A contemporary view of the macula densa: kidney remodeling

A high-salt intake has deleterious effects on blood pressure and kidney function in patients with chronic kidney disease (CKD), compelling a low-salt diet as a critical nonpharmacologic intervention to limit the progression of CKD.1 The traditional view is that the macula densa (MD) serves as the critical salt-sensing machinery in the kidney. The MD comprises a collection of 20 to 25 epithelial cells at the distal end of the thick ascending loop of Henle, which together with the renin-producing and vascular smooth muscle cells of the afferent arteriole form the juxtaglomerular apparatus (JGA).