Future mechanisms of reversing kidney injury

The search for effective strategies to protect the stenotic kidney or to facilitate recovery of kidney function has been the holy grail of the field of renal vascular disease and renovascular hypertension. Over the past few years, a number of novel interventions have been applied in an attempt to blunt and reverse functional and structural kidney remodeling distal to renal artery stenosis. Many of these interventions were designed to target specific deleterious cascades that are activated in the post stenotic kidney, such as mitochondrial injury, inadequate intrinsic regeneration mechanisms, downregulation of angiogenic pathways, and processes that promote inflammation or fibrosis. Emerging strategies show promise to revitalize the renal parenchyma regardless of restoration of proximal renal arterial patency. Such developments could improve our success in treating this important cause of kidney injury and cardiovascular morbidity and mortality.