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Previous Volume 332:647-655 March 9, 1995 Number 10 Next

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In land mammals, a major task of the kidney is to reabsorb water to allow survival in a dry environment. Water conservation is enhanced by the renal medulla, which concentrates the urine to a level up to four times the osmolality of plasma. To produce this unique gradient of osmolality, the medulla has a countercurrent system of vessels and tubules that dictates active reabsorption of sodium in a milieu poor in oxygen (Figure 1).¹ In this review, we describe how hypoxia of the medulla may relate to susceptibility to acute and chronic renal injury.

View larger version (44K): [in this window] [in a new window]   Figure 1. Anatomical and Physiologic Features . . . [Full Text of this Article]

 
The Renal Medullary Concentrating Mechanism as the Physiologic Basis of Medullary Hypoxia

Adaptive Mechanisms to Minimize Medullary Hypoxia

Prostaglandins and Related Metabolites

Other Vasoactive Mediators

Adenosine

Tubuloglomerular Feedback

Growth Factors

Neuroendocrine and Other Protective Mechanisms

Experimental Amelioration and Exacerbation of Medullary Hypoxia

Synergy of Toxic and Hypoxic Insults in the Kidney

Diversity of Expression of Hypoxic Renal Injury

Cellular, Molecular, and Functional Alterations

Acute Morphologic Lesions in Tubules

            Distribution of Gradients of Hypoxia in the Kidney

            Structural Expression of Tubular Hypoxic Injury

Chronic Structural Lesions and Intrarenal Hypoxia

Clinical Implications of Medullary Hypoxic Injury

Additional Dangers to the Renal Medulla

Therapeutic Implications

Conclusions

Source Information

From the Department of Medicine, Hadassah University Hospital, Mount Scopus, Jerusalem, Israel (M.B.); and the Department of Pathology, Beth Israel Hospital and Harvard Medical School, Boston (S.R.).

Address reprint requests to Dr. Brezis at the Department of Medicine, Hadassah University Hospital, Mount Scopus, P.O. Box 24035, Jerusalem, Israel, 91240.

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