Distal Tubular Cells Research Articles

Impact of trimethoprim on serum creatinine, sodium, and potassium concentrations in patients taking trimethoprim-sulfamethoxazole without changes in glomerular filtration rate.

Trimethoprim (TMP) inhibits the Na+ /K+ -ATPase present in the basement membrane of distal tubular epithelial cells. However, hyponatremia and hyperkalemia may develop in patients taking TMP-sulfamethoxazole (SMX). In addition, because TMP inhibits drug transporters, such as organic cation transporter 2 and multidrug and toxin extrusion protein 2-K in proximal tubules, reversible increases in the concentration of serum creatinine (SCr), the substrate of these transporters, may occur. Here, we investigated variability in SCr, serum sodium (Na+ ), and serum potassium (K+ ) concentrations after initiation of TMP-SMX treatment and evaluated the risk of hyponatremia and hyperkalemia in patients with increased SCr concentrations without changes in the glomerular filtration rate (GFR). In this retrospective study, all patients aged 20 years or older who received oral TMP-SMX during hospitalization were enrolled. The patients with estimated creatinine (Cr) clearance (eCCr) lower than 30 mL/min were excluded, as were patients taking drugs that were likely to induce renal dysfunction, drugs other than glucocorticoids that were likely to induce electrolyte imbalances, or drugs other than TMP that inhibit tubular Cr secretion. Additionally, those with SCr concentrations elevated more than 30% from baseline or serum blood urea nitrogen concentration levels above 20 mg/dL during follow-up were also excluded. In total, 111 patients were enrolled in the study. The common independent variable affecting the change rate in SCr, Na+ , and K+ concentrations (ΔSCr, ΔNa+ , and ΔK+ ) from baseline to the highest value during the follow-up period (14 days after initiation of TMP-SMX treatment) was the daily dose of TMP. There were significant correlations between ΔSCr and ΔNa+ or ΔK+ (ρ=-0.199, p=0.036 and ρ=0.244, p=0.010, respectively). Kaplan-Meier curves for hyponatremia and hyperkalemia with greater than or equal to grade 1 severity showed different profiles when the TMP dose varied (≤ 160 vs. > 160 mg/day; p=0.005 and 0.008). The cumulative incidences of both adverse effects were 64.7% (median: 7 days) and 29.4% in patients taking more than 160 mg/day TMP and 35.2% and 6.7% in patients taking 160 mg/day TMP or less. Thus, TMP may affect the kinetics of Cr, Na+ , and K+ in the proximal and distal tubules in a dose-dependent without changing the GFR. This study is the first report to demonstrate the degree of changes in SCr, Na+ , and K+ concentrations after initiation of TMP-SMX treatment. If SCr is elevated after initiation of TMP-SMX treatment, clinicians should be aware of decreased Na+ and increased K+ concentrations. TMP may increase the risks of hyponatremia and hyperkalemia in a dose-dependent manner without altering GFR.

FC074: Mineralocorticoid Receptor Drives Parietal Epithelial Cell Activation and Glomerular Injury During Crescentic Glomerulonephritis

Abstract BACKGROUND AND AIMS We have recently demonstrated that targeting specific pathways in parietal epithelial cells (PEC) can markedly alleviate experimental extracapillary glomerular injury (1). Accumulating evidence has indicated the potential contributions of aldosterone and mineralocorticoid receptor (MR) to the pathophysiology of chronic kidney disease. MR is strongly expressed in endothelial cells, glomerular mesangial cells, podocytes and distal tubular cells. Previous studies have shown that administration of mineralocorticoid receptor antagonists, including spironolactone and eplerenone, has beneficial effects in various renal injury animal models, such as unilateral ureteral obstruction, ischemia-reperfusion, cyclosporine-induced nephrotoxicity and hypertensive renal injury. The role of the MR in extra capillary glomerulopathies is still elusive and mechanistically unclear. METHOD To investigate the cell-specific role of the MR in PEC in the course of crescentic glomerulonephritis, we generated chimeric mice specifically lacking MR (Pec Cre Nr3c2lox/lox) in PECs using an inducible Cre recombinase system. Crescentic glomerulonephritis (GN) was induced using the antiglomerular basement membrane nephrotoxic serum (NTS) model. In vivo, biological parameters (albuminuria, blood urea nitrogen—BUN), glomerular injury, as well as PEC activation (CD44, CD9 and fibronectin staining) were assessed. RESULTS At baseline, Pec Cre Nr3c2wt/wt and Pec Cre Nr3c2lox/lox mice displayed no kidney morphology and function differences. When challenged using the NTS model, Pec Cre Nr3c2lox/lox mice showed less albuminuria and preserved renal function as compared to Pec Cre Nr3c2 wt/wt counterparts. Crescents were also more numerous and organized in Pec Cre Nr3c2wt/wt mice. Next, we examined whether pharmacological MR inhibition could alleviate the severity of crescentic GN. When Pec Cre Nr3c2wt/wt mice were orally given eplerenone for 14 days after the onset of the crescentic GN, they were significantly protected from renal injury and failure (decreased proteinuria, normal BUN and reduced number of crescent). Such global action was associated with less activation molecule CD44 on PECs. Thus, genetic disruption of MR in PEC as well as pharmacological inhibition using eplerenone reduced glomerular expression of CD44 and crescent formation. Furthermore, kidney biopsies of individuals diagnosed with crescentic glomerulonephritis displayed increased expression of MR in PEC and crescents. CONCLUSION Altogether, these results indicate the critical role of MR in PEC activation during crescentic glomerulonephritis along with the recently discovered CD9/EGFR/PDGFR pathway. This further supports the idea that the PEC phenotype switch is not a bystander event but plays a targetable critical active pathogenic role in crescentic GN. MR modulation using eplerenone may be a new therapeutic option for the management of such severe disease.

