. Renal fibrosis is the final common pathway for many kidney lesions that lead to chronic progressive organ failure. The tubulointerstitial
space occupies up to 90% of kidney volume, indicating that pathological changes in that space can not be without functional
significance. By analogy to wound healing, renal fibrogenesis can be divided arbitrarily into three phases: induction, inflammatory,
and post-inflammatory phases. The latter phase is of particular importance, since its length often exceeds what would be required
for healing. The induction phase is characterized by the infiltration of the tubulointerstitial space by mononuclear inflammatory
cells. This influx is mediated by proinflammatory cytokines and chemokines often secreted by activated tubular epithelial
cells. Subsequently, these infiltrating mononuclear cells stimulate a heterogeneous group of resident fibroblasts and tubular
epithelial cells to undergo phenotypic conversion into activated fibroblasts that secrete abundant extracellular matrix. Tubular
epithelial cells contribute to this process through epithelial-mesenchymal transition. During the inflammatory phase these
activated fibroblasts are stimulated to produce collagenous matrix mainly by cytokines, such as TGF-β1, EGF, ET-1, and FGF-2,
which are secreted by inflammatory and injured somatic cells. Occasionally however, when inflammation subsides, the matrix
synthesis in the post-inflammatory phase of renal fibrogenesis continues and may be more dependent on autocrine stimulation
from resident renal cells such as remaining tubular epithelium. Eventually, the collagenous matrix of fibrogenesis destroys
blood supply and the perimeter of viability for fibroblasts regresses to the point where scars become acellular.
Acknowledgements. This work has been made possible in part by a grant from the Deutsche Forschungsgemeinschaft (DFG) to F. Strutz (DFG Str
388/6–1) and NIH grants DK-46282 RO1 and HL-68121 to E. G. Neilson. We apologize to all authors whose work could not be cited
due to space limitations.
Correspondence to: F. Strutz