Elevated Renal Blood Flow Research Articles

Role of TLR4 in lipopolysaccharide-induced acute kidney injury: Protection by blueberry

Inflammation has been implicated in the pathophysiology of kidney disorders. Previous studies have documented the contributions of various inflammatory cascades in the development of kidney and other organ dysfunctions. The Toll-like receptor 4 (TLR4) inflammatory pathway is a major contributor of inflammation in the kidney. Interestingly, lipopolysaccharide (LPS), a specific ligand for TLR4, has been shown to induce acute kidney injury (AKI) in animal models. We have previously studied the beneficial effects of nonpharmacological agents, particularly blueberries (BB), in attenuating inflammation and oxidative stress. We hypothesize that BB protect against the LPS-induced AKI by inhibiting TLR4 activation and kidney injury markers. Twelve-week-old male Sprague-Dawley rats received a BB solution or saline intragastric gavage for 2 days. One group of BB and saline-gavaged animals was injected with LPS (10mg/kg bw). Another group of rats was injected with VIPER (0.1mg/kg iv), a TLR4-specific inhibitory peptide, 2h before LPS administration. Compared to LPS-administered rats, the BB-pretreated animals exhibited improved glomerular filtration rate, elevated renal blood flow, and a reduced renal vascular resistance. In addition, a reduction in the rate of production of free radicals, namely total reactive oxygen species (ROS) and superoxide, was observed in the BB-supplemented LPS group. Gene and protein expressions for TLR4, proinflammatory cytokine, and acute kidney injury markers were also attenuated in animals that were pretreated with BB as measured by real time RT-PCR and Western blotting, respectively. These results in the BB-pretreated group were consistent with those in the VIPER-treated rats, and indicate that BB protects against AKI by inhibiting TLR4 and its subsequent effect on inflammatory and oxidative stress pathways.

Effect of selective inhibition of renal inducible nitric oxide synthase on renal blood flow and function in experimental hyperdynamic sepsis*

Nitric oxide plays an important role in the control of renal blood flow and renal function. In sepsis, increased levels of inducible nitric oxide synthase produce excessive nitric oxide, which may contribute to the development of acute kidney injury. We, therefore, examined the effects of intrarenal infusion of selective inducible nitric oxide synthase inhibitors in a large animal model of hyperdynamic sepsis in which acute kidney injury occurs in the presence of increased renal blood flow. Prospective crossover randomized controlled interventional studies. University-affiliated research institute. Twelve unilaterally nephrectomized Merino ewes. Infusion of a selective (1400W) and a partially selective inducible nitric oxide synthase inhibitor (aminoguanidine) into the renal artery for 2 hrs after the induction of sepsis, and comparison with a nonselective inhibitor (Nω-nitro-L-arginine methyl ester). In sheep with nonhypotensive hyperdynamic sepsis, creatinine clearance halved (32 to 16 mL/min, ratio [95% confidence interval] 0.51 [0.28-0.92]) despite increased renal blood flow (241 to 343 mL/min, difference [95% confidence interval] 102 [78-126]). Infusion of 1400W did not change renal blood flow, urine output, or creatinine clearance, whereas infusion of Nω-nitro-L-arginine methyl ester and a high dose of aminoguanidine normalized renal blood flow, but did not alter creatinine clearance. In hyperdynamic sepsis, intrarenal infusion of a highly selective inducible nitric oxide synthase inhibitor did not reduce the elevated renal blood flow or improve renal function. In contrast, renal blood flow was reduced by infusion of a nonselective NOS inhibitor or a high dose of a partially selective inducible nitric oxide synthase inhibitor. The renal vasodilatation in septic acute kidney injury may be due to nitric oxide derived from the endothelial and neural isoforms of nitric oxide synthase, but their blockade did not restore renal function.

Core Concepts: Neonatal Glomerular Filtration Rate

Although the placenta is the primary organ responsible for fetal clearance and electrolyte homeostasis, fetal kidneys contribute to amniotic fluid production and fetal hemodynamics. Maternal factors can significantly influence fetal urinary output and blood pressure. Maturation of neonatal glomerular filtration rate (GFR) depends on the development of renal blood flow (RBF). After birth, a marked increase in systemic blood pressure and decrease in renal vascular resistance results in elevated RBF and consequent increases in GFR. Vasoactive factors, including renin, angiotensin II, glucocorticoids, nonsteroidal anti-inflammatory drugs, nitric oxide, prostaglandins, bradykinin, and endothelin, each play vital roles in the regulation and development of neonatal GFR. Prematurity and intrauterine growth restriction (IUGR) may affect renal endowment and place infants at risk for hypertension and accelerated loss of renal function later in life.

