Renal Blood Research Articles

Abstract P174: Loss of Bmal1 in the Collecting Duct Lowers Blood Pressure in Male, but Not Female, Mice

Kidney function follows a 24-hour rhythm that is subject to regulation by so-called circadian clock genes. Previous studies suggested a potential role of circadian gene Bmal1 in regulating renal excretory function and blood pressure, yet the mechanism is not completely clear. Our lab showed that high salt diet induces a phase shift in Bmal1 expression in the renal inner medulla that is dependent on endothelin B receptor (ET B ) function. In addition, the ET B receptor-mediated natriuretic effect is time-of-day- and sex-dependent. We recently generated a mouse model that lacks Bmal1 expression in principal cells of the renal collecting duct, which has the highest concentration of ET B receptor. The current study was designed to test the hypothesis that Bmal1 in the collecting duct regulates blood pressure in a sex-dependent manner. Male (n=8-9) and female (n=6) collecting duct Bmal1 knockout (CD Bmal1 KO) and floxed control (flox) mice were implanted with telemetry transmitters, and fed normal salt (0.49% NaCl) diet (NS) for 6 days, followed by 6 days of high salt (4% NaCl) diet (HS). After this period, mice were treated with an ET B receptor antagonist (A-192621; 30mg/kg/day) for another 6 days. At the end of the study, we performed cosinor analysis on telemetry data collected throughout the study. Under NS, male CD Bmal1 KO showed significantly lower 24-hr mean arterial pressure (MAP) compared to flox (105±1 vs 112±1 mmHg, p=0.01). However, we did not observe any significant differences in the MAP of female mice (106±1 vs 108±1 mmHg, p=0.26). Under HS, MAP of male CD Bmal1 KO was significantly lower compared to flox (107±1 vs 114±1, p=0.01). No significant differences were observed in female mice (109±1 vs 110±1 mmHg, p=0.63). In male CD Bmal1 KO, the increase in MAP in response to the ET B receptor antagonist was significantly attenuated compared to flox (124±1 vs 130±1 mmHg, p<0.01). However, the increase in MAP in female mice was not significantly different between CD Bmal1 KO and flox (130±1 vs 127±2 mmHg, p=0.33) during ET B blockade. There were no differences in the amplitude of diurnal MAP between genotype in either sex on any diet. These data suggest that collecting duct Bmal1 plays an important role in blood pressure regulation in male, but not female, mice.

Endovascular treatment of transplant renal artery stenosis based on hemodynamic assessment using a pressure wire: a case report

BackgroundTransplant renal artery stenosis (TRAS) is a serious complication after renal transplantation, leading to hypertension, deterioration in renal function, and/or graft loss. The incidence of TRAS reportedly varies from 1 to 23%, depending on its definition or diagnostic tools. The hemodynamic definition or therapeutic indication of TRAS is unclear.Case presentationA 66-year-old man with a history of diabetes, chronic kidney disease, and angina presented with a 2-week history of dyspnea and leg edema. He had undergone living-donor kidney transplantation for end-stage renal disease secondary to diabetic nephropathy 7 years earlier. He developed acute deterioration in renal function after the administration of an angiotensin II receptor blocker and required emergency hospitalization owing to acute congestive heart failure with pulmonary edema. A vasodilator and loop diuretics were administered following his admission, and the patient’s symptoms resolved quickly. Further investigation, including magnetic resonance angiography and ultrasonography, revealed severe stenosis of the transplant renal artery. Renal arteriography and pressure gradient measurement using a 0.014-inch pressure wire were performed. The systolic pressure gradient was 40 mmHg, and the resting Pd/Pa ratio (ratio of mean distal to lesion and mean proximal pressures) was 0.90 without hyperemia. Hemodynamically significant stenosis was suspected. Intravascular ultrasonography revealed vessel shrinkage in the stenotic area, suggestive of the end-to-end anastomosis site. Pre-dilation using a 4-mm balloon, implantation of a 6-mm self-expandable stent, and post-dilatation using a 5-mm balloon were performed. Although the moderate stenosis persisted angiographically, the systolic pressure gradient dropped to 20 mmHg with the mean systolic pressure ratio increased to 0.95, which was considered an acceptable result. One month after the procedure, the patient’s renal function and blood pressure control had significantly improved.ConclusionsHemodynamic assessment using a pressure wire is useful in determining the appropriate therapeutic indication and endpoint of endovascular treatment of TRAS.

