NYMC Faculty Publications
Glomerular microcirculation: Implications for diabetes, preeclampsia, and kidney injury
Author Type(s)
Faculty
DOI
10.1111/apha.14048
Journal Title
Acta Physiologica
First Page
e14048
Document Type
Article
Publication Date
11-1-2023
Department
Medicine
Abstract
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.
Recommended Citation
Goligorsky, M. S. (2023). Glomerular microcirculation: Implications for diabetes, preeclampsia, and kidney injury. Acta Physiologica, 239 (3), e14048. https://doi.org/10.1111/apha.14048