Glomerular repair: present status and future expectations.

This book covers much on mechanisms involved in glomerular damage which may lead to irreversible changes and loss of nephron function. The fact that these mechanisms have been elucidated is very important for the design of therapeutic options aiming at controlling and ameliorating tissue damage, thus delaying and, in some instances, completely stopping progression to end-stage renal disease, and facilitating repair. The ability of the body to maintain renal homeostasis indicates that a reservoir of cells should exist somewhere in the body to support normal turnover of glomerular cells but insufficient to adequately repair the damage in major glomerular damage. Although tubular cells can repopulate damaged tubules spontaneously after major injury, that is not the case with glomerular cells. Chronic progressive renal disease is characterized by glomerulosclerosis, interstitial inflammation, tubular damage and interstitial fibrosis. If the adaptive capacity of the cells present in a particular renal compartment is exceeded, the injurious agent/reaction produces irreversible damage leading to cell death which may be by apoptosis or necrosis. Lost cells need to be restored and the extracellular matrix scaffold must be remodeled to its original form. This chapter will recapitulate what is known about glomerular healing and repair. The field is evolving and changing rapidly.