Study on the relationship between left atrial diameter with serum uric acid level in male patients with essential hypertension

Objective To study the relationship between serum uric acid and left atrial size in male patients with essential hypertension. Methods From June 2015 to December 2016, 298 males with essential hypertension in the People′s Hospital of Guangdong Province were selected.They were divided into normal left atrial group and enlarged left atrial group based on the size of left atrial diameter.The fasting blood glucose, serum lipid, serum uric acid, hepatic and renal function and blood pressure were measured by routine methods, and multivariate logistic regression was used to analyze. Results The average age and serum uric acid level of 298 males with essential hypertension were (55.29±8.48) years old and (488.93±112.46)μmol/L.There were 47 cases with enlarged left atrial.The serum uric acid level in the enlarged left atrial group was significant higher than that in the normal left atrial group[(512.21±90.82)μmol/L vs.(474.38±94.26)μmol/L, t=9.34, P<0.001]. Pearson correlation analysis showed that serum uric acid level was positively associated with left atrial diameter(r=0.589, P<0.001). Multiple logistic regression analysis showed that the serum uric acid level was a risk factor for enlarged left atrial(OR=1.894, 95%CI: 1.13, 2.69; P<0.001). Conclusion Serum uric acid level is positively correlated with left atrial size in male patients with essential hypertension, and is a risk factor for enlarged left atrial. Key words: Atrial funcyion, left; Hypertension; Serum uric acid; Men

High Dietary Salt Intake Drives Sympathetically Mediated Alpha‐1 Adrenoceptor Regulation of NCC to Increase Renal Sodium Retention and Blood Pressure via an OXSR1 Dependent Pathway

BackgroundAcute studies have suggested that sympathetic nervous system (SNS) release of norepinephrine (NE) mediates upregulation of the sodium chloride cotransporter (NCC) via synergistic α1 and β adrenergic receptor pathways. Moreover, recent data suggests a key role of oxidative stress responsive 1 (OXSR1), in NCC regulation.HypothesisNorepinephrine (NE) activates an α1 adrenoceptor pathway that is dependent on OXSR1 to mediate increases in NCC activity that drive the development of salt sensitive hypertension (HTN).MethodsMale Sprague‐Dawley (SD) rats receiving a continuous s.c. saline or NE (600ng/min) infusion were fed a 0.6% (NS) or 4% NaCl (HS) diet for 14 days respectively. Separate groups of NE infused SD rats were given terazosin (10mg/kg/day; s.c.) and a NS or HS diet for 14‐days. An OXSR1 targeted lentivirus was injected in the kidneys of NE infused SD rats prior to a 14 day HS diet. On day 14 basal MAP, NCC activity (peak natriuresis to iv hydrochlorothiazide (HCTZ; 2mg/kg) infusion) and peak MAP change in response to ganglionic blockade (iv hexamethonium; 30mg/kg) were assessed. NCC expression, phosphoNCC, and OXSR1 levels were assayed via immunoblotting (N=4/gp).ResultsSD rats remain normotensive when fed a high salt diet and NCC expression and activity is downregulated. NE infusion however, inhibits the NCC downregulation associated with HS intake and evokes salt sensitive HTN. Use of an α1‐adrenoceptor antagonist in NE infused SD rats abolishes salt sensitive HTN and downregulates NCC activity. Significantly, lentiviral knockdown of OXSR1 (confirmed by immunoblot) also eliminates salt sensitive HTN in a similar fashion. Furthermore, ganglionic blockade did not produce any observable differences in NE infused rats on HS or NS that were treated or not treated with the α1‐adrenoceptor antagonist or lentivirus.ConclusionOur data reveals that SNS release of NE can modulate NCC activity via an α1‐adrenoceptor pathway to prevent dietary evoked salt sensitive HTN. Remarkably, both OXSR1 knockdown and α1‐adreoceptor antagonism reverse salt sensitive HTN. As a theoretical model, the SNS release of NE activates a linear α1‐adreoceptor pathway that stimulates OXSR1 mediated regulation of NCC. The PATHWAY‐2 Trail implicates sodium retention as a driver of resistant HTN suggesting that α1‐adreoceptor antagonism and OXSR1 blockade may represent novel therapeutic targets for HTN.Support or Funding InformationThis work was supported by NIH grants R01HL107330 and K02HL112718 and AHA grants 16MM32090001 and AHA17GRNT3367002 to RDW and NIH grant F31DK116501 to AAF.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Striking a balance between renal ischemia and excessive blood loss decreases risk of acute kidney injury following partial nephrectomy of solitary kidney