MO1012: Variability of Klotho and FGF-23 Levels After Kidney Transplantation Depending on the Glomerular Filtration Rate

Abstract BACKGROUND AND AIMS Klotho is a transmembrane protein expressed mainly in distal tubular epithelial cells of the kidneys. Its gene expression and soluble form levels play a crucial role in the interaction of the aging-inflammation binomial and act as a co-receptor for the phosphaturic fibroblast growth factor 23 (FGF-23). Klotho deficiency, which is the norm in chronic kidney disease (CKD), has been reported as an independent risk factor for cardiovascular disease and subclinical atherosclerosis [1, 2]. This study investigates the evolution of Klotho and FGF-23 levels during the first 2 years after kidney transplantation and their variability depending on the glomerular filtration rate (GFR). METHOD Serum levels of Klotho and FGF-23 were determined in 42 patients right before kidney transplantation (KT) and at 3rd, 12th and 24th month after KT. The measurements were made by ELISA. The GFR of the kidney graft was performed by indirect methods (formula: MDRa and CKD-EPI) at each study visit. Variables were reported as mean ± SD, and a value of P < .05 was considered to be statistically significant for each test. RESULTS KT recipients were divided into two groups arbitrary: the first group with a GFR > 40 mL/min (n = 26) and the other one with a GFR ≤ 40 mL/min (n = 16). At the starting point, there was not found any statistical difference in Klotho and FGF-23 levels between groups (GFR > 40 mL/min: 462.65 ± 264.99 pg/mL and 786.84 ± 521.67 pg/mL, respectively; versus GFR ≤ 40 mL/min: 436.5 ± 189.33 and 779.02 ± 589.86). Those with better kidney function after KT significantly increased Klotho levels on 12th and 24th month of follow-up (baseline 462.65 ± 264.99 versus 12th month 561.96 ± 314.68 and 24th month 581.15 ± 350.10; P = .001), whereas KT recipients with a GFR ≤ 40 mL/min only proved an increase in Klotho levels at 12th month after a non-significant initial decrease at 3rd month (462 ± 204.91 versus 356.96 ± 177.07, respectively; P = .028). This trend was not confirmed at the 24th month (397.12 ± 182.05). Klotho levels were found significantly different at the 24th month between groups (P = .031). See Fig. 1. Figure 2 shows the changes in FGF-23 levels. There are significant differences in both groups from baseline to month 24. (P < .001 group GFR > 40 mL/min and P < .001 group GFR ≤ 40 mL/min). FGF-23 dropped significantly in both groups at the 3rd month (P = .018) and 12th months (P = .003). CONCLUSION Vascular disease and mineral metabolism malfunction are relevant abnormalities in patients with CKD as well as in KT recipients. This study shows that Klotho is increasingly produced after KT in those patients whose allografts achieve a better function. We failed to prove the same effect on those with a GFR < 40 mL/min. Nonetheless, FGF-23 production declines satisfactorily independently of GRF. These results suggest the promotion of cardiovascular health after KT, particularly in those with higher GFR. The clinical and prognostic value of these changes are yet to be determined.

MO276: Renal Tubular CD24 Upregulation Aggravates Folic Acid-Induced Acute Kidney Injury Through Inhibition of Regulatory T Cells in Mice

Abstract BACKGROUND AND AIMS Acute kidney injury (AKI) is characterized by cell death and inflammation. CD24 is a sialoglycoprotein which is induced during tissue damage and is not expressed in matured renal tissue. We explored the role of CD24 in the pathogenesis of folic acid-induced AKI (FA-AKI) in mice. METHOD A single i.p. injection of folic acid induced AKI in WT and CD24-/- mice. Renal function tests, histological analysis, immunohistochemistry, Western blot analysis and ELISA were performed to assess the severity of renal damage and the intensity of the inflammatory response. RESULTS FA-AKI induced the expression of CD24 in the distal tubular epithelial cells. Compared to WT mice, FA-AKI CD24-/- mice exhibited an attenuated reduction in renal function and histological injury, lower serum IL-10 and interferon γ, and decreased expression of renal TNFα. Renal and systemic IL-33 were upregulated in both groups. However, it was more pronounced in FA-AKI CD24-/- animals. FA-AKI CD24-animals exhibited increased splenic margination and renal infiltration of regulatory T cells (Tregs). At day 7, FA-AKI CD24-/- mice demonstrated increased expression of tubular pro-apoptotic (activated caspase 3) and decreased anti-apoptotic (Bcl-xL) proteins compared with WT animals. Administration of anti CD24 antibody to FA-AKI mice attenuated the decrease in renal function and ameliorated the histological injury in comparison with untreated animals. Renal biopsies from patients with ATN stained strongly for CD24 in the distal tubules. CONCLUSION During AKI, upregulation of CD24 promotes renal inflammation through inhibition of Tregs infiltration and diversion of cell death towards necrosis rather than apoptosis. Neutralization of CD24 may prove as a target for future therapies in AKI.