Nitric Oxide Mediates Redistribution of Intrarenal Blood Flow during Bacteremia

The normal or hyperdynamic circulatory response during the early phases of the systemic septic response is associated with renal microvascular constriction and can result in renal dysfunction. Intrarenal redistribution of blood flow from the outer cortex to the medulla appears to account for decreased glomerular filtration in spite of normal or elevated renal blood flow, but the mechanisms of this response are not well described. Nitric oxide is recognized as an important regulator of regional blood flow during both normal and pathologic conditions including sepsis, and we hypothesized that alterations in nitric oxide contribute to redistribution of renal blood flow during sepsis. The current study used laser Doppler fluximetry and clearance of p-aminohippuric acid (effective renal plasma flow, ERPF) to study intrarenal distribution of blood flow during basal conditions and during normodynamic Escherichia coli bacteremia, with and without inhibition of nitric oxide. Inhibition of nitric oxide in normal animals resulted in a decrease in ERPF (-19%) with a decrease in cortical flux (-39%) without alteration of medullary flux. Bacteremia resulted in a decrease in cortical flow (-17%), an increase in medullary flow (36%), and a modest reduction (-9%) in ERPF. Inhibition of nitric oxide synthase during bacteremia worsened cortical flow (-43%), reversed the increase in medullary flux (-42%), and further impaired ERPF (-28%). These data suggest that nitric oxide regulates renovascular tone during normal conditions and bacteremia, and indicate that it is a prime mediator of intrarenal redistribution of blood flow during sepsis.

Duplex sonography of renal arteries as a diagnostic tool in hypertensive children

Computed duplex sonography was used to examine the renal arteries in 36 hypertensive children and adolescents (ages 4-17 years) with arterial hypertension of either renal or non-renal origin. Time-averaged flow velocities, maximum blood flow velocities as well as absolute renal blood flow and renal blood flow per gram kidney weight were measured. Normal flow velocities and normal to elevated renal blood flow volume was found in patients with acute glomerulonephritis and those with signs of chronic glomerulonephritis onset. Patients having advanced stages of chronic glomerulonephritis, on the other hand, were characterized by lower levels of all parameters. Unilateral renal artery stenosis was diagnosed correctly in four patients, although one intra-renal artery stenosis escaped imaging. Scarred kidneys exhibited low-normal or reduced flow velocities and renal blood flow volumes corresponded roughly to kidney size and preservation of normal kidney structure. Hypertension in some patients with normal kidneys showed a tendency to cause higher renal blood flow without consistent acceleration of blood flow velocities. We conclude that duplex sonography is a suitable primary diagnostic tool in measuring blood flow velocities and absolute renal blood flow volume in hypertensive children, thus facilitating the choice of the next diagnostic step.

Renal vascular response to amino acids: effect of pancreatectomy

We ascertained the importance of glucagon in modulating the renal hemodynamic response to amino acid (AA) infusion in anesthetized dogs. In controls (n = 6), AAs (L-serine, alanine, and proline; 0.051 mmol.kg-1.min-1 iv) elevated renal blood flow (RBF) and glomerular filtration rate (GFR) by 35 and 34%, respectively, while elevating arterial plasma glucagon-like immunoreactivity (AGLI) by 96 pmol/l. In control pancreatectomized (PX) dogs (n = 6), all parameters remained at control values over 2 h. In PX dogs, AAs (n = 6) failed to reproduce the renal hemodynamic and AGLI responses elicited by AAs in controls. In PX dogs infused with AAs, replacement of AGLI (n = 6) to an incremental plasma level of 111 pmol/l, a level no different than that produced by AAs in controls, elevated RBF and GFR by 25 and 26.5%, respectively. These hemodynamic responses were 71 and 78%, respectively, of the total responses elicited by AAs in controls. In PX dogs infused with glucagon alone (0.86 pmol.kg-1.min-1; n = 6), an incremental change in AGLI of 112 pmol/l was accompanied by only small increases in RBF and GFR (9%). These data suggest the importance of glucagon in modulating the renal hyperemia and hyperfiltration ascribed to AA infusion in anesthetized dogs.

Effects of amino acid isomers on canine renal hemodynamics

The major objective of this study was to ascertain whether the renal hemodynamic response to amino acid infusion in dogs is stereospecific. To test this hypothesis, we examined the renal hemodynamic effects of two isomers (L and D) of an amino acid mixture of serine, alanine, and proline (SAP; 0.051 mmol.kg-1.min-1) in anesthetized dogs. Intravenous infusion of L-SAP (n = 6) significantly elevated renal blood flow (RBF) and glomerular filtration rate (GFR) by 33 +/- 3 and 30 +/- 5%, respectively, over 1 h. DL-SAP (n = 6) elevated RBF and GFR by only 14 +/- 3 and 13 +/- 3%, respectively. Yet D-SAP (n = 6) failed to elevate either RBF or GFR over 1 h. Intravenous mannitol (940 mos-mol/kg; osmotic control; n = 6) also failed to elevate renal hemodynamics. In six other dogs, intrarenal infusion of L-, but not D-, SAP marginally elevated RBF and GFR by 13 +/- 2 and 12 +/- 2%, respectively, over 1 h. Infusion of alpha-aminoisobutyric acid (0.051 mmol.kg-1.min-1; n = 6), an amino acid analogue that is cotransported with sodium but not metabolized by renal cells, elevated RBF and GFR by 22 +/- 5 and 18 +/- 6%, respectively, over 1 h. These data indicate that vascular infusion of L, but not D, isomers of amino acids elevate RBF and GFR. We therefore suggest the importance of amino acid stereospecificity in the renal vascular response to amino acid infusion in dogs.

