What is Polycystic Kidney Disease (PKD)?

Polycystic kidney disease (PKD) is a genetic disorder characterized by the growth of numerous cysts (fluid-filled sacs) in the kidneys. These cysts can vary in size and number and can lead to enlargement of the kidneys and disruption of their normal structure and function over time. PKD is one of the most common inherited kidney disorders, affecting millions of people worldwide.


There are two main types of PKD:


  • Autosomal Dominant Polycystic Kidney Disease (ADPKD): This is the most common form of PKD and is caused by mutations in genes such as PKD1 and PKD2. ADPKD is inherited in an autosomal dominant pattern, meaning that a person only needs to inherit one copy of the mutated gene from either parent to develop the disease. Symptoms of ADPKD typically develop in adulthood and may include abdominal pain, high blood pressure, blood in the urine, and kidney stones. Complications of ADPKD can include kidney failure, cyst infections, and the development of cysts in other organs such as the liver and pancreas.


  • Autosomal Recessive Polycystic Kidney Disease (ARPKD): This form of PKD is much less common and is caused by mutations in the PKHD1 gene. ARPKD is inherited in an autosomal recessive pattern, meaning that a person must inherit two copies of the mutated gene (one from each parent) to develop the disease. ARPKD is usually diagnosed in infancy or childhood and can cause severe kidney and liver problems, including kidney failure in some cases. Children with ARPKD may also have other health issues such as high blood pressure, urinary tract infections, and lung problems.


The development and progression of cysts in PKD are thought to be driven by abnormal cell proliferation, fluid secretion, and structural changes in the kidney tubules. As the cysts grow and multiply, they can compress surrounding kidney tissue, leading to reduced kidney function and eventually kidney failure.


What is the relationship between PKD and oxidative stress?

The relationship between polycystic kidney disease (PKD) and oxidative stress is complex and multifaceted. Oxidative stress refers to an imbalance between the production of reactive oxygen species (ROS) and the body’s ability to neutralize them with antioxidants, leading to cellular damage and inflammation. Several mechanisms linking oxidative stress to PKD have been proposed:


  • Mitochondrial Dysfunction: Dysfunction of mitochondria, the energy-producing organelles within cells, is implicated in the pathogenesis of PKD. Abnormalities in mitochondrial structure and function can lead to increased production of ROS, contributing to oxidative stress. Mitochondrial dysfunction in PKD is thought to be driven by various factors, including altered cellular metabolism, impaired autophagy (cellular recycling process), and dysregulation of calcium signaling.


  • Cyst Growth and Expansion: The growth and expansion of cysts in PKD are associated with increased oxidative stress. Cyst-lining epithelial cells exhibit higher levels of oxidative stress markers compared to normal kidney cells. ROS can stimulate cyst epithelial cell proliferation and fluid secretion, promoting cyst growth. Conversely, oxidative stress-induced damage to cellular structures such as DNA, proteins, and lipids can impair cellular function and contribute to cyst progression.


  • Inflammation and Fibrosis: Oxidative stress plays a role in promoting inflammation and fibrosis in PKD. ROS can activate pro-inflammatory signaling pathways and promote the release of inflammatory cytokines, chemokines, and growth factors, contributing to the recruitment of immune cells and the development of chronic inflammation within the kidneys. Additionally, oxidative stress can stimulate the production of extracellular matrix proteins by renal fibroblasts, leading to fibrosis and progressive kidney damage.


  • Cellular Signaling Pathways: Oxidative stress can modulate various signaling pathways implicated in the pathogenesis of PKD, including the mammalian target of rapamycin (mTOR) pathway, the cAMP/protein kinase A (PKA) pathway, and the nuclear factor erythroid 2-related factor 2 (Nrf2) pathway. Dysregulation of these pathways can disrupt cellular homeostasis, promote cell proliferation and cyst growth, and impair antioxidant defenses, exacerbating oxidative stress and contributing to disease progression.


Overall, oxidative stress is considered a key contributor to the pathogenesis and progression of PKD, contributing to cyst growth, inflammation, fibrosis, and kidney dysfunction.