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1 Renal Section, Boston Medical Center, Boston University School of Medicine, Boston 02118; and 2 Renal Division, Brigham and Women's Hospital, Harvard Institutes of Medicine, Boston, Massachusetts 02115
For more than 15 years, there has been an ongoing debate
regarding the nephron segment(s) most severely injured in acute renal failure (ARF) induced by an ischemic or toxic insult. Although some
investigators have argued that the proximal tubule (and particularly the S3 segment) is the major target of injury in ARF, others have held
the view that damage to the distal nephron [particularly the medullary
thick ascending limb (MTAL) segment] plays a more important role in
this disease. In this discussion, the first of three on
different aspects of ARF that have been hotly debated, we have invited
several experts to discuss their opinions on this issue. The goals of
this first discussion (and the subsequent two articles in this forum)
are to establish areas of consensus in each area of
controversy and also to identify unanswered questions that represent
important areas for future research.
isolated perfused kidney; acute tubular necrosis; single injury experimental model
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