Endothelin in kidney disease.

The role of endothelin in renal physiology and pathophysiology continues to be the subject of intense current research. Further insight into the mechanisms of interaction of endothelin in the kidney has provided a better understanding of its effects on renal hemodynamics and tubular function. Of interest is the emerging role of endothelin as a potential physiologic osmotic regulator of sodium and water reabsorption in the renal medulla. Increasing evidence implicates endothelin in the pathophysiology of progressive glomerulosclerosis, postischemic renal failure, cyclosporine-induced nephrotoxicity, and radiocontrast-induced nephropathy. The recent finding of elevated plasma endothelin levels in patients with the hepatorenal syndrome is particularly exciting and implicates a potential role for endothelin in the pathophysiology of the renal failure that occurs in patients with this syndrome.