Adult mouse kidney stem cell‐derived exosomes navigate nephron repair and regeneration in aged mice

The physiological function of kidney stem cell‐derived extracellular vesicles remains elusive. Most recently, we isolated kidney stem cells (KSCs) from adult mouse kidneys and demonstrated that KSCs‐derived exosomes normalized blood pressure and improved kidney functions in hypertensive aged mice. To study if KSCs‐derived exosomes play a role in nephron repair and regeneration, we treated aged mice with CD63‐GFP labelled KSC‐exosome (CD63/GFP KSC‐Exo) (~1.0×1011particles/mouse) and traced CD63/GFP KSC‐Exo in the kidney. We found that KSC‐exosomes were mainly detected in the proximal and distal tubular cells near the damaged glomerulus in cortex area of the aging kidney. BrdU tracing study showed that BrdU positive cells were mainly detected in the glomerulus and co‐located with Ki67 cell proliferation marker in the kidney of KSC‐exosome treated mice. KSC‐exosome treatment also increased numbers of Sca1+cells surrounding the glomerulus area of aging kidney. Interestingly, the glomerular filtration rate (GFR) was significantly increased in KSC‐exosome‐treated aged mice, suggesting improved glomerular function. To explore the mechanisms how KSC‐exosome improves kidney functions, we performed proteome analysis of KSC‐exosomes by mass spectrometry. We found several pathways that involve in the kidney development were upregulated in the KSC‐exosome from adult mice compared to that of aged mice. Notably, we further identified that FBLN2, an extracellular matrix protein, plays an important role in aging‐associated hypertension. We showed that expression of FBLN2 was downregulated in the kidney of aged mice and recombinant FBLN2 (rFBLN2) treatment normalized blood pressure and improved GFR of hypertensive aged mice. Furthermore, we found that FBLN2 is mainly located in the basement membrane of glomerulus (GBM). The thickness of GBM was increased in aged mice determined by TEM. KSC‐exosome or rFBLN2 treatment reduced the thickness of GBM, suggesting that FBLN2 may play an important role in maintaining the integrity of GBM and kidney functions. In conclusion, our finding provided the first evidence that the adult mouse kidney stem cell‐derived exosomes play an important role in nephron repair and regeneration partly via FBLN2. KSC‐exosome treatment may be a novel therapeutic strategy for hypertension‐associated kidney injuries in aging.

Increase in Salt Concentration in the Culture Media Enhances Protein Expression of Tumor Necrosis Factor‐Alpha Receptor Type 1 in Cultured Renal Cortical Collecting Duct Cells But Not in Proximal Tubular Cells

Tumor necrosis factor‐alpha (TNFα) exerts its biological responses via interaction with its’ two cell surface receptors, type 1 (TNFR1) and type 2 (TNFR2) which are differentially expressed and regulated in the kidney. Previously, we have demonstrated that circulating TNFα exerts natriuresis via its action on TNFR1 but not on TNFR2 and such TNFR1 activation exerts inhibitory action on distal tubular sodium transport, particularly tubular ENaC activity. As TNFα level is elevated during dietary intake of high salt (HS), we hypothesized that increases in salt concentration in renal tissue enhances TNFα ‐TNFR1 activity in the renal tubules to induce natriuretic response to HS intake. To test this hypothesis, we examined the protein expression of TNFR1 and TNFR2 in cultured proximal (human kidney [HK‐2] cell line) and distal (murine cortical collecting duct [M‐1] cell line) tubular cells at different concentrations of NaCl in the culture media. Both these HK‐2 and M‐1 cells were incubated for 24 hours in control media with normal NaCl concentration (120 mM) and at media containing higher NaCl (140 mM and 160 mM) concentrations. TNF receptors protein expressions were analyzed by the Western Blot technique using appropriate antibodies for TNFR1 (rabbit anti‐TNFR1; Abcam cat # 19139) and TNFR2 (rabbit anti‐TNFR2; Abcam cat # 109322), which were normalized by expression of β‐actin or GAPDH proteins using appropriate antibodies. The blot image was quantified and measured as band intensity density with Image J software. The quantitative immunoblot analysis in HK‐2 cells showed that there were no significant changes in the band intensity unit (IU) in TNFR1 (120 mM, 70.1±12.8 IU; 140 mM, 73.7±9.9 IU; 160 mM, 57.2±9.8 IU; n=6 in each condition) or TNFR2 protein (120 mM, 83.9 ±6.3 IU; 140 mM, 66.8±14.1 IU; 160 mM, 77.8±2.3 IU; n=6 in each condition) levels. On the other hand, TNFR1 protein expression was significantly higher in M‐1 cells incubated in 160 mM NaCl conc. (135.6 ±7.8 IU, n=7; P< 0.005) than that in 120 mM (109.3±2.8 IU, n=7) and in 140 mM (91.1±10.8 IU, n=7) NaCl conc. However, TNFR2 protein expression in M‐1 cells did not significantly alter with the changes in NaCl conc. in the media (120 mM, 137±20.1 IU; 140 mM, 128±7.2 IU; 160 mM, 143±7.2 IU; n=7 in each condition). These data indicate that TNFR1 activity is upregulated in renal collecting duct cells (CCD) in response increases in tissue NaCl concentration in the kidney. Such upregulation of TNFR1 activity in the CCD induced by high salt concentration, exerts inhibitory action on distal sodium transport and plays a role in enhancing urinary sodium excretion during dietary HS intake.

Proteomic landscape of SARS-CoV-2- and MERS-CoV-infected primary human renal epithelial cells.

