title: Role of medullary blood flow in the pathogenesis of renal ischemia-reperfusion injury.
abstract: OBJECTIVE
  Renal ischemia-reperfusion injury (IRI) is a common cause of acute kidney injury (AKI). Alterations in renal medullary blood flow (MBF) contribute to the pathogenesis of renal IRI. Here we review recent insights into the mechanisms of altered MBF in the pathogenesis of IRI.
  
  
  RESULTS
  Although cortical blood flow fully recovers following 30-45  min of bilateral IRI, recent studies have indicated that there is a prolonged secondary fall in MBF that is associated with a long-term decline in renal function. Recent findings indicate that angiopoietin-1, atrial natriuretic peptide, heme oxygenase-1, and the gasotransmitters CO and H(2)S, may limit the severity of IRI by preserving MBF. Additional studies have also suggested a role for cytochrome P450-derived 20-HETE in the postischemic fall in MBF.
  
  
  CONCLUSIONS
  Impaired MBF contributes to the pathogenesis of renal IRI. Measurement of renal MBF provides valuable insight into the underlying mechanisms of many renoprotective pathways. Identification of molecules that preserve renal MBF in IRI may lead to new therapies for AKI.
authors.affiliation: Department of Medicine (Nephrology), Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Regner
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Roman
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology* / Q000517:prevention & control; D042683:Angiopoietin-1 / Q000378:metabolism; D000818:Animals; D009320:Atrial Natriuretic Factor / Q000378:metabolism; D002248:Carbon Monoxide / Q000378:metabolism; D051547:Heme Oxygenase-1 / Q000378:metabolism; D006801:Humans; D006862:Hydrogen Sulfide / Q000378:metabolism; D006893:Hydroxyeicosatetraenoic Acids / Q000378:metabolism; D007679:Kidney Medulla / Q000098:blood supply* / Q000378:metabolism; D012079:Renal Circulation; D015427:Reperfusion Injury / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology* / Q000517:prevention & control
chemical_list: D042683:Angiopoietin-1; D006893:Hydroxyeicosatetraenoic Acids; C055987:20-hydroxy-5,8,11,14-eicosatetraenoic acid; D002248:Carbon Monoxide; D009320:Atrial Natriuretic Factor; D051547:Heme Oxygenase-1; D006862:Hydrogen Sulfide
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