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Original ArticleOpen Access
Renal Perfusion and Disease Progression
Sensirivatana R 
,
Kingwatanakul P ,
Futrakul P
,
Kingwatanakul P ,
Futrakul P The pathogenetic concept of renal hyperperfusion and hyperfiltration in inducing glomerular
pathology and disease progression documented in the renal ablation model in experimental
animals to mimic renal disease with reduced nephron mass has recently been challenged. In contrast
to the above, the intrarenal hemodynamic study in a variety of chronic glomerulonephropathies
reveals a unique characteristic of renal hypoperfusion rather than hyperperfusion. This is
associated with an elevated renal arteriolar resistance and reductions in renal plasma flow and peritubular
capillary blood flow. The magnitude of reduction in peritubular capillary blood flow is
inversely proportional to the degree of tubulointerstitial disease and tubular dysfunction. A progressive
reduction in the vascular space due to nonvascular expansion with disease progression supports
the concept of hypoperfusion of a whole kidney as well as a single nephron. In accordance with the
renal ablation model and early diabetes mellitus, a similar hypoperfusion pattern is also subsequently
observed in the chronic stage of renal ablation model in animals and late diabetic nephropathy.
The disparity between the hyperperfusion and hypoperfusion in inducing renal disease progression
can be enlightened by the Noble Truth of Lord Buddha stating "The Middle Tract is The
Balance of Nature". Further support of this conceptual view of renal hypoperfusion as a determinant
of tubulointerstitial disease and disease progression is in accordance with the therapeutic
benefit with an enhanced-renal-perfusion formula per se in a variety of chronic glomerulonephropathies.
Key Word : Hemodynamics, Peritubular Capillary Blood Flow, Tubulointerstitial Disease
pathology and disease progression documented in the renal ablation model in experimental
animals to mimic renal disease with reduced nephron mass has recently been challenged. In contrast
to the above, the intrarenal hemodynamic study in a variety of chronic glomerulonephropathies
reveals a unique characteristic of renal hypoperfusion rather than hyperperfusion. This is
associated with an elevated renal arteriolar resistance and reductions in renal plasma flow and peritubular
capillary blood flow. The magnitude of reduction in peritubular capillary blood flow is
inversely proportional to the degree of tubulointerstitial disease and tubular dysfunction. A progressive
reduction in the vascular space due to nonvascular expansion with disease progression supports
the concept of hypoperfusion of a whole kidney as well as a single nephron. In accordance with the
renal ablation model and early diabetes mellitus, a similar hypoperfusion pattern is also subsequently
observed in the chronic stage of renal ablation model in animals and late diabetic nephropathy.
The disparity between the hyperperfusion and hypoperfusion in inducing renal disease progression
can be enlightened by the Noble Truth of Lord Buddha stating "The Middle Tract is The
Balance of Nature". Further support of this conceptual view of renal hypoperfusion as a determinant
of tubulointerstitial disease and disease progression is in accordance with the therapeutic
benefit with an enhanced-renal-perfusion formula per se in a variety of chronic glomerulonephropathies.
Key Word : Hemodynamics, Peritubular Capillary Blood Flow, Tubulointerstitial Disease
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