Acute kidney injury is associated with mortality in COVID-19 patients. However, host cell changes underlying infection of renal cells with SARS-CoV-2 remain unknown and prevent understanding of the molecular mechanisms that may contribute to renal pathology. Here, we carried out quantitative translatome and whole-cell proteomics analyses of primary renal proximal and distal tubular epithelial cells derived from human donors infected with SARS-CoV-2 or MERS-CoV to disseminate virus and cell type-specific changes over time. Our findings revealed shared pathways modified upon infection with both viruses, as well as SARS-CoV-2-specific host cell modulation driving key changes in innate immune activation and cellular protein quality control. Notably, MERS-CoV infection-induced specific changes in mitochondrial biology that were not observed in response to SARS-CoV-2 infection. Furthermore, we identified extensive modulation in pathways associated with kidney failure that changed in a virus- and cell type-specific manner. In summary, we provide an overview of the effects of SARS-CoV-2 or MERS-CoV infection on primary renal epithelial cells revealing key pathways that may be essential for viral replication.

Hyaluronic acid promotes calcium oxalate crystal growth, crystal-cell adhesion, and crystal invasion through extracellular matrix

Hyaluronic acid (HA), a macromolecule in glycosaminoglycans family, is normally excreted into the urine with a small amount, but with much greater level in the urine from stone patients (formers). However, its precise roles in kidney stone pathogenesis remained unclear. This study examined its roles in calcium oxalate (CaOx) kidney stone formation processes, including neocrystallization, crystal growth, adhesion, internalization, aggregation and invasion. The results showed that HA (1, 10, 100, 1000, or 10,000 ng/ml) did not affect CaOx neocrystallization, aggregation, and internalization into MDCK distal renal tubular cells. However, HA significantly promoted CaOx crystal growth (at 10–10,000 ng/ml), adhesion onto renal tubular cells (at 1000–10,000 ng/ml), and invasion through extracellular matrix (ECM) (at 1–10,000 ng/ml). Analysis of the plasminogen sequence revealed six sites with the HA-binding motif “B(X7)B" that explained the HA ability to trigger the plasminogen-plasmin system required for crystal invasion. In summary, our systematic analysis highlights the promoting effects of HA on CaOx crystal growth, crystal-cell adhesion and invasion through the ECM. These effects of HA may explain its high level in the stone patients' urine, thereby promoting the stone formation.

Association of plasma fatty acid-binding protein 3 with estimated glomerular filtration rate in patients with type 2 diabetes mellitus.

Background: Fatty acid-binding protein 3 (FABP3) located in renal mesangial and distal tubular cells, and had been shown to be a sensitive marker of renal injury, potentially be a mediator in pathogenesis of chronic kidney disease (CKD). Our previous study revealed that plasma FABP1 and FABP2 were independently associated with CKD, however, little is known about the relationship between plasma FABP3 level and CKD. The aim of this study was therefore to evaluate the plasma levels of FABP3 at different stages of estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes mellitus (T2DM).Methods: A total of 334 subjects with T2DM who enrolled in a disease management program were included in this study and stratified according to eGFR. Plasma FABP3 concentrations were measured by an enzyme-linked immunosorbent assay.Results: FABP3 levels increased in parallel with the eGFR level. Increasing concentrations of FABP3 were independently and significantly associated with eGFR stage G2-G4. Age- and sex-adjusted FABP3 levels were positively associated with uric acid, urinary albumin-to-creatinine ratio, FABP1, FABP2, and fatty liver index, but negatively associated with eGFR and hemoglobin.Conclusion: Our results indicate that circulating FABP3 in patients with T2DM is associated with eGFR, which suggests that increased plasma FABP3 may be involved in the pathogenesis of CKD.

Histological, ultrastructural, and biochemical studies on the expected role of thyme oil on ameliorating renal toxicity induced by doxorubicin in female albino rats

Doxorubicin is antibiotics anticancer drug which proved to be useful in treatment of cancer, but it has bad effect on healthy body organs. Thymus vulgaris (thyme) cultivated around the world for cosmetic, cooking, and medical uses. So, the present work aims to investigate the possible ameliorating effect of thyme oil on renal toxicity induced by doxorubicin. Adult female albino rats (Rattus norvegicus) were randomly divided into four groups (5 rats/group): control group, thyme group received orally 0.5 mL thyme oil/kg body weight once/week for 6 consecutive weeks, doxorubicin group received intraperitoneally 2 mg doxorubicin/kg body weight once/week for 6 consecutive weeks, and doxorubicin + thyme group received both doxorubicin and thyme oil once/week for 6 consecutive weeks. A significant rising in urea and creatinine level in the sera of rats injected with doxorubicin was recorded. Moreover, their kidney sections showed degenerated, vacuolated and little hemorrhage glomeruli, abnormal renal tubular cells, aggregation of mononuclear leucocytes and hyaline cast. Ultrastructure examination showed degenerated glomerular endothelial, untypical filtrating barrier, degenerated podocyte, mesangial cell, pathological proximal and distal tubular cell with damage microvilli. Treating rats with thyme oil after doxorubicin decreases the elevated levels of urea and creatinine. The glomeruli, Podocyte, intraglomerular mesangial cells and glomerular filtration barrier approximately restored its typical structure, the winding in Bouma’s space is disappeared. Most tubular cells have normal nuclei and cytoplasm. Thyme oil can improve renal functions, histological and ultrastructural changes induced by doxorubicin. So, it can be used to decrease its side effect on kidney. Keywords: Doxorubicin, Histology, Ultrastructure, Thyme oil, urea, creatinine.

