ABSTRACT
Endothelium is a fl at monolayer of cells that covers vascular lumina throughout the body. It is well recognized as the principal regulator of vascular function such as vascular tone, permeability, platelet aggregation, infl ammation and smooth muscle cell proliferation. Endothelial dysfunction is characterized by loss of protective endothelial characteristics and is widely recognized as a key factor in the initiation and progression of atherosclerosis (Davignon 2004, Deanfi eld 2007). Patients with chronic kidney disease (CKD) experience accelerated atherosclerosis leading to excessive cardiovascular death. The impressive cardiovascular morbidity and mortality of CKD patients cannot be fully explained by traditional risk factors including hypertension, dyslipidemia, obesity, smoking and is attributable in a signifi cant proportion to endothelial dysfunction (ED), abnormal vascular reactivity, arterial stiffness, and vascular calcifi cations. (Hogas-Covic 2010, Shroff 2011a, Pediatr Nephrol and Shroff 2011b, Nat Rev Nephrol). The individual effect of one risk factor is probably amplifi ed by the presence of multiple risk factors in this population of patients (Wilson
Professor of Pediatrics, Department of Pediatric Nephrology, Gazi University, 06500, Besevler, Ankara, Turkey. E-mail: sevcan@gazi.edu.tr
2009). Additionally, chronic infl ammatory state and increased oxidative stress contribute to CV risk in patients with CKD. The balance between proand anti-oxidant capacities is shifted towards a state of increased oxidative stress in CKD patients (Del Vecchio 2011 Semin in Dial). In this chapter we will discuss endothelial dysfunction in CKD patients in the context of premature and accelerated atherosclerosis, chronic ongoing infl ammation and oxidative stress.