Striking a balance between renal ischemia and excessive blood loss decreases risk of acute kidney injury following partial nephrectomy of solitary kidney

Renal FGFR1 signaling and blood pressure regulation

Renal FGFR1 signaling and blood pressure regulation

The value of superb microvascular imaging in evaluating the renal function of transplanted kidney

Objective To investigate the value of vascular index(VI) in renal functionevaluation after renal transplantation by superb microvascular imaging(SMI). Methods Ultrasound and clinical data of 115 renal transplant recipients were collected: 32 cases had good recovery of renal function after surgery(group A); 35 cases of abnormal renal function caused by diseases or unexplained fluctuations in Scr, but the renal function was normal during the follow-up(group B); 48 cases with abnormal renal function, Scr increased continuously(group C). The correlation between VI of renal cortex and Scr was analysed. Results The VI of renal cortex in group A, B and C were (33.51±3.26)%, (31.64±4.83)%, (25.58±6.07)%, respectively. There were significant differences between VI in group A and C, and between group B and C (P 0.05). There was significant negative correlation between VI of renal cortex and Scr in group C (rs=-0.90, P 0.05). Conclusions When renal function is normal, VI is maintained at a high level. When renal function declines, VI decreases. VI can reflect the renal cortex blood flow, indirectly reflect the glomerular filtration function, and provide a reliable indicator for clinical evaluation of renal allograft function. Key words: Ultrasonography; Kidney transplantition; Superb microvascular imaging; Vascular index

Relationship between left atrial diameter with serum glutamyl transpeptidase level in patients with essential hypertension

Objective To analyze the relationship and clinical significance of serum glutamyl transpeptidase (GGT) level with left atrial diameter. Methods All the newly diagnosed 200 essential hypertension patients with complete data were selected.They were divided into normal left atrial group and enlarged left atrial group based on the size of left atrial diameter.Fasting blood glucose, serum lipid, routine laboratory tests, hepatic and renal function and blood pressure were measured by routine methods, and compared between the two groups. Results The GGT level in the enlarged left atrial group was lower than that in the normal left atrial group among essential hypertension patients[(21.56±11.95)U/L vs.(37.28±12.64)U/L](P=0.001). Spearman correlation showed that GGT level was negatively associated with left atrial diameter(r=-0.413, P=0.002). Multiple linear regression analysis showed that the serum GGT was also negatively correlated with left atrial diameter(β=-0.394, 95%CI: -0.131, -0.692; P=0.005). Conclusion Our study demonstrated that the level of GGT was negatively correlated with left atrial diameter among essential hypertension patients, and monitoring the changes of serum liver enzyme may have significant effect on the early detection of enlarged left atrial diameter. Key words: Left atrial diameter; Hypertension; Glutamyl aminopeptidase

