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The Importance of Tubular Function in Chronic Kidney Disease

Authors Risso MA, Sallustio S, Sueiro V, Bertoni V, Gonzalez-Torres H, Musso CG

Received 22 May 2019

Accepted for publication 2 December 2019

Published 12 December 2019 Volume 2019:12 Pages 257—262


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Pravin Singhal

Maria A Risso,1 Sofía Sallustio,1 Valentin Sueiro,1 Victoria Bertoni,1 Henry Gonzalez-Torres,2,3 Carlos G Musso1,2

1Human Physiology Department, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 2Facultad de Ciencias de la Salud, Universidad Simon Bolivar, Barranquilla, Colombia; 3Ciencias Biomédicas, Universidad del Valle, Cali, Colombia

Correspondence: Carlos G Musso
Human Physiology Department, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

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: tubular function, chronic kidney disease, drugs

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