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Supplement: Arginine Metabolism: Enzymology, Nutrition, and Clinical Significance

Role of L-Arginine in the Pathogenesis and Treatment of Renal Disease^1,2

Gautam Cherla^*, and Edgar A. Jaimes^*,,**,3

^* Nephrology Section VA Medical Center, Renal Division and ^** Vascular Biology Institute, University of Miami School of Medicine, Miami, FL 33136

³To whom correspondence should be addressed. E-mail: ejaimes{at}med.miami.edu.

L-arginine is a semi essential amino acid and also a substrate for the synthesis of nitric oxide (NO), polyamines, and agmatine. These L-arginine metabolites may participate in the pathogenesis of renal disease and constitute the rationale for manipulating L-arginine metabolism as a strategy to ameliorate kidney disease. Modification of dietary L-arginine intake in experimental models of kidney diseases has been shown to have both beneficial as well as deleterious effects depending on the specific model studied. L-arginine supplementation in animal models of glomerulonephritis has been shown to be detrimental, probably by increasing the production of NO from increased local expression of inducible NO synthase (iNOS). L-arginine supplementation does not modify the course of renal disease in humans with chronic glomerular diseases. However, beneficial effects of L-arginine supplementation have been reported in several models of chronic kidney disease including renal ablation, ureteral obstruction, nephropathy secondary to diabetes, and salt-sensitive hypertension. L-arginine is reduced in preeclampsia and recent experimental studies indicate that L-arginine supplementation may be beneficial in attenuating the symptoms of preeclampsia. Administration of exogenous L-arginine has been shown to be protective in ischemic acute renal failure. In summary, the role of L-arginine in the pathogenesis and treatment of renal disease is not completely understood and remains to be established.

KEY WORDS: • L-arginine • kidney failure • glomerulonephritis • hypertension • preeclampsia • nitric oxide

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