The expression of TIMP-1 and MCP-1 in 5/6 nephrectomy rats

Objective Through observing tissue metalloproteinase inhibitor-1 (TIMP-1), monocyte chemoattractant protein-1 (MCP-1)expression of the 5/6 nephrectomy rat, and observing the relationship between TIMP-1 and MCP-1 with renal fibrosis, to find the probability of TIMP-1 and MCP-1 as biomarkers in early renal fibrosis. Methods The clean grade male rats were randomly divided into the model group and the control group.The rats in the control group were only stripped the renal capsule, without resection of renal parenchyma, the others in the model group were established to be 5/6 renal failure models.Using enzyme-linked immunosorbent assay (ELISA)to detect the expression level of serum hyaluronic acid, laminin, egg white type Ⅲ collagen, type Ⅳ collagen, and using the fluorescent quantitative PCR to detect the expression level of MCP-1 and TIMP-1 mRNA in kidney tissue of two groups of rats, combined with renal pathological changes and serum creatinine and urea nitrogen levels, assessing the significance of MCP-1, TIMP-1 in renal fibrosis. Results After the modeling, the glomerular score, renal interstitial score, serum creatinine and blood urea nitrogen in the model group were higher than those in the control group, and the difference was statistically significant (P<0.05); after the modeling of 4, 8and12 weeks in the model group, the expression of MCP-1 in renal tissue was gradually elevated, the expression of TIMP-1 was gradually reduced, and the expression level born a strong resemblance with the early renal fibrosis process. Conclusion The expression level of the MCP-1 and TIMP-1 born a strong resemblance with the early renal fibrosis, it can be used as a potential biomarker for early renal fibrosis. Key words: Renal fibrosis; Tissue inhibitor of metalloproteinase-1; Monocyte chemoattractant protein-1; Nephrectomy model

Abstract 110: Reduced Expression, Knockout, and Pharmacological Intervention of Arhgef11 -RhoA Pathway Significantly Attenuates Renal Injury and Blood Pressure

Through genetic analysis of the Dahl salt-sensitive (SS) rat, a model of hypertension and chronic kidney disease (CKD), Arhgef11, a Rho guanine nucleotide exchange factor was implicated in kidney injury. Arhgef11, via exchange of GDP for GTP, plays a role in the activation of RhoA signaling cascades through a number of cell stimuli that impact cytoskeletal structure and influence cell-cell contacts and promotes cell transformation. Previously, we demonstrated that reduced Arhgef11 expression/protein function in an SS- Arhgef11 SHR -minimal congenic strain resulted in significantly decreased proteinuria, fibrosis, and improved renal hemodynamics compared to SS-WT, without impacting BP. More recently, an SS-Arhgef11 -/- knockout rat model was studied. On low-salt (0.3% NaCl), SS-Arhgef11 -/- animals demonstrated reduced proteinuria and renal injury, with no impact on BP versus SS-WT. In contrast, SS-Arhgef11 -/- animals on an elevated-salt diet (2% NaCl) demonstrated a significant (p&lt;0.001) attenuation of proteinuria (41±7.9 mg/24 hrs.), along with a substantial reduction in BP (124±2.6 mm Hg) compared to SS-WT (119±15.3 mg/24 hrs. and 151±5.9 mm Hg). This data suggests that reduced expression/loss of Arhgef11 (on low-salt) similarly leads to renoprotection, whereas the loss of Arhgef11 (vs reduced expression) leads to blunting of salt-induced elevations in BP vs SS-WT. These animal studies, in combination with in vitro work, suggest that inhibition of Arhgef11-RhoA could be an effective therapeutic for CKD. Using an in vitro cell screen, several hundred natural product compounds were tested for ability to inhibit Arhgef11/RhoA activity and identified 3 compounds. A pilot study done using one compound (sufficient for a one-week study) was very encouraging as animals treated with XTL-019-G7 (20mg/kg/day) exhibited an ~25% reduction in proteinuria compared to vehicle (VEH) treated animals (70±8.5 versus 95±9.6 mg/24hours, p=0.07), demonstrating that in vivo testing is feasible and that the compound warrants further testing. In summary, genetic analysis of a model of CKD identified a gene/pathway involved in kidney injury that served as a target to screen natural product derived small molecules, and may ultimately lead to a new treatment for CKD.

