Recent studies emphasize the role of chronic hypoxia in the tubulointerstitium as a final
common pathway to end-stage renal failure. When advanced, tubulointerstitial damage is
associated with the loss of peritubular capillaries. Associated interstitial fibrosis impairs
oxygen diffusion and supply to tubular and interstitial cells. Hypoxia of tubular cells leads to
apoptosis or epithelial-mesenchymal transdifferentiation. This in turn exacerbates fibrosis of
the kidney and subsequent chronic hypoxia, setting in train a vicious cycle whose end point …