Abstract
Loss of redox homeostasis and formation of excessive free radicals play an important role in the pathogenesis of kidney disease and hypertension. Free radicals such as reactive oxygen species (ROS) are necessary in physiologic processes. However, loss of redox homeostasis contributes to proinflammatory and profibrotic pathways in the kidney, which in turn lead to reduced vascular compliance and proteinuria. The kidney is susceptible to the influence of various extracellular and intracellular cues, including the renin–angiotensin–aldosterone system (RAAS), hyperglycemia, lipid peroxidation, inflammatory cytokines, and growth factors. Redox control of kidney function is a dynamic process with reversible pro– and anti-free radical processes. The imbalance of redox homeostasis within the kidney is integral in hypertension and the progression of kidney disease. An emerging paradigm exists for renal redox contribution to hypertension. Antioxid. Redox Signal. 11, 2047–2089.
Introduction
Redox Control of Cellular Function: How Is It Achieved?
Free radical contribution to redox control of hypertension
Clinical contribution to redox control of hypertension
Prooxidant enzymes and pathways
NAD(P)H oxidase
Xanthine oxidase (XO)
Lipooxygenases (LOX) and cyclooxygenases (COX)
P450 monooxygenase and mitochondrial respiratory chain enzymes (I–IV)
Antioxidant enzymes and pathways
Role of ROS in physiologic processes
Pathologic Role of ROS in Hypertension
Non–RAAS-mediated oxidative stress in hypertension
High intravascular pressure
Shear stress
Lipids
Eicosanoids
High salt
Cigarette smoke
Insulin resistance/hyperinsulinemia
eNOS uncoupling
Dopaminergic system (DS)/sympathetic nervous system
Role of the RAAS in oxidative stress and hypertension
Ang II, ROS, and systemic hypertension
Ang II stimulation of NAD(P)H oxidase and hypertension
p22phox and hypertension
gp91phox (Nox2) and hypertension
p47phox and hypertension
p67phox and hypertension
p40phox and hypertension
Kidney Redox Function and Hypertension
ROS in normal kidney physiology
RAAS in the kidney
RAAS expression in developing and adult kidneys
RAAS-mediated redox mechanisms
Methods for detecting ROS in the laboratory and clinic
Nephron handling of ROS and hypertension: redox control of renal function
Redox control of kidney function
Tubuloglomerular feedback and role of ROS in macula densa
Medullary perfusion and renal hemodynamics
Pressure natriuresis
Tubular sodium transport
Renal sympathetic nerves
Nephron components and their contribution to ROS and hypertension
ROS in the glomeruli/podocytes
ROS and the glomerular basement membrane (GBM)
ROS and the mesangium
ROS and the tubule
NAD(P)H Oxidase Inhibition for the Treatment of Hypertension: Promises and Limitations
NAD(P)H oxidase–specific inhibitors
Apocynin
DPI
Neopterin/phenylarsine oxide
Phycobilins
gp91ds/gp91ds-tat
PR-39
VAS2870, SI7834, and AEBSF
siRNAs
Monoclonal antibodies
Nonspecific NAD(P)H oxidase inhibitors
PKC inhibitors
Antioxidants
Statins, ACE inhibitors/ARBs, and aldosterone antagonists
Future Perspectives/Conclusions