Glomerular microcirculation: Implications for diabetes, preeclampsia, and kidney injury

This review outlines the features of tandem regulation of glomerular microcirculation by autoregulatory mechanisms and intraglomerular redistribution of blood flow. Multiple points of cooperation exist between autoregulatory and distributional mechanisms. Mutual interactions between myogenic and tub...

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Bibliographic Details
Published in:Acta Physiologica 2023-11, Vol.239 (3), p.e14048-e14048
Main Author: Goligorsky, Michael S
Format: Article
Language:English
Subjects:
Angiotensin
Angiotensin II
Blood flow
Capillaries
Diabetes
Diabetes Mellitus
Female
Humans
Kidney - blood supply
Kidney - physiology
Kidney Diseases
Kidney Glomerulus
Kidneys
Mesangial cells
Microcirculation
Pre-Eclampsia
Preeclampsia
Pregnancy complications
Renal function
Renin
Sensory neurons
Signal transduction
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Summary:This review outlines the features of tandem regulation of glomerular microcirculation by autoregulatory mechanisms and intraglomerular redistribution of blood flow. Multiple points of cooperation exist between autoregulatory and distributional mechanisms. Mutual interactions between myogenic and tubuloglomerular feedback (TGF) mechanisms regulating the inflow are briefly discussed. In addition to this, TGF operation involving purinergic, autocoid, and NO signaling affects, however, not only afferent arteriolar tone, but mesangial cell tone as well. The latter reversibly reconfigures the distribution of blood flow between the shorter and longer pathways in the glomerular tuft. I advance a hypothesis that blood flow in these pathways spontaneously alternates, and mesangial cell tonicity serves as a rheostatic shift between them. Furthermore, humoral messengers from macula densa cells, themselves dependent on myogenic mechanisms, fine-tune the secretion of renin and, subsequently, the local, intrarenal generation of angiotensin II, which, in turn, provides additional vasomotor signaling to glomerular capillaries through changing the tone of mesangial cells. This complex regulatory network may partially explain the phenomenon of renal functional reserve, as well as suggest implications for changes in renal function during pregnancy, early diabetes mellitus, and acute kidney injury.
ISSN:1748-1708
1748-1716
1748-1716
DOI:10.1111/apha.14048