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Leaked protein and interstitial damage in the kidney: is complement the missing link?

The link between glomerular leakage of protein and progressive renal damage is a recurrent but incompletely understood observation in many clinical and experimental studies. High urinary protein levels in patients with glomerular disease predicts an adverse outcome. These patients frequently demonstrate tubular and interstitial fibrosis on renal biopsy. From this has emerged the hypothesis, supported by animal studies, that proteinuria leads to a fibrotic response within the tubulointerstitial compartment. The exact mechanism by which proteinuria exerts this effect is unknown.