Heterogeneous afferent arteriolopathy: a key concept for understanding blood pressure-dependent renal damage.

Autor: Kohagura K; Dialysis Unit, University of the Ryukyus Hospital, Okinawa, Japan. kohagura@med.u-ryukyu.ac.jp., Zamami R; Department of Cardiovascular Medicine, Nephrology and Neurology Faculty of Medicine, University of the Ryukyus, Okinawa, Japan., Oshiro N; Dialysis Unit, University of the Ryukyus Hospital, Okinawa, Japan.; Department of Cardiovascular Medicine, Nephrology and Neurology Faculty of Medicine, University of the Ryukyus, Okinawa, Japan., Shinzato Y; Department of Cardiovascular Medicine, Nephrology and Neurology Faculty of Medicine, University of the Ryukyus, Okinawa, Japan., Uesugi N; Department of Pathology, Fukuoka University School of Medicine, Fukuoka, Japan.
Jazyk: angličtina
Zdroj: Hypertension research : official journal of the Japanese Society of Hypertension [Hypertens Res] 2024 Dec; Vol. 47 (12), pp. 3383-3396. Date of Electronic Publication: 2024 Oct 08.
DOI: 10.1038/s41440-024-01916-z
Abstrakt: Hypertension, aging, and other factors are associated with arteriosclerosis and arteriolosclerosis, primary morphological features of nephrosclerosis. Although such pathological changes are not invariably linked with renal decline but are prevalent across chronic kidney disease (CKD), understanding kidney damage progression is more pragmatic than precisely diagnosing nephrosclerosis itself. Hyalinosis and medial thickening of the afferent arteriole, along with intimal thickening of small arteries, can disrupt the autoregulatory system, jeopardizing glomerular perfusion pressure given systemic blood pressure (BP) fluctuations. Consequently, such vascular lesions cause glomerular damage by inducing glomerular hypertension and ischemia at the single nephron level. Thus, the interaction between systemic BP and afferent arteriolopathy markedly influences BP-dependent renal damage progression in nephrosclerosis. Both dilated and narrowed types of afferent arteriolopathy coexist throughout the kidney, with varying proportions among patients. Therefore, optimizing antihypertensive therapy to target either glomerular hypertension or ischemia is imperative. In recent years, clinical trials have indicated that combining renin-angiotensin system inhibitors (RASis) and sodium-glucose transporter 2 inhibitors (SGLT2is) is superior to using RASis alone in slowing renal function decline, despite comparable reductions in albuminuria. The superior efficacy of SGLT2is may arise from their beneficial effects on both glomerular hypertension and renal ischemia. A comprehensive understanding of the interaction between systemic BP and heterogeneous afferent arteriolopathy is pivotal for optimizing therapy and mitigating renal decline in patients with CKD of any etiology. Therefore, in this comprehensive review, we explore the role of afferent arteriolopathy in BP-dependent renal damage.
Competing Interests: Compliance with ethical standards. Conflict of interest: KK received personal fees for lectures from AstraZeneca, Daiichi Sankyo, Mitsubishi Tanabe Pharma, Ono Pharma, Taisho Pharma, Otsuka Pharma, and Boehringer Ingelheim.
(© 2024. The Author(s).)
Databáze: MEDLINE
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