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. Author manuscript; available in PMC: 2016 Apr 1.
Published in final edited form as: Kidney Int. 2015 May 20;88(4):804–814. doi: 10.1038/ki.2015.150

Figure 4. Integrative model of declining renal function.

Figure 4

In patients with ESRD receiving HD, we hypothesized phenyacetylglutamine, p-cresol sulfate, and ROS may increase vascular endothelial injury and subsequent release of RNASE1, which then degreades eRNA. Purines are degraded into uric acid. Since humans lack functional uricase, a free-radical, non-enzymatic oxidation converts uric acid to allantoin. Increased 4PY, a degradation product of NAD, inhibits PARP1, which along with allantoin may decrease leukocyte gene transcription. These interactions between 4PY, allantoin, renal function, and gene expression are hypothetical.