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BioMed Research International
Volume 2015 (2015), Article ID 578453, 6 pages
Review Article

The Potential Role of NFAT5 and Osmolarity in Peritoneal Injury

1Division of Nephrology, University Hospital Zurich, 8091 Zurich, Switzerland
2Institute of Physiology and Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, 8057 Zurich, Switzerland
3Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Hospital, 70376 Stuttgart, Germany

Received 9 June 2015; Accepted 12 July 2015

Academic Editor: Donald Fraser

Copyright © 2015 Harald Seeger et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


A rise in osmotic concentration (osmolarity) activates the transcription factor Nuclear Factor of Activated T Cells 5 (NFAT5, also known as Tonicity-responsive Enhancer Binding Protein, TonEBP). This is part of a regulatory mechanism of cells adjusting to environments of high osmolarity. Under physiological conditions these are particularly important in the kidney. Activation of NFAT5 results in the modulation of various genes including some which promote inflammation. The osmolarity increases in patients with renal failure. Additionally, in peritoneal dialysis the cells of the peritoneal cavity are repeatedly exposed to a rise and fall in osmotic concentrations. Here we review the current information about NFAT5 activation in uremic patients and patients on peritoneal dialysis. We suggest that high osmolarity promotes injury in the “uremic” milieu, which results in inflammation locally in the peritoneal membrane, but most likely also in the systemic circulation.