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Kidney ischemic preconditioning
1Medical Services, Massachusetts General Hospital, Charlestown, MA 02129, USA. joseph_bonventre@hms.harvard.edu
Abstract:
Ischemic injury to the kidney is associated with high morbidity and mortality. Improving the ability of the kidney to tolerate ischemic injury would have important implications. A significant amount of data now exists to suggest that there may be intrinsic mechanisms brought to bear by the kidney when exposed to a toxic or ischemic insult, which protect it against a subsequent exposure to ischemia. While it is frequently stated that this phenomenon, termed ischemic preconditioning, was first described in the heart, in fact there is almost a century of literature on the kidney that supports the concept that prior injury protects against a second insult. The protective effect of preconditioning is greater than most reported protective effects with pharmacological interventions in animals. There is compelling evidence in other organs that preconditioning occurs in humans. It therefore behooves us to understand the endogenous processes that the kidney has developed to protect itself against an ischemic insult. Armed with this understanding we can then attempt to mimic these processes and thereby prevent and treat ischemic acute renal failure.
Insights
Kidneys possess natural protective mechanisms against ischemic injury, a phenomenon known as ischemic preconditioning. Understanding these intrinsic kidney processes can help prevent and treat acute renal failure.
Area of Science:
- Nephrology
- Renal Physiology
- Ischemic Injury
Background:
- Kidney ischemic injury leads to significant morbidity and mortality.
- Intrinsic kidney mechanisms may protect against subsequent ischemic insults.
- Ischemic preconditioning, though often attributed to the heart, has a long history in renal literature.
Purpose of the Study:
- To explore the endogenous protective mechanisms of the kidney against ischemic injury.
- To understand the phenomenon of ischemic preconditioning in the kidney.
- To lay the groundwork for mimicking these processes to treat ischemic acute renal failure.
Main Methods:
- Review of existing scientific literature on ischemic preconditioning in the kidney.
- Analysis of data suggesting intrinsic protective mechanisms in response to ischemic or toxic insults.
- Comparison of preconditioning effects with pharmacological interventions.
Main Results:
- Evidence suggests prior kidney injury can protect against a second ischemic insult.
- The protective effects of ischemic preconditioning in the kidney appear substantial.
- Preconditioning is observed in other organs and likely occurs in humans.
Conclusions:
- The kidney has evolved endogenous processes to protect itself from ischemic damage.
- Further understanding of these mechanisms is crucial for developing treatments.
- Mimicking these natural protective processes holds promise for preventing and treating acute renal failure.