Renal hemodynamic response to galanin: importance of elevated plasma glucose

Although recent data point to a possible indirect role for galanin in modulating renal blood flow (RBF) and fluid homeostasis in experimental animals, there have been no systematic studies exploring the possible direct effects of the peptide on the mammalian kidney. We ascertained the RBF, glomerular filtration rate (GFR) and plasma glucose responses to direct intrarenal infusion of three progressively increasing doses of synthetic galanin in anesthetized dogs. A 50 ng/kg per min dose ( n = 6) failed to affect RBF, GFR or arterial plasma glucose (APG). Yet, a 100 ng/kg per min dose elevated RBF and GFR by 13 and 14%, respectively, while concomitantly increasing APG by 38%. At 200 ng/kg per min, galanin elevated RBF and GFR by 32 and 33%, respectively, while elevating APG by 57%. Intrarenal infusion of glucose (12.5 mg/kg per min; n = 6), reproducing the percentage rise in glucose (62%) elicited by the highest dose of galanin, elevated RBF and GFR by 20 and 23%, respectively. These data indicate that the elevated plasma glucose level, stimulated by galanin infusion, may account for about 63 and 70% of the RBF and GFR responses, respectively, elicited by galanin infusion at the 200 ng dose. The factors mediating the remaining renal hyperemia and hyperfiltration await resolution.

Nature of the renal hemodynamic action of amino acids in dogs

Anesthetized dogs were used to study the nature of the renal hyperemia and hyperfiltration ascribed to amino acids. Intravenous (n = 6) or intraportal venous (n = 6) infusion of a solution of three metabolizable amino acids [serine, alanine, and proline (SAP) approximately 0.051 mmol.kg-1.min-1] elevated renal blood flow (RBF) and glomerular filtration rate (GFR) by a similar amount (30%) over the same time course (60 min). Yet, direct intra-arterial infusion of SAP into the kidney at either approximately 0.0051 or 0.051 mmol.kg-.min-1 (n = 12) failed to significantly elevate either RBF or GFR over 60 min. A transient increase in RBF (approximately 13%) was, however, noted by minute 15 of the infusion. Unlike SAP, intraportal venous infusion of a physiological dose of branched-chain amino acids (valine, leucine, and isoleucine, approximately 0.0195 mmol.kg-1.min-1, n = 6) failed to elevate either RBF or GFR over 60 min. By comparison, either intravenous or intraportal venous infusion of SAP at approximately 0.020 mmol.kg-1.min-1 (n = 12) elevated renal hemodynamics by approximately 14% over 60 min. The data suggest that the liver does not directly mediate amino acid-induced increases in renal hemodynamics but that some other intermediary step activated following amino acid administration may be necessary before the renal hyperemia and hyperfiltration ascribed to amino acids are manifested in anesthetized dogs.

Effect of Volume Expansion on Hemodynamics of the Hypoperfused Rat Kidney

The hemodynamics of the rat kidney were studied during reduction of renal arterial pressure to 35-40 mm Hg (H), and after volume expansion at that pressure with 0.9% NaCl (IS), 1.7% NaCl (HS), 5% mannitol in 0.9% NaCl (MS), 5% mannitol in water (MW), or 50 mM mannitol + 125 mM NaCl. During H, left renal blood flow (RBF) was 0.8+/-0.1 ml/min. Expansion with IS did not alter RBF, but expansion with HS, MS, MW, and 50 + 125 mM NaCl elevated RBF to 200-250% of hypoperfusion values. Glomerular capillary pressure rose significantly from 15.7+/-0.7 mm Hg during H to 22.3+/-1.1, 24.4+/-0.7, and 26.6+/-0.7 mm Hg following expansion with HS, MS, or MW, respectively. Efferent arteriolar pressure also rose significantly to 6.9+/-0.5, 9.7+/-0.8, and 9.5+/-0.9 mm Hg, respectively. Preglomerular resistance fell to 18-24% of H values, and postglomerular resistance fell to 58-74% of H values after expansion with HS, MS, or MW. Glomerular filtration (GFR) could not be detected during H or after IS expansion. HS and mannitol-containing solutions restored GFR to 0.10+/-0.02-0.15+/-0.02 ml/min, and single nephron glomerular filtration to 6-12 nl/min. Papaverine, acetylcholine, and kinins had no effect on RBF or GFR at a perfusion pressure of 35-40 mm Hg. We conclude that mannitol and HS have the capacity to augment RBF during hypoperfusion by reducing arteriolar resistance. The mechanism of the rise in RBF is uncertain; it may be due to changes in effective osmolality of the extracellular fluid or to a direct action of mannitol on vascular smooth muscle. Other potent vasodilators were ineffective during hypoperfusion. Restoration of GFR occurs as a result of the combined effects of augmented RBF and elevated net filtration pressure.