Oxidants and iron in progressive kidney disease.

Oxidants derived either from leukocytes in proliferative glomerulonephritis or from resident glomerular cells in nonproliferative glomerulonephritis have been shown to have several biological effects relevant to chronic kidney disease. These include the ability of oxidants to damage the glomerular basement membrane and directly induce proteinuria, effects that would lead to a fall in the glomerular filtration rate and account for the morphologic changes observed in chronic kidney disease. In experimental models, the role of oxidants has been shown in both proliferative glomerulonephritis (eg, antiglomerular basement membrane antibody disease) as well as experimental models of minimal change disease and membranous nephropathy. Oxidants have also been shown to be an important mediator of the various pathways that have been implicated in diabetic nephropathy. Antioxidants and iron chelators have also been shown to retard functional and morphologic changes observed in progressive kidney disease. Taken together, these experimental studies suggest an important role of oxidants in chronic kidney disease.