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Title: | Renal functional reserve: From physiological phenomenon to clinical biomarker and beyond. | Austin Authors: | Jufar, Alemayehu H;Lankadeva, Yugeesh R;May, Clive N;Cochrane, Andrew D;Bellomo, Rinaldo ;Evans, Roger G | Affiliation: | Intensive Care Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, Australia Department of Cardiothoracic Surgery, Monash Health and Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Melbourne, Victoria, Australia |
Issue Date: | Dec-2020 | Date: | 2020-10-14 | Publication information: | American Journal of Physiology. Regulatory, Integrative and Comparative Physiology 2020; 319(6): R690-R702 | 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 infusion of amino acids can be used to identify patients at risk of developing either chronic kidney disease or acute kidney injury and as a treatment target for acute kidney injury. However, large multicenter clinical trials are required to test these propositions. A renewed effort to understand the renal physiology underlying the response to amino acid infusion is also warranted. | URI: | https://ahro.austin.org.au/austinjspui/handle/1/25147 | DOI: | 10.1152/ajpregu.00237.2020 | Journal: | American Journal of Physiology. Regulatory, Integrative and Comparative Physiology | PubMed URL: | 33074016 | Type: | Journal Article | Subjects: | acute kidney injury amino acids chronic kidney disease glomerular filtration rate renal blood flow |
Appears in Collections: | Journal articles |
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