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Correspondence
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Volume 357:2204-2206 November 22, 2007 Number 21
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Normotensive Ischemic Acute Renal Failure

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by Chobanian, A. V.
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by Abuelo, J. G.
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To the Editor: In his review of normotensive ischemic acute renal failure (Aug. 23 issue),1 Abuelo mainly emphasizes altered glomerular hemodynamics and a reduced glomerular filtration rate in the pathogenesis of normotensive ischemic acute renal failure. However, most often, primary hypoxic or toxic tubular injury initiates upstream tubuloglomerular feedback mechanisms that lead to altered glomerular hemodynamics and to secondary reduction of the glomerular filtration rate. Tubular oxygenation and viability depend on these regulatory mechanisms, which control and match both regional supply and consumption of oxygen for tubular transport.2 These regulatory mechanisms are altered by nephrotoxins such as nonsteroidal antiinflammatory drugs . . . [Full Text of this Article]



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