Obstructive nephropathy: from mechanical disturbance to immune activation?

Acute obstructive uropathy is a major cause of renal impairment world-wide and leads to end-stage renal failure if left untreated. It is now clear that obstructive nephropathy is not simply a mechanical impairment to urine flow but a complex syndrome resulting in the alteration in both glomerular haemodynamics and tubular function. This appears to result from the interactions of a variety of vasoactive factors and cytokines which are activated as a result of an obstruction in the urinary tract. A hitherto unrecognized leukocyte infiltrate appears to play a key role in such alterations in renal function, suggesting that ureteral obstruction should now be considered to have an immunological component.