fibrosis; D006801:Humans; D007674:Kidney Diseases / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology; D007684:Kidney Tubules / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology; D009395:Nephritis, Interstitial / Q000378:metabolism / Q000473:pathology*; D015398:Signal Transduction