ISSN 1306-0015 | E-ISSN 1308-6278
Review
Vascular toxicity of urea, a new “old player” in the pathogenesis of chronic renal failure induced cardiovascular diseases
1 Research Center of Laboratory Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy  
2 Department of Pediatrics. Scientific Institute “Casa Sollievo della Sofferenza”, University of Foggia, Italy  
3 Diabetes Research Center and Departments of Internal Medicine and Pathology, Albert Einstein College of Medicine, Bronx, NY, USA.  
4 Campus Bio-Medico University Medical School, Rome, Italy  
5 Department of Pediatrics. Scientific Institute “Casa Sollievo della Sofferenza”, University of Foggia, Italy; European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany.  
Turk Pediatri Ars 2017; 52: 187-193
DOI: 10.5152/TurkPediatriArs.2017.6314
Key Words: Atherogenesis, atherosclerosis, cardiovascular disease, chronic renal failure, urea, vascular toxicity
Abstract

Chronic kidney disease in children is an irreversible process that may lead to end-stage renal disease. The mortality rate in children with end-stage renal disease who receive dialysis increased dramatically in the last decade, and it is significantly higher compared with the general pediatric population. Furthermore, dialysis and transplant patients, who have developed end-stage renal disease during childhood, live respectively far less as compared with age/race-matched populations. Different reports show that cardiovascular disease is the leading cause of death in children with end-stage renal disease and in adults with childhood-onset chronic kidney disease, and that children with chronic kidney disease are in the highest risk group for the development of cardiovascular disease. Urea, which is generated in the liver during catabolism of amino acids and other nitrogenous metabolites, is normally excreted into the urine by the kidneys as rapidly as it is produced. When renal function is impaired, increasing concentrations of blood urea will steadily accumulate. For a long time, urea has been considered to have negligible toxicity. However, the finding that plasma urea is the only significant predictor of aortic plaque area fraction in an animal model of chronic renal failure -accelerated atherosclerosis, suggests that the high levels of urea found in chronic dialysis patients might play an important role in accelerated atherosclerosis in this group of patients. The aim of this review was to provide novel insights into the role played by urea in the pathogenesis of accelerated cardiovascular disease in renal failure.

 

Cite this article as: Giardino I, D’Apolito M, Brownlee M, et al. Vascular toxicity of urea, a new “old player” in the pathogenesis of chronic renal failure induced cardiovascular diseases. Turk Pediatri Ars 2017; 52: 187-93.

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