Role of growth factors in acute renal failure.

Abstract

Recovery from ischemic and nephrotoxic acute renal failure (ARF) requires the replacement of damaged tubular cells with new ones that restore the continuity of the renal epithelium. The repair process involves a number of growth factors produced in renal tissue that participate as autocrine or paracrine regulators in the repair process. The aim of this review is threefold: (1) to focus on the role of local growth factors such as EGF, TGF-alpha, IGF-1, HGF and TGF-beta in renal regeneration immediately after an acute renal insult. Receptors for these growth factors have been found in renal epithelial cells, medullary interstitial cells and glomeruli. These mediators play an important role in renal repair by promoting tubular cell proliferation. (2) A review the data supporting the administration of these growth factors in animal models of ARF, and the possibility of using these mediators in humans for the purpose of accelerating renal recovery and decreasing the morbidity and mortality rates, and the costs of multidisciplinary medical care, is presented. (3) Finally, the possibilities of introducing supportive therapy aimed at specific targets such as RGD peptides to reduce intratubular obstruction, atrial natriuretic factor to improve altered glomerular hemodynamics, and cell therapy such as bioartificial renal tubule in association with dialysis are discussed.