La sabiduría del riñón III. La adaptación de la función renal a su daño progresivo. Hipótesis de la nefrona intacta

Abstract

In this article, we present and analyzed the Intact Nephron Hypothesis that explains in part the great capacity of the diseased kidney, that after the destruction of thousands of nephrons and the loss of more than 80% of the renal function, the adaptive changes of the renal function were sufficient to maintain the body homeostasis with mild clinical symptoms. This saga began with the paper published by the eminent pathologist Jean Oliver “When is the kidney not a kidney”. In this article, Dr. Oliver states: “The answer I will give in (this) question is, therefore, now apparent. There is no kidney, either structural or functional, in chronic kidney disease”. Even though the loss of structural homogeneity, necessarily destroys the functional homogeneity. Dr. Bricker and other investigators believe that in the usual forms of chronic renal failure, a basic orderliness is conserved in the urine-forming nephrons. They studied the renal function with clearance methods in different models of kidney lesions in humans and animals, such as unilateral renal disease with one intact kidney, 5/6 nephrectomy, and induced Heyman’s nephritis and other models. These studies demonstrated that the intact nephrons, maintained the sodium balance, the control of calcium and phosphorus equilibrium with the so-called “Trade-off hypothesis”. The excretion of hydrogen and ammonium to maintain the acid-base balance. The potassium excretion and the concentration mechanism of the urine and other functions. The results of all these investigations are derived from the “Intact Nephron hypothesis” that explains the great adaptive functional capacity of the kidney