Role of iron in progressive renal disease

The importance of iron in renal injury is derived from the ease with which iron is reversibly oxidized or reduced, enabling it to participate in the p roduction of free radicals. Experimental evidence for the role of oxidants and iron in progressive renal disease fails into two broad categories. Firs t, considerable data implicate oxidants in the proteinuria of glomerular di sease. To the extent that proteinuria is an important determinant of progre ssion, reduction of proteinuria would result in retardation of progression. Evidence also suggests a role of oxidants and iron in diabetic nephropathy , a major cause of end-stage kidney disease. Second, more direct studies ha ve examined the role of oxidants and iron in models of progressive renal di sease. These studies include the demonstration of increased iron in the kid ney in models of progressive kidney disease; enhanced generation of oxidant s, providing a mechanism by which iron can be mobilized; and more direct ev idence of the beneficial effect of iron-deficient diets and iron chelators. Although the collective information on the role of oxidants and iron deriv ed from in vitro studies and animal models of glomerular disease and progre ssive renal failure is impressive, control studies of patients are needed t o show the efficacy of antioxidants and/or iron chelators in retarding the progression of renal failure and may offer an important therapeutic modalit y to patients with renal disease. (C) 2001 by the National Kidney Foundatio n, Inc.