Renal functional reserve: From physiological phenomenon to clinical biomarker and beyond.

Renal functional reserve: From physiological phenomenon to clinical biomarker and beyond. Am J Physiol Regul Integr Comp Physiol. 2020 Oct 14;: Authors: Jufar AH, Lankadeva YR, May CN, Cochrane AD, Bellomo R, Evans RG Abstract Glomerular filtration rate (GFR) is acutely increased following a high protein meal or systemic infusion of amino acids. The mechanisms underlying this renal functional response remain to be fully elucidated. Nevertheless, they appear to culminate in pre-glomerular vasodilation. Inhibition of the tubuloglomerular feedback signal appears critical. However, nitric oxide, vasodilator prostaglandins, and glucagon also appear important. The increase in GFR during amino acid infusion reveals a 'renal reserve' which can be utilized when the physiological demand for single nephron GFR increases. This has led to the concept that in sub-clinical renal disease, before basal GFR begins to reduce, renal functional reserve can be recruited in a manner that preserves renal function. The extension of this concept is that, once a decline in basal GFR can be detected, renal disease is already well-progressed. This concept likely applies both in the contexts of chronic kidney disease and acute kidney injury. Critically, its corollary is that deficits in renal functional reserve have the potential to provide early detection of renal dysfunction, before basal GFR is reduced. There is growing evidence that the renal response to infu...
Source: American Journal of Physiology. Regulatory, Integrative and Comparative Physiology - Category: Physiology Authors: Tags: Am J Physiol Regul Integr Comp Physiol Source Type: research