Endothelial ADAM17 Expression in the Progression of Kidney Injury in an Obese Mouse Model of Pre-Diabetes

Disintegrin and metalloproteinase domain 17 (ADAM17) activates inflammatory and fibrotic processes through the shedding of various molecules such as Tumor Necrosis Factor-α (TNF-α) or Transforming Growht Factor-α (TGF-α). There is a well-recognised link between TNF-α, obesity, inflammation, and diabetes. In physiological situations, ADAM17 is expressed mainly in the distal tubular cell while, in renal damage, its expression increases throughout the kidney including the endothelium. The aim of this study was to characterize, for the first time, an experimental mouse model fed a high-fat diet (HFD) with a specific deletion of Adam17 in endothelial cells and to analyse the effects on different renal structures. Endothelial Adam17 knockout male mice and their controls were fed a high-fat diet, to induce obesity, or standard rodent chow, for 22 weeks. Glucose tolerance, urinary albumin-to-creatinine ratio, renal histology, macrophage infiltration, and galectin-3 levels were evaluated. Results showed that obese mice presented higher blood glucose levels, dysregulated glucose homeostasis, and higher body weight compared to control mice. In addition, obese wild-type mice presented an increased albumin-to-creatinine ratio; greater glomerular size and mesangial matrix expansion; and tubular fibrosis with increased galectin-3 expression. Adam17 deletion decreased the albumin-to-creatinine ratio, glomerular mesangial index, and tubular galectin-3 expression. Moreover, macrophage infiltration in the glomeruli of obese Adam17 knockout mice was reduced as compared to obese wild-type mice. In conclusion, the expression of ADAM17 in endothelial cells impacted renal inflammation, modulating the renal function and histology in an obese pre-diabetic mouse model.

Abstract 10915: Unappreciated Mechanisms of Fatty Acid Uptake in the Kidney: Fatty Acids Are Taken Up from Both Basolateral and Apical Side

Introduction: The kidney combusts a large amount of fatty acid (FA) for body fluid homeostasis. Despite the high demand for FA, however, little is known about the mechanisms of FA uptake. We aimed to determine how FAs are taken up by tubular epithelial cells. Methods and Results: Immunohistochemistry showed that CD36, known as an important FA transporter in the heart, was also expressed in the basolateral side of proximal tubule epithelial cells (PTECs). The uptake of 125 I-BMIPP, radio-labeled FA tracer, was significantly reduced in the kidney in CD36 knockout mice 1 min after its injection compared with wild-type mice, while the significant difference disappeared 30 min after the injection. In vivo imaging with two-photon microscopy revealed that BODIPY-C 12 , fluorescence-labeled FA tracer, was accumulated in the basolateral side (blood side) of PTECs shortly after its injection, which was followed by accumulation in the apical side (primary urine side), suggesting bidirectional FA uptake by PTECs. A large amount of neutral lipid was accumulated in the kidney when serum FA concentration was increased by accelerated lipolysis by administration of a β3 adrenergic receptor agonist. Immunofluorescence with cell-specific antibodies revealed that the cells with the most abundant lipid accumulation were PTECs, followed by tubular epithelial cells of the distal nephron. In addition, neutral lipid accumulation was enhanced even in the distal nephron when PTECs were injured with administrations of diphtheria toxin (DT) in mice overexpressing DT-receptor in a PTEC-specific manner. Importantly, the PTEC-injured mice exhibited marked albuminuria, suggesting disturbance of protein reabsorption. Despite marked albuminuria, however, urinary FA was not detected at all, suggesting complete FA reabsorption independently of albumin reabsorption in the kidney. Conclusions: Our results revealed the unique and prominent capability of proximal and distal tubular epithelial cells to take up FA from both blood (CD36-dependent) and primary urine (CD36-independent) and to store them as neutral lipids. We further suggest that the kidney acts not only as FA consuming tissue but also as FA keeping tissue to completely reabsorb FA from primary urine for unwasted energy use.

