Glomerular pathology and the progression of chronic kidney disease.
Structural studies of the glomerulus, largely undertaken in animal models, have informed our understanding of the progression of chronic kidney disease (CKD) for decades. A fundamental tenet of that understanding is that a loss of podocytes underlies progression in many or most cases of progressive CKD. Recent attempts have been made to reconcile earlier findings from glomerular physiology (the primacy of glomerular capillary hypertension in causation of secondary glomerular sclerosis) with structural findings and have suggested a more detailed model of the mechanisms underlying podocyte detachment as viable cells. A new appreciation of the main locus of mechanical challenges to the podocyte (in the filtration slit) may both explain the renoprotective action of some current therapies and help to suggest novel therapeutic strategies.
Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California; and Division of Nephrology, Children's Hospital Los Angeles, Los Angeles, California klemley@chla.usc.edu.
Kevin V
0000-0001-8342-5458
KV
Lemley
D000818:Animals; D004195:Disease Models, Animal; D018450:Disease Progression; D006801:Humans; D007678:Kidney Glomerulus / Q000473:pathology*; D050199:Podocytes / Q000473:pathology*; D051436:Renal Insufficiency, Chronic / Q000473:pathology*
glomerular sclerosis; podocyte; ultrafiltration coefficient