Smoking has been recognized as an independent risk factor for CKD, and smoking might result in intraglomerular hypertension, vascular damage, or glomerulosclerosis via multiple complex interactions of nonhemodynamic (angiotensin II, transforming growth factor-[beta]1, endothelin-1) and hemodynamic factors (Orth and Hallan 2008).
Caption: FIGURE 1: ((a), (b)) Unremarkable glomeruli with acute tubular injury with scattered inflammatory cells and intratubular granular-pigmented cast and (c) Prussian blue stain highlighting the intratubular and intraglomerular pigmented cast.
These results provide confirmatory evidence that ACE inhibitors are able to prevent the intraglomerular vascular action that resulted from renal hypertension and glomerular hyperfiltration more effectively than other antihypertensives .
An interesting study using computer-aided reconstruction of three-dimensional images in patients with diabetic nephropathy demonstrated that these abnormal vessels are anastomosed to lobular structure of the intraglomerular capillary network and that the distal end of the vessels is anastomosed to the peritubular capillary .
Another possible mechanism is the hemodynamic effect of ET-1, which in conjunction with other vasoactive factors lead to an increase in intraglomerular capillary pressure which increases glomerular permeability and thus leads to increased filtration of proteins [18, 19].
Entre las hipotesis que explicarian tal proteinuria se describe el aumento de la filtracion glomerular, la alteracion de la presion intraglomerular con dano de la barrera glomerular y la reduccion de la reabsorcion tubular (7).