The Importance of Tubular Function in Chronic Kidney Disease
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Fecha
2019
Autores
Risso, Maria A
Sallustio, Sofía
Sueiro, Valentin
Bertoni, Victoria
Gonzalez Torres, Henry
Musso, Carlos G
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Editor
Dove Press
Resumen
Glomerular filtration rate (GFR) and proteinuria-albuminuria are the renal functional
parameters currently used to evaluate chronic kidney disease (CKD) severity.
However, tubular secretion is another important renal functional parameter to be taken into
account since proximal tubule (PT) secretion, in particular, is a crucial renal mechanism for
endogenous organic cations, anions and drug elimination. The residual diuresis is a relevant
survival predictor in patients on dialysis, since their urine is produced by the glomerular and
tubular functions. It has been hypothesized that drugs which up-regulate some renal tubular
transporters could contribute to uremic toxin excretion, and nephroprevention. However, if
tubular transporters' down-regulation observed in CKD patients and experimental models is
a PT adaptation to avoid intracellular accumulation and damage from uremic toxins, consequently
the increase of toxin removal by inducing tubular transporters' up-regulation could be
deleterious to the kidney. Therefore, a deeper understanding of this phenomenon is currently
needed. In conclusion, tubular function has an important role for endogenous organic cations,
anions and drug excretion in CKD patients, and a deeper understanding of its multiple
mechanisms could provide new therapeutic alternatives in this population.
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Palabras clave
Tubular function, Chronic kidney disease, Drugs