Renal Interstitial Fibrosis: Mechanisms and Evaluation In: Current Opinion in Nephrology and Hypertension

• Type of Material: Article
• Authors: Alton B Farris III, Emory University; Robert B. Colvin, Harvard
• Language: English
• Date: 2012-05
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2012 Lippincott Williams & Wilkins, Inc.
• Final Published Version (URL): http://journals.lww.com/co-nephrolhypertens/pages/articleviewer.aspx?year=2012&issue=05000&article=00010&type=abstract
• Title of Journal or Parent Work: Current Opinion in Nephrology and Hypertension
• ISSN: 1062-4821
• Volume: 21
• Issue: 3
• Start Page: 289
• End Page: 300
• Grant/Funding Information: Prior work by the authors related to this publication has been supported by grants from the National Institutes of Health (U01-AI-63623, U01-AI-077816, U01-AI-070107).
• Keywords: kidney/renal fibrosis; epithelial/mesenchymal transition; myofibroblast; morphometry
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Pathology

Abstract

Purpose of Review Tubulointerstitial injury in the kidney is complex, involving a number of independent and overlapping cellular and molecular pathways, with renal interstitial fibrosis and tubular atrophy (IF/TA) as the final common pathway. Furthermore, there are multiple ways to assess IFTA. Recent findings Cells involved include tubular epithelial cells, fibroblasts, fibrocytes, myofibroblasts, monocyte/macrophages, and mast cells with complex and still incompletely characterized cell-molecular interactions. Molecular mediators involved are numerous and involve pathways such as transforming growth factor (TGF-β), bone morphogenic protein (BMP), platelet-derived growth factor (PDGF), and hepatocyte growth factor (HGF). Recent genomic approaches have shed insight into some of these cellular and molecular pathways. Pathologic evaluation of IFTA is central in assessing the severity of chronic disease; however, there are a variety of methods used to assess IFTA. Most assessment of IFTA relies on pathologist assessment of special stains such as trichrome, Sirius Red, and collagen III immunohistochemistry. Visual pathologist assessment can be prone to inter- and interobserver variability, but some methods employ computerized morphometery, without a clear consensus as to the best method. Summary IFTA results from on orchestration of cell types and molecular pathways. Opinions vary on the optimal qualitative and quantitative assessment of IFTA.