Diet and kidney disease: the role of dietary fatty acids

Several general principles with respect to the role of the fatty acids in the progression of kidney disease have begun to emerge from the mass of observational detail. Interventions that increase renal exposure to prostaglandins of the E series appear to be beneficial. They include administration of prostaglandin analogues and dietary supplementation with their fatty acid precursor, linoleate. The beneficial effects may be attributed to preservation of renal blood flow and glomerular filtration, reduction in blood pressure, direct effects on the lipid composition and function of cell membranes, and immune suppression. Interventions that inhibit thromboxane and leukotriene production, such as omega-3 fatty acid supplementation of the diet or administration of enzyme or receptor inhibitors, are also protective. Prevention of vasoconstriction, inhibition of platelet activation, and regulation of cell proliferation and matrix production have all been implicated in the mediation of the observed retardation of sclerosis. Fish oil may have synergistic, suppressive effects on various parameters of immune activation. Essential fatty acid deficiency, of course, inhibits both prostaglandin E and thromboxane production, cancelling out the protective and injurious components of arachidonate oxidation. Yet, studies on its beneficial effects have revealed another aspect of eicosanoid metabolism, independent of cyclooxygenase and lipoxygenase activity, that appears to regulate monocyte migration into injured tissue. Dietary interruption of this pathway has proven protective to renal structure and function. Alterations in lipid metabolism may represent a common, mediating pathway of glomerular and interstitial susceptibility to progressive sclerosis in the kidney. The process appears to be amenable to manipulation by pharmacologic or dietary modulation of fatty acid metabolism. Eicosanoid metabolites and tissue-leukocyte signaling are two mechanisms by which lipid alterations can affect renal function. There are doubtless many others awaiting elucidation. Delineation of all the mechanisms whereby fatty acid metabolism can contribute to progressive kidney injury may provide a useful model for the examination of progressive sclerosis affecting other tissues subsequent to immune, vascular, or metabolic injury.