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Restoring the renal microvasculature to treat chronic kidney disease

Nature Reviews Nephrology volume 8, pages 244–250 (2012)Cite this article

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Abstract

Chronic kidney disease is characterized by progressive loss of the renal microvasculature, which leads to local areas of hypoxia and induction of profibrotic responses, scarring and deterioration of renal function. Revascularization alone might be sufficient to restore kidney function and regenerate the structure of the diseased kidney. For revascularization to be successful, however, the underlying disease process needs to be halted or alleviated and there must remain a sufficient number of surviving nephron units that can serve as a scaffold for kidney regeneration. This Perspectives article describes how revascularization might be achieved using vascular growth factors or adoptive transfer of endothelial progenitor cells and provides a brief outline of the studies performed to date. An overview of how therapeutic strategies targeting the microvasculature could be enhanced in the future is also presented.

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Figure 1: Therapeutic strategies that target the microvasculature in chronic kidney disease.
Figure 2: Disruption of the angiogenic balance in CKD.
Figure 3: The microarchitecture of a diseased kidney from a patient with terminal hemorrhagic Bright's disease of 2 years duration.

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Acknowledgements

This work was supported by a Kidney Research UK Senior Non-Clinical Fellowship and a Medical Research Council New Investigator Award to D. A. Long and research support for L. G. Fine from Cedars-Sinai Medical Center.

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Authors and Affiliations

  1. Nephro-Urology Unit, UCL Institute of Child Health, 30 Guilford Street, WC1N 1EH, London, UK

    David A. Long

  2. UCL Centre of Nephrology, UCL Medical School Royal Free Campus, Rowland Hill, NW3 2PF, London, UK

    Jill T. Norman

  3. Department of Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, 90048, CA, USA

    Leon G. Fine

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Correspondence to David A. Long.

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Long, D., Norman, J. & Fine, L. Restoring the renal microvasculature to treat chronic kidney disease. Nat Rev Nephrol 8, 244–250 (2012). https://doi.org/10.1038/nrneph.2011.219

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