Renal Microcirculation Injury as the Main Cause of Ischemic Acute Kidney Injury Development
Acute kidney injury (AKI) can result from multiple factors. The main cause is reduced renal perfusion. Kidneys are susceptible to ischemia due to the anatomy of microcirculation that wraps around the renal tubules–peritubular capillary (PTC) network. Cortical and medullary superficial tubules have a...
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MDPI AG
2023-02-01
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| author | Ewa Kwiatkowska Sebastian Kwiatkowski Violetta Dziedziejko Izabela Tomasiewicz Leszek Domański |
| author_facet | Ewa Kwiatkowska Sebastian Kwiatkowski Violetta Dziedziejko Izabela Tomasiewicz Leszek Domański |
| author_sort | Ewa Kwiatkowska |
| collection | DOAJ |
| description | Acute kidney injury (AKI) can result from multiple factors. The main cause is reduced renal perfusion. Kidneys are susceptible to ischemia due to the anatomy of microcirculation that wraps around the renal tubules–peritubular capillary (PTC) network. Cortical and medullary superficial tubules have a large share in transport and require the supply of oxygen for ATP production, while it is the cortex that receives almost 100% of the blood flowing through the kidneys and the medulla only accounts for 5–10% of it. This difference makes the tubules present in the superficial layer of the medulla very susceptible to ischemia. Impaired blood flow causes damage to the endothelium, with an increase in its prothrombotic and pro-adhesive properties. This causes congestion in the microcirculation of the renal medulla. The next stage is the migration of pericytes with the disintegration of these vessels. The phenomenon of destruction of small vessels is called peritubular rarefaction, attributed as the main cause of further irreversible changes in the damaged kidney leading to the development of chronic kidney disease. In this article, we will present the characteristic structure of renal microcirculation, its regulation, and the mechanism of damage in acute ischemia, and we will try to find methods of prevention with particular emphasis on the inhibition of the renin–angiotensin–aldosterone system. |
| first_indexed | 2024-03-11T09:08:23Z |
| format | Article |
| id | doaj.art-d16fb4d9b9654b888ebef8f83d90a385 |
| institution | Directory Open Access Journal |
| issn | 2079-7737 |
| language | English |
| last_indexed | 2024-03-11T09:08:23Z |
| publishDate | 2023-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Biology |
| spelling | doaj.art-d16fb4d9b9654b888ebef8f83d90a3852023-11-16T19:14:53ZengMDPI AGBiology2079-77372023-02-0112232710.3390/biology12020327Renal Microcirculation Injury as the Main Cause of Ischemic Acute Kidney Injury DevelopmentEwa Kwiatkowska0Sebastian Kwiatkowski1Violetta Dziedziejko2Izabela Tomasiewicz3Leszek Domański4Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University in Szczecin, Powstańców Wlkp, 72, 70-204 Szczecin, PolandDepartment of Obstetrician and Gynecology, Pomeranian Medical University in Szczecin, Powstańców Wlkp, 72, 70-204 Szczecin, PolandDepartment of Biochemistry and Medical Chemistry, Pomeranian Medical University in Szczecin, Powstańców Wlkp, 72, 70-204 Szczecin, PolandDepartment of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University in Szczecin, Powstańców Wlkp, 72, 70-204 Szczecin, PolandDepartment of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University in Szczecin, Powstańców Wlkp, 72, 70-204 Szczecin, PolandAcute kidney injury (AKI) can result from multiple factors. The main cause is reduced renal perfusion. Kidneys are susceptible to ischemia due to the anatomy of microcirculation that wraps around the renal tubules–peritubular capillary (PTC) network. Cortical and medullary superficial tubules have a large share in transport and require the supply of oxygen for ATP production, while it is the cortex that receives almost 100% of the blood flowing through the kidneys and the medulla only accounts for 5–10% of it. This difference makes the tubules present in the superficial layer of the medulla very susceptible to ischemia. Impaired blood flow causes damage to the endothelium, with an increase in its prothrombotic and pro-adhesive properties. This causes congestion in the microcirculation of the renal medulla. The next stage is the migration of pericytes with the disintegration of these vessels. The phenomenon of destruction of small vessels is called peritubular rarefaction, attributed as the main cause of further irreversible changes in the damaged kidney leading to the development of chronic kidney disease. In this article, we will present the characteristic structure of renal microcirculation, its regulation, and the mechanism of damage in acute ischemia, and we will try to find methods of prevention with particular emphasis on the inhibition of the renin–angiotensin–aldosterone system.https://www.mdpi.com/2079-7737/12/2/327kidney microcirculationacute kidney injuryrenin–angiotensin–aldosterone system |
| spellingShingle | Ewa Kwiatkowska Sebastian Kwiatkowski Violetta Dziedziejko Izabela Tomasiewicz Leszek Domański Renal Microcirculation Injury as the Main Cause of Ischemic Acute Kidney Injury Development Biology kidney microcirculation acute kidney injury renin–angiotensin–aldosterone system |
| title | Renal Microcirculation Injury as the Main Cause of Ischemic Acute Kidney Injury Development |
| title_full | Renal Microcirculation Injury as the Main Cause of Ischemic Acute Kidney Injury Development |
| title_fullStr | Renal Microcirculation Injury as the Main Cause of Ischemic Acute Kidney Injury Development |
| title_full_unstemmed | Renal Microcirculation Injury as the Main Cause of Ischemic Acute Kidney Injury Development |
| title_short | Renal Microcirculation Injury as the Main Cause of Ischemic Acute Kidney Injury Development |
| title_sort | renal microcirculation injury as the main cause of ischemic acute kidney injury development |
| topic | kidney microcirculation acute kidney injury renin–angiotensin–aldosterone system |
| url | https://www.mdpi.com/2079-7737/12/2/327 |
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