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Review
. 2019 Dec 12:12:257-262.
doi: 10.2147/IJNRD.S216673. eCollection 2019.

The Importance of Tubular Function in Chronic Kidney Disease

Maria A Risso  1 , Sofía Sallustio  1 , Valentin Sueiro  1 , Victoria Bertoni  1 , Henry Gonzalez-Torres  2   3 , Carlos G Musso  1   2
Affiliations
Review

The Importance of Tubular Function in Chronic Kidney Disease

Maria A Risso et al. Int J Nephrol Renovasc Dis. .

Abstract

Glomerular filtration rate (GFR) and proteinuria-albuminuria are the renal functional parameters currently used to evaluate chronic kidney disease (CKD) severity. However, tubular secretion is another important renal functional parameter to be taken into account since proximal tubule (PT) secretion, in particular, is a crucial renal mechanism for endogenous organic cations, anions and drug elimination. The residual diuresis is a relevant survival predictor in patients on dialysis, since their urine is produced by the glomerular and tubular functions. It has been hypothesized that drugs which up-regulate some renal tubular transporters could contribute to uremic toxin excretion, and nephroprevention. However, if tubular transporters' down-regulation observed in CKD patients and experimental models is a PT adaptation to avoid intracellular accumulation and damage from uremic toxins, consequently the increase of toxin removal by inducing tubular transporters' up-regulation could be deleterious to the kidney. Therefore, a deeper understanding of this phenomenon is currently needed. In conclusion, tubular function has an important role for endogenous organic cations, anions and drug excretion in CKD patients, and a deeper understanding of its multiple mechanisms could provide new therapeutic alternatives in this population.

Keywords: chronic kidney disease; drugs; tubular function.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Organic cation/anion/zwitterion solute carrier family (protein; gene).
See this image and copyright information in PMC

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