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논문분류	춘계학술대회 초록집
제목	Role of the proximal tubule in renal albumin handling
저자	Philip Poronnik
출판정보	2016; 2016(1):
키워드
초록	This talk will review the ongoing debate around the mechanisms of albumin handling by the proximal tubule cells. It is well accepted that a gradual increase in urinary albumin is a hallmark of renal dysfunction. Therapeutic strategies to reduce albuminuria are therefore highly desirable, however, this depends to some extent on our understanding of the molecular pathways that govern the for albumin handling. For many decades, a relatively simple paradigm formed the basis of our understanding: the glomerular barrier presents an effective barrier to albumin with only very small amounts of albumin entering the tubule. These small amounts of albumin are taken up via a low-affinity high capacity endocytic scavenger pathway. In disease, the glomerular barrier becomes compromised and urinary albumin gradually increases. Initially albumin was thought to simply be a marker of renal disease, however, it is now clear that the increase in filtered albumin leads to activation of proinflammatory mediators that cause tubulointerstitial damage resulting in progressive decline in renal function. In this process the proximal tubule was considered to play a passive constitutive role. Over the last decade, considerable debate has raged around the exact amount of albumin that crosses the glomerular barrier and the mechanisms that govern its uptake by the proximal tubule. It is now emerging that there may be multiple pathways for albumin uptake by the proximal tubule epithelium and that these may distinguish between different forms of modified albumin. Most recently it has been demonstrated that rather than playing a passive role, the proximal tubule can dynamically regulate albumin uptake in response to serum albumin levels. The talk will summarize the major findings to date and discuss some new emerging concepts.
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