Urine flow rate monitoring in hypovolemic multiple trauma patients

BackgroundThe urine output is an important clinical parameter of renal function and blood volume status, especially in critically ill multiple trauma patients. In the present study, the minute-to-minute urine flow rate and its variability were analyzed in hypotensive multiple trauma patients during the first 6 h of their ICU (intensive care unit) stay. These parameters have not been previously reported.MethodsThe study was retrospective and observational. Demographic and clinical data were extracted from the computerized Register Information Systems. A total of 59 patients were included in the study. The patients were divided into two study groups. Group 1 consisted of 29 multiple trauma patients whose systolic blood pressure was greater than 90 mmHg on admission to the ICU and who were consequently deemed to be hemodynamically compromised. Group 2 consisted of 30 patients whose systolic blood pressure was less than 90 mmHg on admission to the ICU and who were therefore regarded as hemodynamically uncompromised.ResultsThe urine output and urine flow rate variability during the first 6 h of the patients’ ICU stay was significantly lower in group 2 than in group 1 (p < 0.001 and 0.006 respectively). Statistical analysis by the Pearson method demonstrated a strong direct correlation between decreased urine flow rate variability and decreased urine output per hour (R = 0.17; P = 0.009), decreased mean arterial blood pressure (R = 0.24; p = 0.001), and increased heart rate (R = 0.205; p = 0.001).ConclusionThese findings suggest that minute-to-minute urine flow rate variability is a reliable incipient marker of hypovolemia and that it should therefore take its place among the parameters used to monitor the hemodynamic status of critically ill multiple trauma patients.

2221Validating renal nerve stimulation-induced blood pressure changes as a predictor of clinical response to renal sympathetic denervation

2221Validating renal nerve stimulation-induced blood pressure changes as a predictor of clinical response to renal sympathetic denervation

Water Loading in Combat Sport Athletes as a Means to Acutely Manipulate Body Mass

Athletes in weight category sports practice various methods of acute weight loss, with recent research and long standing “grey literature” demonstrating the popularity of ‘water loading’ (the consumption of large volumes of fluid for several days, prior to withholding intake) as a means to increase body water losses following fluid restriction. No research has examined this technique or its risk of causing hyponatremia. PURPOSE: To determine the effectiveness and safety of water loading and assess potential mechanisms. METHODS: Male combat sport athletes (n=21, 77.5±8.1kg 177.5±6.1cm, 26.6±4.0years) were separated into a control (CON, n=10) and water loading (WL, n=11) group. Subjects were fed a standardised isoenergetic diet based on fat free mass (assessed via DXA scan) controlling for macronutrient, sodium and fibre content for 6 days. Day 1-3 fluid intake was 40mL/kg CON and 100mL/kg WL. Day 4 fluid intake was 15mL/kg CON and WL. Day 5 no fluid was consumed until midday with both groups following the same rehydration protocol until day 6. Urine sodium, specific gravity (USG) and volume were recorded alongside training sweat losses and sleep quality/ duration (measured via actigraphy) throughout. Renal hormones (vasopressin, renin, and aldosterone), blood urea and electrolytes (U+Es) and body mass (BM) were measured each morning (fasted) and evening following 30 min supine rest. Physical performance was assessed pre and post intervention. Two way repeated measures ANOVAs were used to assess differences between groups. RESULTS: Following fluid restriction, significant differences with large effect sizes were found in fluid input/output ratio (39.11%, p < 0.01, ES=1.2) and BM loss (0.6%BM, p=0.02, ES=0.82). No differences in sleep or performance measures existed. Time had a significant effect on USG, all U+Es and renal hormones (p < 0.05). An interaction effect existed between time and intervention on blood sodium, potassium, chloride, urea, creatinine, USG and vasopressin (p < 0.05) but not on other hormones or electrolytes. No mean U+Es differed from reference range or approached critical values. CONCLUSION: Water loading appears to be a safe and effective method of acute BM loss under the conditions utilised in this study. Changes in vasopressin may in part underlie the mechanism facilitating this technique.

Apparent Disparity Between Renal Cortical Blood Flow and Oxygenation in Diabetic Nephropathy as Evaluated by Magnetic Resonance Imaging

Apparent Disparity Between Renal Cortical Blood Flow and Oxygenation in Diabetic Nephropathy as Evaluated by Magnetic Resonance Imaging

Albuminuria, renal function and blood pressure in undernourished children and recovered from undernutrition.

