Thick Ascending Limb Sodium Transport in the Pathogenesis of Hypertension

Agustin Gonzalez-Vicente, Fara Saez, Casandra M. Monzon, Jessica Asirwatham, Jeffrey L. Garvin

Research output: Contribution to journalArticle

Abstract

The thick ascending limb plays a key role in maintaining water and electrolyte balance. The importance of this segment in regulating blood pressure is evidenced by the effect of loop diuretics or local genetic defects on this parameter. Hormones and factors produced by thick ascending limbs have both autocrine and paracrine effects, which can extend prohypertensive signaling to other structures of the nephron. In this review, we discuss the role of the thick ascending limb in the development of hypertension, not as a sole participant, but one that works within the rich biological context of the renal medulla. We first provide an overview of the basic physiology of the segment and the anatomical considerations necessary to understand its relationship with other renal structures. We explore the physiopathological changes in thick ascending limbs occurring in both genetic and induced animal models of hypertension. We then discuss the racial differences and genetic defects that affect blood pressure in humans through changes in thick ascending limb transport rates. Throughout the text, we scrutinize methodologies and discuss the limitations of research techniques that, when overlooked, can lead investigators to make erroneous conclusions. Thus, in addition to advancing an understanding of the basic mechanisms of physiology, the ultimate goal of this work is to understand our research tools, to make better use of them, and to contextualize research data. Future advances in renal hypertension research will require not only collection of new experimental data, but also integration of our current knowledge.

LanguageEnglish (US)
Pages235-309
Number of pages75
JournalPhysiological reviews
Volume99
Issue number1
DOIs
StatePublished - Jan 1 2019

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Extremities
Sodium
Hypertension
Research
Blood Pressure
Sodium Potassium Chloride Symporter Inhibitors
Kidney
Renal Hypertension
Water-Electrolyte Balance
Nephrons
Research Design
Animal Models
Research Personnel
Hormones

ASJC Scopus subject areas

  • Physiology
  • Molecular Biology
  • Physiology (medical)

Cite this

Thick Ascending Limb Sodium Transport in the Pathogenesis of Hypertension. / Gonzalez-Vicente, Agustin; Saez, Fara; Monzon, Casandra M.; Asirwatham, Jessica; Garvin, Jeffrey L.

In: Physiological reviews, Vol. 99, No. 1, 01.01.2019, p. 235-309.

Research output: Contribution to journalArticle

Gonzalez-Vicente, Agustin ; Saez, Fara ; Monzon, Casandra M. ; Asirwatham, Jessica ; Garvin, Jeffrey L. / Thick Ascending Limb Sodium Transport in the Pathogenesis of Hypertension. In: Physiological reviews. 2019 ; Vol. 99, No. 1. pp. 235-309.
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