Cited by 214Chronic Kidney Disease and DiabetesRenal Diseases and GlomerulopathiesRenal and Vascular Pathologies

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Glomerular hyperfiltration

Cortinovis, Monica, Perico, Norberto, Ruggenenti, Piero, Remuzzi, Andrea, Remuzzi, Giuseppe·2022·Nature Reviews Nephrology

DOI 10.1038/s41581-022-00559-y

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Abstract

Circulating blood is filtered across the glomerular barrier to form an ultrafiltrate of plasma in the Bowman's space. The volume of glomerular filtration adjusted by time is defined as the glomerular filtration rate (GFR), and the total GFR is the sum of all single-nephron GFRs. Thus, when the single-nephron GFR is increased in the context of a normal number of functioning nephrons, single glomerular hyperfiltration results in 'absolute' hyperfiltration in the kidney. 'Absolute' hyperfiltration can occur in healthy people after high protein intake, during pregnancy and in patients with diabetes, obesity or autosomal-dominant polycystic kidney disease. When the number of functioning nephrons is reduced, single-nephron glomerular hyperfiltration can result in a GFR that is within or below the normal range. This 'relative' hyperfiltration can occur in patients with a congenitally reduced nephron number or with an acquired reduction in nephron mass consequent to surgery or kidney disease. Improved understanding of the mechanisms that underlie 'absolute' and 'relative' glomerular hyperfiltration in different clinical settings, and of whether and how the single-nephron haemodynamic and related biomechanical forces that underlie glomerular hyperfiltration promote glomerular injury, will pave the way toward the development of novel therapeutic interventions that attenuate glomerular hyperfiltration and potentially prevent or limit consequent progressive kidney injury and loss of function.

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Authors: Cortinovis, M., Perico, N., Ruggenenti, P., Remuzzi, A., & Remuzzi, G.
Affiliations: Mario Negri Institute for Pharmacological Research (IT)
University of Bergamo (IT)
Corresponding author: Remuzzi, Giuseppe
ORCID: Cortinovis, Monica
Perico, Norberto
Ruggenenti, Piero
Remuzzi, Andrea
Remuzzi, Giuseppe
Venue: Nature Reviews Nephrology
Publisher: Springer Science and Business Media LLC
Published: 2022-04-01
Volume: 18
Issue: 7
Pages: 435-451
ISSN: 1745-8323 (ISSN-L)
1759-5061
1759-507X
DOI: 10.1038/s41581-022-00559-y
OpenAlex: W4220773194
Cited by: 214
References: 264
Citations by year: 2026: 48 · 2025: 62 · 2024: 48 · 2023: 42 · 2022: 13
FWCI: 6.20
Type: journal article
Language: en
Open access: closed
Licence: www.springer.com/tdm (tdm)
www.springer.com/tdm (vor)
Locations: Nature Reviews Nephrology (publishedVersion)
PubMed (publishedVersion)
Aisberg (University of Bergamo) (submittedVersion)
Topics: Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
Health Sciences › Medicine › Nephrology › Renal Diseases and Glomerulopathies
Health Sciences › Medicine › Nephrology › Renal and Vascular Pathologies
Keywords: glomerular hyperfiltration, glomerular filtration rate, single nephron glomerular filtration rate, nephron number, glomerular injury, kidney injury, renal protection, protein intake, pregnancy, diabetes mellitus, obesity, polycystic kidney disease
MeSH terms: Female, Glomerular Filtration Rate, Humans, Kidney, Kidney Glomerulus, Nephrons, Pregnancy, Polycystic Kidney, Autosomal Dominant

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