The objective of this study was to investigate some biomarkers of renal function and blood pressure in children who had recovered from undernutrition. This was cross-sectional, comparative study in which a convenience sample of children of both genders (n = 126; age range 6-16 years) treated at the Centre for Nutritional Recovery and Education (São Paulo, Brazil) was used. These children were classified into four groups for analysis: (1) children who were well nourished (control group; n = 50), (2) those showing stunted growth (stunted group; n = 22), (3) those who were underweight (underweight group; n = 23) and (4) those who had recovered from undernutrition (recovered group; n = 31). No between-group differences were found for mean levels of albuminuria, serum creatinine and cystatin C, and similar mean estimates of glomerular filtration rate (eGFR; using either creatinine, cystatin C or both). Almost 14% of the stunted group, 4% of the underweight group and 3% of the recovered group had albuminuria of >30mg/g creatinine (chi-square p = 0.034); none of the control children showed albuminuria of >30mg/g creatinine. Mean systolic (SBP) and diastolic blood pressure (DBP) adjusted for age and gender of the children in the stunted [SBP (95% confidence interval): 92 (88-96)mmHg; DBP: 47 (44-49)mmHg] and recovered [SBP: 93 (90-96)mmHg; DBP: 49 (47-51)mmHg] groups were significantly lower than those of the controls [SBP: 98 (95-100)mmHg, P = 0.027; DBP: 53 (52-55)mmHg, P = 0.001]. After additional adjustment for height, mean DBP remained significantly lower in the recovered group compared with the control group [49 (46-51) vs. 53 (51-55)mmHg, respectively; P = 0.018). Logistic regression analysis showed that the stunted group had a 8.4-fold higher chance of developing albuminuria (>10mg/g creatinine) than the control children (P = 0.006). No alterations in renal function were found in underweight children and those who had recovered from undernutrition, whereas children with stunted growth presented with a greater risk for albuminuria. A lower DBP was found in children with stunted growth and those who had recovered from undernutrition.

Impact of Sickle Cell Disease in Renal Arteries Blood Flow Indices Using Ultrasonography

The aim of this study was to evaluate the impact of sickle cell diseases (SCD) on renal arteries blood flow indices by using of color Doppler ultrasonography (CDU) in addition to relationships with age and body mass index (BMI). The method adapted was an experimental study among a sample consists of 115 SCD patients and 100 as control group. CDU of the main renal and segmental arteries performed among all patients and controls. All the patients were scanned in stable state condition. The results analysis carried out by EXCELL software for the collected variables which revealed that: the patients showed higher resistivity index RI and pulsatility index PI than control subjects (for patients 0.8 & 1.5 and 0.7 & 1.4 for control group. The significant positive correlation between RI and age (r = 0.194, and r = 0.061) for patients and control group respectively in the right renal artery and as well the RI correlated proportionally with BMI (r=0.53) for patients and (r=0.05) for control group.

Urinary tract infection in children: Current aspects of etiological diagnosis and treatment

The paper gives an update on the etiology and pathogenetic mechanisms for developing renal infection in children. It describes the clinical features of urinary tract infection. The diagnostic criteria based on the data of comprehensive studies confirming the source of urinary tract infection, as well as structural and functional criteria for changes in tubulointerstitial tissue, by involving the pyelocaliceal system and renal blood and lymph vessels are discussed. The authors propose an etiologic approach to diagnosis and treatment in terms of the pathogenetic mechanisms of urinary tract infection and a morphofunctional approach to predicting the course and to choosing the management tactics for children with renal infection.

Downregulation of Thromboxane A2 Receptor Occurs Mainly via Nuclear Factor-KappaB Signaling Pathway in Rat Renal Artery.

