Atrial natriuretic factor: a protective role after acute renal ischemia? Is there room for it in kidney transplantation?

Because of the deleterious effects of acute tubular necrosis (ATN) after kidney transplantation, the search for new and effective means of protecting the kidneys from ischemic or nephrotoxic injuries continues. The beneficial effects of hyperhydration with mannitol or furosemide infusions in renal allograft recipients have now been well documented. The recent discovery by De Bold and coworkers that hypervolemia (by atrial distension) induces the release of atrial natriuretic factor (ANF) suggests an important physiopathological, and perhaps therapeutic, role for this natriuretic peptide in kidney transplantation. In addition to providing an overview of the current knowledge about ANF and its effects on both intact and ischemically injured kidneys, the physiological role of ANF in various situations, similar to those found in kidney transplantation, is analyzed. The effects of ANF on arachidonic acid metabolites and on the nephrotoxic side effects of cyclosporin are also reported. If the results of the preliminary experimental studies appear to be effective, further prospective clinical trails must be carried out to confirm them.