A CASE OF FANCONI SYNDROME SECONDARY TO LEGIONELLA PNEUMONIA

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Fanconi syndrome is a generalized dysfunction of the renal proximal tubules without primary glomerular involvement, characterized by wasting of phosphate, amino acids, or glucose by the proximal tubules. In addition, hypokalemia, hypouricemia, metabolic acidosis and proteinuria can be found (1, 2, 3). Acquired forms of Fanconi syndrome are caused by paraproteinemia, Sjogren syndrome, Primary Biliary Cirrhosis, and medications like cisplatin. Infectious diseases have not been reported as a common cause of Fanconi Syndrome (2). In this case report, we present an extremely rare case of Legionella pneumonia complicated by Fanconi syndrome. CASE PRESENTATION: A 42 year old woman with no past medical history was admitted to the hospital with fever, myalgias, diarrhea, and dyspnea. Vital signs on admission were; temperature 38.4 °C, blood pressure 114/57 mmHg, pulse 102 beats/min, respiration rate 20. Labs showed a white blood cell count of 10.9 x 10^3/ul, sedimentation rate of 126 mm/hr, procalcitonin 0.17 ng/ml, and C-reactive protein of 22.9 mg/dL. A CXR revealed a mild left lower lobe opacity compatible with pneumonia (figure 1). The patient tested positive for the Legionella urine antigen and was diagnosed with Legionella pneumonia. Multiple electrolyte abnormalities coexisted with the pneumonia including hypokalemia of 2.8mm/l, hypouricemia of 1.9mg/dl, hypophosphatemia of 1.8mg/dl and hypocalcemia of 8mg/dl. The patient's renal function was normal with no indication of metabolic acidosis. The urinalysis showed 4+ proteinuria, glucosuria and bilirubin with no WBCs. The patient was diagnosed with Fanconi Syndrome based on these findings. The patient was treated for Legionella pneumonia with Levaquin and improved clinically and serum electrolytes normalized. The repeat urinalysis after treatment revealed trace amounts of protein, negative glucose, decreased urobilinogen, and negative bilirubin. DISCUSSION: In this case because the electrolyte abnormalities disappeared after treatment for Legionella pneumonia and there was no evidence of other causes of Fanconi syndrome, it is most likely that Fanconi syndrome was associated with Legionella pneumonia. However, we are uncertain; (1) if Legionella pneumophila entered from basolateral/apical side of the renal proximal tubular cells and (2) why it specifically targeted the proximal tubular cells, developing reabsorption defects but not distal tubular cells. To our knowledge, only two cases (2, 3) have been reported in the literature linking Fanconi syndrome to Legionella pneumonia which makes our case exceedingly rare. CONCLUSIONS: This is an extremely rare case of Fanconi syndrome associated with Legionella pneumonia. Further studies are needed to understand the mechanisms responsible for electrolyte imbalances, which is important for the management of this potentially fatal infection. REFERENCE #1: Klootwijk ED, Reichold M, Unwin RJ, Kleta R, Warth R, Bockenhauer D. Renal Fanconi syndrome: taking a proximal look at the nephron. Nephrol Dial Transplant 30: 1456-1460, 2015. REFERENCE #2: Kinoshita-Katahashi, N., Fukasawa, H., Ishigaki, S., Isobe, S., Imokawa, S., Fujigaki, Y., & Furuya, R. (2013). Acquired Fanconi syndrome in patients with Legionella pneumonia. BMC nephrology, 14, 171. REFERENCE #3: Ryuge, A., Ito, Y., Yamakawa, T., Tanaka, H., Yasui, H., Mashimo, S., Watanabe, K., Nomura, R., Suganuma, N., & Maruyama, S. (2016). Fanconi Syndrome Associated with Hyponatremia in Two Patients with Legionella Pneumonia. Internal medicine (Tokyo, Japan), 55(23), 3479–3484. DISCLOSURES: No relevant relationships by Dilesha Kumanayaka, source=Web Response No relevant relationships by Richard Miller, source=Web Response No relevant relationships by Rutwik Patel, source=Web Response No relevant relationships by Bhavik Patel, source=Web Response

MP29-06 USE OF AUTOLOGOUS RENAL CELLS FROM DISEASED KIDNEYS FOR THE TREATMENT OF RENAL FAILURE

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder II (MP29)1 Sep 2021MP29-06 USE OF AUTOLOGOUS RENAL CELLS FROM DISEASED KIDNEYS FOR THE TREATMENT OF RENAL FAILURE Sunil George, Mehran Albolbashari, John Jackson, Tamer Aboushwareb, Anthony Atala, and James Yoo Sunil GeorgeSunil George More articles by this author , Mehran AlbolbashariMehran Albolbashari More articles by this author , John JacksonJohn Jackson More articles by this author , Tamer AboushwarebTamer Aboushwareb More articles by this author , Anthony AtalaAnthony Atala More articles by this author , and James YooJames Yoo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002026.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Chronic kidney disease (CKD) occurs when certain conditions cause the kidneys to gradually lose function. For patients with CKD, renal transplantation is the only treatment option that restores kidney function. In this study, we evaluated primary renal cells obtained from diseased kidneys to determine whether their normal phenotypic and functional characteristics are retained, and could be used for cell therapy. METHODS: Renal cells were isolated and cultured from three normal kidneys (NK) and three kidneys from donors with CKD. Primary renal cells from each group were evaluated for cell growth patterns and histo-morphological analyses. To confirm renal specific phenotypes, immunofluorescent staining was performed on the cultured cells using renal cell specific markers. Scanning and transmission electron microscopy were performed for surface and ultrastructural analysis. Glutathione assay, sodium uptake function and albumin uptake assay were performed to evaluate cellular function. RESULTS: Primary renal cells isolated from both normal kidneys (NK) and diseased kidneys (CKD) showed similar phenotypic characteristics and growth kinetics. The expression levels of renal tubular cell markers, Aquaporin-1 and E-Cadherin, and podocyte-specific markers, WT-1 and Nephrin, were similar in both NK and CKD kidney derived cells. Using fluorescence- activated cell sorting (FACS), specific renal cell populations were identified and included proximal tubular cells (83.1 % from NK and 80.3 % from CKD kidneys); distal tubular cells (11.03 % from NK and 10.9 % from CKD kidneys); and podocytes (1.91 % from NK and 1.78 % from CKD kidneys). Ultra-structural analysis using scanning electron microscopy (SEM) revealed microvilli on the apical surface of cultured cells from NK and CKD samples. Moreover, transmission electron microscopy (TEM) analysis showed a similar organization of tight junctions, desmosomes, and other intracellular structures. The Na+ uptake characteristics of NK and CKD derived renal cells were also similar (24.4 mmol/L and 25 mmol/L, respectively) and no significant differences were observed in the protein uptake and transport characteristics of these two cell isolates. CONCLUSIONS: These results show that primary renal cells derived from diseased kidneys such as CKD have similar structural and functional characteristics to their counterparts from a normal healthy kidney (NK) when grown in vitro. This study suggests that cells derived from diseased kidney may be used as an autologous cell source for renal cell therapy, particularly in patients with CKD or end-stage renal disease (ESRD). Source of Funding: Tengion, Inc © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e491-e492 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sunil George More articles by this author Mehran Albolbashari More articles by this author John Jackson More articles by this author Tamer Aboushwareb More articles by this author Anthony Atala More articles by this author James Yoo More articles by this author Expand All Advertisement Loading ...

