Figure 159

After injury, alterations can occur in the cytoskeleton and in the normal distribution of membrane proteins such as Na+, K+-ATPase and p integrins in sublethally injured renal tubular cells. These changes result in loss of cell polarity, tight junction integrity, and cell-substrate adhesion. Lethally injured cells undergo oncosis or apoptosis, and both dead and viable cells may be sloughed into the tubular lumen. Adhesion of sloughed cells to other sloughed cells and to cells remaining adherent to the basement membrane may result in cast formation, tubular obstruction, and further compromise the glomerular filtration rate. (Adapted from Fish and Molitoris [1], and Gailit et al. [2]; with permission.)

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