Thromboxane A2 (TXA2) acts on TXA2 receptors (TP) to regulate renal artery blood flow and subsequently contributes to the pathogenesis of renal ischemia. The present study was designed to examine if nuclear factor-kappaB (NF-κB) signaling pathway is involved in the downregulation of TP receptors in rat renal artery. Rat renal artery segments were organ cultured for 6 or 24 h. Downregulation of TP receptors was monitored using myograph (contractile function), real-time PCR (receptor mRNA), and immunohistochemistry (receptor protein). Specific inhibitors (MG-132 and BMS345541) for NF-κB signaling pathway were used to dissect the underlying molecular mechanisms involved. Compared to fresh (noncultured) segments, organ culture of the renal artery segments for 24 h induced a significant rightward shift of U46619 (TP receptor agonist) contractile response curves (pEC50: 6.89 ± 0.06 versus 6.48 ± 0.04, P < 0.001). This decreased contractile response to U46619 was paralleled with decreased TP receptor mRNA and protein expressions in the renal artery smooth muscle cells. Specific inhibitors (MG-132 and BMS345541) for NF-κB signaling pathway significantly abolished the decreased TP protein expression and receptor-mediated contractions. In conclusion, downregulation of TP receptors in the renal artery smooth muscle cells occurs mainly via the NF-κB signaling pathway.

Cyclosporine-induced Hemolytic Uremic Syndrome Following ABO Incompatible Living Donor Renal Transplantation: Case Report

We experienced a case with suspected drug-induced Hemolytic Uremic Syndrome (HUS) by immunosuppressive drug cyclosporine (CYA). HUS developed in a 51-year- old woman treated with CYA after ABO blood type Incompatible Living Donor Renal Transplant (ILDRTx). Her blood type was A positive, underwent ILDRTx from her husband whose blood type was B positive. She had developed hemolytic anemia with erythrocyte fragmentation, severe thrombocytopenia and acute renal failure on the first day after ILDRTx. It was thought with CYA-induced HUS not ABO blood type antibody mediated rejection at that point because the ABO blood type antibody titers did not rise, and there were no renal graft blood flow decreases in ultrasonography and renography. On day 2 after ILDRTx, CYA was converted to tacrolimus. After conversion without therapy for rejection, HUS was gradually improved. On day 20, she was discharged from our hospital with a serum creatinine (S-Cr) level of 1.65 mg/dl, and S-Cr level was 0.86 mg/dl six years and seven months after discharge. CYAinduced HUS is extremely rare with less than 1%, but serious complication of CYA therapy resulting in graft loss in many cases. Therefore early detection, early treatment is important.

CAFETERIA DIET INCREASES LIQUID INTAKE AND SERUM CREATININE LEVELS IN RATS

Introduction: Important changes in human dietary pattern occurred in recent decades. Increased intake of processed foods leads to obesity, which is related with the development of chronic diseases such as type 2 diabetes mellitus, hypertension, as well as cardiovascular and chronic kidney diseases. The prevalence of hypertension has also dramatically increased in recent years, and high sodium intake contributes to this scenario. In healthy individuals, kidneys are the primary end-organs that regulate sodium homeostasis. This study aims to evaluate renal function parameters and systolic blood pressure measurements in an animal model of obesity. Methods: Sixty-day-old male Wistar rats (n=30) were divided into two groups: standard (SD) and cafeteria diet (CD). Cafeteria diet was altered daily and was composed by crackers, wafers, sausages, chips, condensed milk, and soda. All animals had free access to water and chow and the experiment was carried out for 6 weeks. Weight gain, sodium and liquid intake control, systolic blood pressure measurements, and renal function parameters were evaluated. Results: Animals exposed to cafeteria diet had an increase of 18% in weight compared to the control group. Sodium intake was increased by cafeteria diet and time (F (1,28) = 773.666, P=0.001 and F (5,28) = 2.859, P=0.02, respectively) and by the interaction of both factors (F (6,28) = 2.859, P=0.02). On liquid intake occurred only effect of cafeteria diet and time (F (1,28) = 147.04, P=0.001 and F (5,28) =3.996, P=0.003, respectively). Cafeteria diet exposure also induced an increase on creatinine serum levels (P=0.002), however this effect was not observed on creatinine urine levels (P>0.05) nor on systolic pressure measurements (Students’ t test, P>0.05). Conclusions: Obesity induced by cafeteria diet exposure increases liquid intake and alters creatinine serum levels, an important renal function marker. Considering the high consumption of hypercaloric food currently in the world, further studies are required to elucidate the modifications on renal function triggered by this diet over time. Key-words: Hypertension; kidney; renal function; obesity; hypercaloric diet