Renal Perfusion and Disease Progression

RAJANEE SENSIRIV AT ANA, M.D.*, PORNCHAI KINGWATANAKUL, M.D.*, PRASIT FUTRAKUL, M.D.*

Affiliation : * Department of Pediatrics, Faculty of Medicine, Chulalongkom University, Bangkok I 0330, Thailand.

AbstractThe pathogenetic concept of renal hyperperfusion and hyperfiltration in inducing glo- merular pathology and disease progression documented in the renal ablation model in experimental animals to mimic renal disease with reduced nephron mass has recently been challenged. In con- trast to the above, the intrarenal hemodynamic study in a variety of chronic glomerulonephro- pathies reveals a unique characteristic of renal hypoperfusion rather than hyperperfusion. This is associated with an elevated renal arteriolar resistance and reductions in renal plasma flow and peri- tubular capillary blood flow. The magnitude of reduction in peritubular capillary blood flow is inversely proportional to the degree of tubulointerstitial disease and tubular dysfunction. A progres- sive reduction in the vascular space due to nonvascular expansion with disease progression supports the concept of hypoperfusion of a whole kidney as well as a single nephron. In accordance with the renal ablation model and early diabetes mellitus, a similar hypoperfusion pattern is also sub- sequently observed in the chronic stage of renal ablation model in animals and late diabetic nephro- pathy. The disparity between the hyperperfusion and hypoperfusion in inducing renal disease pro- gression can be enlightened by the Noble Truth of Lord Buddha stating "The Middle Tract is The Balance of Nature". Further support of this conceptual view of renal hypoperfusion as a deter- minant of tubulointerstitial disease and disease progression is in accordance with the therapeutic benefit with an enhanced-renal-perfusion formula per se in a variety of chronic glomerulonephro- pathies.

Keywords : Hemodynamics, Peritubular Capillary Blood Flow, Tubulointerstitial Disease

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