Calcium oxalate monohydrate crystal disrupts tight junction via F-actin reorganization

Tight junction is an intercellular protein complex that regulates paracellular permeability and epithelial cell polarization. This intercellular barrier is associated with actin filament. Calcium oxalate monohydrate (COM), the major crystalline composition in kidney stones, has been shown to disrupt tight junction but with an unclear mechanism. This study aimed to address whether COM crystal disrupts tight junction via actin deregulation. MDCK distal renal tubular epithelial cells were treated with 100 μg/ml COM crystals for 48 h. Western blot analysis revealed that level of a tight junction protein, zonula occludens-1 (ZO-1), significantly decreased, whereas that of β-actin remained unchanged after exposure to COM crystals. Immunofluorescence study showed discontinuation and dissociation of ZO-1 and filamentous actin (F-actin) expression at the cell border. In addition, clumping of F-actin was found in some cytoplasmic areas of the COM-treated cells. Moreover, transepithelial resistance (TER) was reduced by COM crystals, indicating the defective barrier function of the polarized cells. All of these COM-induced defects could be completely abolished by pretreatment with 20 μM phalloidin, an F-actin stabilizer, 2-h prior to the 48-h crystal exposure. These findings indicate that COM crystal does not reduce the total level of actin but causes tight junction disruption via F-actin reorganization.

Expression of renal vitamin D receptors and metabolizing enzymes in IgA nephropathy

AimOne of the main causes of end-stage renal disease (ESRD) in the world is IgA nephropathy (IgAN). Since kidney is a key player in vitamin D metabolism, we investigated the expression of renal vitamin D receptors (VDR) and metabolizing enzymes in IgA nephropathy patients (IgAN-P). MethodsThe sample included twelve IgAN-P who underwent ultrasound-guided renal biopsies and five controls who underwent nephrectomy due to clear renal carcinoma. Immunofluorescent staining was used to determine the expression of VDR, 25-hydroxyvitamin D3 -alpha-hydroxylase (1alpha-OHase) and vitamin D3 24-hydroxylase (CYP24A1). ResultsSignificant increase in expression of VDR, which was prominent in distal tubular cells (DTCs) in tissues from IgAN-P, was found in comparison to the controls (p = 0.0368). The expression of 1alpha-OHase, calcitriol synthesizing enzyme, was significantly lower in IgAN-P, in comparison with controls (p < 0.0001). The opposite, expression of CYP24A1 (vitamin D degrading enzyme), was significantly higher in IgAN-P in comparison with controls (p = 0.0003). Additionally, we found significant negative correlation between percentage of CYP24A1 immunoreactive nuclei in proximal tubular cells (PTCs) and estimated glomerular filtration rate (eGFR) in IgAN-P (r = −0.6139; p = 0.0337). ConclusionsOur research indicates substantially decreased renal calcitriol production and increased vitamin D degradation in kidneys of IgAN-P, but larger studies are needed to confirm our results.

SARS-CoV-2 Causes Acute Kidney Injury by Directly Infecting Renal Tubules.

Acute kidney injury (AKI) is one of the most prevalent complications among hospitalized coronavirus disease 2019 (COVID-19) patients. Here, we aim to investigate the causes, risk factors, and outcomes of AKI in COVID-19 patients. We found that angiotensin-converting enzyme II (ACE2) and transmembrane protease serine 2 (TMPRSS2) were mainly expressed by different cell types in the human kidney. However, in autopsy kidney samples, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleoprotein was detected in ACE2+ or TMPRSS2+ renal tubular cells, whereas the RNAscope® Assay targeting the SARS-CoV-2 Spike gene was positive mainly in the distal tubular cells and seldom in the proximal tubular cells. In addition, the TMPRSS2 and kidney injury marker protein levels were significantly higher in the SARS-CoV-2-infected renal distal tubular cells, indicating that SARS-CoV-2-mediated AKI mainly occurred in the renal distal tubular cells. Subsequently, a cohort analysis of 722 patients with COVID-19 demonstrated that AKI was significantly related to more serious disease stages and poor prognosis of COVID-19 patients. The progressive increase of blood urea nitrogen (BUN) level during the course of COVID-19 suggests that the patient’s condition is aggravated. These results will greatly increase the current understanding of SARS-CoV-2 infection.

