Regulation of energy and lipid metabolism in acute and chronic kidney disease

This thesis describes the effect of renal injury on energy and lipid metabolism, as well as the effect of these metabolic pathways on renal health and repair. We emphasize that acute and chronic renal injury are not isolated incidents but are found along the spectrum of kidney disease. Inadequate resolution of acute injury leads to chronic injury, and chronic injury increases the kidney's susceptibility to acute injury, thereby illustrating the vicious cycle of renal disease.
We show that acute ischemic injury results in the shutdown of pathways involved in energy and lipid metabolism, and this gives rise to renal damage. We also bring attention to the role that the innate immune system plays in regulating 'metabolic choice' in renal cells. Failure to restore metabolic homeostasis leads to maladaptive repair and chronic injury ensues. We investigate chronic renal disease, driven by metabolic disorders such as obesity and diabetes mellitus, and attempt to intervene by restoring metabolic order.
In both forms of renal disease, we highlight metabolic disturbance as a cause and perpetuator of injury. By gaining a clear understanding of (1) the interplay between metabolic pathways, (2) their role in renal repair, and (3) the mechanisms by which they are regulated, we can begin to explore the potential of metabolism-based therapies for the treatment of renal disease.