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Oxygen is an important element and maintains metabolic
events in eukaryotes. Continuous supply and sufficient levels of
oxygen are necessary for the functioning of human body.  However, in extreme
environmental conditions deficiency of oxygen in the blood and tissues causes
hypoxia. Adequate supply of oxygen is essential to the aerobic metabolism of
eukaryotes. As a terminal electron acceptor oxygen is utilised as a substrate for mitochondrial oxidative
phosphorylation and therefore  implicated
in the generation of energy within a cell. Even a marginal reduction
of oxygen availability (hypoxia) seriously impairs the energy metabolism in
humans. Hypoxia affects the functioning of many organs
and biological process including kidneys homeostasis. Kidneys hold
low-resistance microvasculature that is unprotected to both high volume and
constant perfusion. The limits of low oxygen supply, dictated by both renal
structural design and high oxygen demand, merge to make the kidney vulnerable
to physiologic, environmental and pathological stresses that cause hypoxia (31,32). Kidneys involved in transport functions within
a relatively narrow range of pO2, which is less in the medulla, vulnerability
to hypoxic injury is high. The constraints in renal tissue oxygen supply during
chronic hypoxia exposes the kidneys to hypoxia-induced alterations and has long
been known as an significant factor in the pathogenesis of acute renal injury (33-36). Therefore, renal cells evolved a range of
mechanisms, allow them to respond and adapt to decreases in renal oxygenation (37). The kidneys have a high oxygen demand, so as
to facilitate energy dependent basic renal functions such as active salt
absorption (38). Oxygen
may become limited by anemia or due to cardiovascular, pulmonary or hematological diseases but also with exercise
and high-altitude exposure. Kidneys are one of the best-perfused organs of the body, in
reference to their weight (39). However,
oxygenation of renal parenchyma is very low, with oxygen tension is about 30mm
Hg and in renal medulla is below 10mm Hg (32,40). The reason is a dramatic difference between oxygen supply and
oxygenation owes both to
the way the kidney is built and to the function it performs (41). The main cause of ESRD is CKD where the CKD is in turn
driven by many risk factors includes- anemia, diabetic hyperglycemia,
hypercholesterolemia, hypertension, cigarette smoking, atherosclerosis,  air pollution, sleep apnea and repeated
episodes of acute kidney injury(41). All the risk factors
are linked with CKD to generate low oxygen tensions within the kidney. Fine
et al., proposed that on the basis of this association chronic
hypoxia is the final regular pathway that clues
to the advancement of ESRD. Subsequently, there is a direct link between hypoxia
and the progression of CKD

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