Renal Autoregulation in Health and Disease
Open accessAbstract
Intrarenal autoregulatory mechanisms maintain renal blood flow (RBF) and glomerular filtration rate (GFR) independent of renal perfusion pressure (RPP) over a defined range (80–180 mmHg). Such autoregulation is mediated largely by the myogenic and the macula densa-tubuloglomerular feedback (MD-TGF) responses that regulate preglomerular vasomotor tone primarily of the afferent arteriole. Differences in response times allow separation of these mechanisms in the time and frequency domains. Mechanotransduction initiating the myogenic response requires a sensing mechanism activated by stretch of vascular smooth muscle cells (VSMCs) and coupled to intracellular signaling pathways eliciting plasma membrane depolarization and a rise in cytosolic free calcium concentration ([Ca 2+ ] i ). Proposed mechanosensors include epithelial sodium channels (ENaC), integrins, and/or transient receptor potential (TRP) channels. Increased [Ca 2+ ] i occurs predominantly by Ca 2+ influx through L-type voltage-operated Ca 2+ channels (VOCC). Increased [Ca 2+ ] i activates inositol trisphosphate receptors (IP 3 R) and ryanodine receptors (RyR) to mobilize Ca 2+ from sarcoplasmic reticular stores. Myogenic vasoconstriction is sustained by increased Ca 2+ sensitivity, mediated by protein kinase C and Rho/Rho-kinase that favors a positive balance between myosin light-chain kinase and phosphatase. Increased RPP activates MD-TGF by transducing a signal of epithelial MD salt reabsorption to adjust afferent arteriolar vasoconstriction. A combination of vascular and tubular mechanisms, novel to the kidney, provides for high autoregulatory efficiency that maintains RBF and GFR, stabilizes sodium excretion, and buffers transmission of RPP to sensitive glomerular capillaries, thereby protecting against hypertensive barotrauma. A unique aspect of the myogenic response in the renal vasculature is modulation of its strength and speed by the MD-TGF and by a connecting tubule glomerular feedback (CT-GF) mechanism. Reactive oxygen species and nitric oxide are modulators of myogenic and MD-TGF mechanisms. Attenuated renal autoregulation contributes to renal damage in many, but not all, models of renal, diabetic, and hypertensive diseases. This review provides a summary of our current knowledge regarding underlying mechanisms enabling renal autoregulation in health and disease and methods used for its study.
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Multiple factors could contribute to renal vasodilation in obesity, including compression of the renal tubules, hyperglycaemia, high protein intake, hyperinsulinaemia and increased blood pressure combined with impaired renal autoregulation.
“Multiple factors could contribute to renal vasodilation in obesity, including compression of the renal tubules, hyperglycaemia, high protein intake, hyperinsulinaemia and increased BP combined with impaired renal autoregulation6,43,44.”
From Obesity, kidney dysfunction and hypertension: mechanistic links (2019) · cites this paper as [43]
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Genetic susceptibility of hypertension‐induced kidney disease
Zhang, C., Fang, X., Zhang, H., Gao, W., Hsu, H. J., Roman, R. J., & Fan, F. (2020) · Physiological Reports · doi:10.14814/phy2.14688 · Cited by 34 · see citing works
Li, L., Lai, E. Y., Wellstein, A., Welch, W. J., & Wilcox, C. S. (2016) · American Journal of Physiology-Renal Physiology · doi:10.1152/ajprenal.00575.2015 · Cited by 34 · see citing works
Self-citation
- Authors
- Carlström, M., Wilcox, C. S., & Arendshorst, W. J.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Venue
- Physiological Reviews
- Publisher
- American Physiological Society
- Published
- 2015-04
- Volume
- 95
- Issue
- 2
- Pages
- 405-511
- ISSN
- 0031-9333 (ISSN-L)
- 1522-1210
- PMC
- PMC4551215
- OpenAlex
- W2078902399
- Cited by
- 485
- References
- 1,700
- Citations by year
- 2026: 44 · 2025: 40 · 2024: 40 · 2023: 47 · 2022: 41 · 2021: 37 · 2020: 41 · 2019: 53 · 2018: 50 · 2017: 51 · 2016: 31 · 2015: 9 · 2014: 1
- FWCI
- 8.11
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Physiological Reviews (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HL‐68686, P01HL068686, R01HL002334, HL 02334)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK109272, DK-049870, DK-036079, R01DK049870)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Renal and Vascular Pathologies
- Keywords
- renal autoregulation, renal blood flow, glomerular filtration rate, myogenic response, tubuloglomerular feedback, macula densa, afferent arteriole, mechanotransduction, calcium signaling, ryanodine receptor, protein kinase C, Rho/ROCK signaling, myosin light chain kinase, reactive oxygen species, nitric oxide, kidney disease
- MeSH terms
- Animals, Diabetic Nephropathies, Glomerular Filtration Rate, Homeostasis, Humans, Hypertension, Kidney, Muscle, Smooth, Vascular, Renal Artery, Renal Circulation, Vasoconstriction, Calcium Channels, Calcium Signaling, Mechanotransduction, Cellular
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