MO263KLOTHO IS PROTECTIVE IN THE CONTEXT OF ACUTE GLOMERULAR INJURY BUT IS NOT EXPRESSED IN PODOCYTES

Abstract Background and Aims Podocyte integrity is crucial for the maintenance of glomerular function in health and disease. Numerous studies have reported that Klotho overexpression, or treatment with recombinant Klotho, reduces glomerular and tubular damage in mouse models of renal disease. However, the mechanism(s) of action are not fully understood. Several recent studies have also reported that Klotho is expressed in podocytes, where it protects against various types of injury. These findings conflict with previous studies, which have shown that renal Klotho expression is exclusively confined to proximal and distal tubular cells. Method To address this discrepancy and enhance our understanding of the putative glomeruloprotective effects mediated by Klotho, we examined the expression pattern of Klotho in human and mouse kidney by several different methods, and explored its protective effects by overexpressing full-length human Klotho directly in podocytes or in a distant organ (i.e. liver). Results Data at the mRNA and protein levels all converged towards an absence or very low expression of Klotho in podocytes. The generation of a podocyte-specific Klotho knockout mouse further demonstrated that its deletion did not affect glomerular structure or function. Moreover, Klotho deficiency did not worsen glomerular injury in an experimental model of glomerulonephritis (anti-GBM). However, when Klotho was overexpressed in hepatocytes (Alb-cre;hKlothofl/+ - Alb-hKL), serum Klotho increased drastically with no changes in Fgf23 or phosphate metabolism. In mice challenged with anti-GBM, renal histology and ultrastructure of the filtration barrier was less severely affected in Alb-hKL compared to WT mice. There were also significantly less albuminuria, podocyte loss and interstitial fibrosis in Alb-hKL mice compared to their WT littermates. In contrast, mice which overexpressed Klotho in podocytes (Pod-hKL) were not protected from renal injury. Conclusion Taken together, these results strongly suggest that Klotho is not expressed in any substantial amounts in human or mouse podocytes, and that membrane-bound Klotho does not play a role in podocyte biology. Importantly, our results confirm a beneficial role for soluble Klotho in protecting podocytes against injury, and in maintaining glomerular integrity and function.

Subcellular spatio-temporal intravital kinetics of aflatoxin B1 and ochratoxin A in liver and kidney

Local accumulation of xenobiotics in human and animal tissues may cause adverse effects. Large differences in their concentrations may exist between individual cell types, often due to the expression of specific uptake and export carriers. Here we established a two-photon microscopy-based technique for spatio-temporal detection of the distribution of mycotoxins in intact kidneys and livers of anesthetized mice with subcellular resolution. The mycotoxins ochratoxin A (OTA, 10 mg/kg b.w.) and aflatoxin B1 (AFB1, 1.5 mg/kg b.w.), which both show blue auto-fluorescence, were analyzed after intravenous bolus injections. Within seconds after administration, OTA was filtered by glomeruli, and enriched in distal tubular epithelial cells (dTEC). A striking feature of AFB1 toxicokinetics was its very rapid uptake from sinusoidal blood into hepatocytes (t1/2 ~ 4 min) and excretion into bile canaliculi. Interestingly, AFB1 was enriched in the nuclei of hepatocytes with zonal differences in clearance. In the cytoplasm of pericentral hepatocytes, the half-life (t1/2~ 63 min) was much longer compared to periportal hepatocytes of the same lobules (t1/2 ~ 9 min). In addition, nuclear AFB1 from periportal hepatocytes cleared faster compared to the pericentral region. These local differences in AFB1 clearance may be due to the pericentral expression of cytochrome P450 enzymes that activate AFB1 to protein- and DNA-binding metabolites. In conclusion, the present study shows that large spatio-temporal concentration differences exist within the same tissues and its analysis may provide valuable additional information to conventional toxicokinetic studies.

Soluble α-klotho anchors TRPV5 to the distal tubular cell membrane independent of FGFR1 by binding TRPV5 and galectin-1 simultaneously.

Hypercalciuria is one of the early manifestations of diabetic nephropathy (DN). This is partially due to a decrease in the expression of renal transient receptor potential vanilloid type 5 (TRPV5), which is responsible for renal Ca2+ reabsorption. Soluble klotho has been previously determined to increase TRPV5 by cleaving sialic acid, causing TRPV5 to bind to membrane protein galectin-1. However, a recent study showed that soluble klotho binds to α2-3-sialyllactose, where sialic acid is located, on TRPV5, rather than cleave it. Here, we report that soluble klotho tethers TRPV5 on the membrane by binding both TRPV5 and galectin-1, thereby protecting membrane TRPV5 from diabetes-induced endocytosis. In the present study, we injected recombinant soluble α-klotho protein (rKL) into db/db and db/m mice for 8 wk and collected urine and kidneys. We administered rKL, AZD4547 [fibroblast growth factor (FGF) receptor type 1 inhibitor], and OTX008 (galectin-1 inhibitor) to cultured mouse distal tubular cells with or without 30 mM high-glucose (HG) exposure. db/db mice showed increased renal Ca2+ excretion and decreased renal TRPV5 expression. rKL treatment reversed this change. In vitro, TRPV5 expression in distal tubular cells decreased under HG conditions, and rKL successfully upregulated TRPV5 with or without FGF23. Also, immunofluorescence showed colocalization of klotho, TRPV5, and galectin-1 in distal tubule cells, suggesting that klotho binds to both TRPV5 and galectin-1. Moreover, when both FGF receptor type 1 and galectin-1 were inhibited, rKL failed to increase TRPV5 under HG conditions. Our results indicate that soluble klotho prevents TRPV5 from degradation and subsequent diabetes-induced endocytosis by anchoring TRPV5 through binding with both TRPV5 and galectin-1.NEW & NOTEWORTHY Soluble α-klotho anchors transient receptor potential vanilloid type 5 (TRPV5) on the apical membrane of the distal tubule by binding both TRPV5 and a membrane-abundant protein, galectin-1. This newly discovered mechanism works even when fibroblast growth factor (FGF)23 signaling is inhibited by treatment with FGF receptor type 1 inhibitor. Therefore, we identified how soluble α-klotho increases TRPV5 without FGF23. We confirmed this mechanism by observing that soluble α-klotho fails to enhance TRPV5 when both FGF receptor type 1 and galectin-1 are inhibited.