Renal Excretory Function Research Articles

Blockade of renal medullary bradykinin B2 receptors increases tubular sodium reabsorption in rats fed a normal-salt diet.

The present study was performed to test the hypothesis that under normal physiological conditions and/or during augmentation of kinin levels, intrarenal kinins act on medullary bradykinin B(2) (BKB(2)) receptors to acutely increase papillary blood flow (PBF) and therefore Na(+) excretion. We determined the effect of acute inner medullary interstitial (IMI) BKB(2) receptor blockade on renal hemodynamics and excretory function in rats fed either a normal (0.23%)- or a low (0.08%)-NaCl diet. For each NaCl diet, two groups of rats were studied. Baseline renal hemodynamic and excretory function were determined during IMI infusion of 0.9% NaCl into the left kidney. The infusion was then either changed to HOE-140 (100 microg.kg(-1).h(-1), treated group) or maintained with 0.9% NaCl (time control group), and the parameters were again determined. In rats fed a normal-salt diet, HOE-140 infusion decreased left kidney Na(+) excretion (urinary Na(+) extraction rate) and fractional Na(+) excretion by 40 +/- 5% and 40 +/- 4%, respectively (P < 0.01), but did not alter glomerular filtration rate, inner medullary blood flow (PBF), or cortical blood flow. In rats fed a low-salt diet, HOE-140 infusion did not alter renal regional hemodynamics or excretory function. We conclude that in rats fed a normal-salt diet, kinins act tonically via medullary BKB(2) receptors to increase Na(+) excretion independent of changes in inner medullary blood flow.

Role of TRPV1 channels in renal haemodynamics and function in Dahl salt-sensitive hypertensive rats.

This study tests the hypothesis that dysfunction of transient receptor potential vanilloid type 1 (TRPV1) channels occurs and contributes to the decrease in the glomerular filtration rate (GFR) and sodium/water excretion in Dahl salt-sensitive hypertensive rats. Recirculating Krebs-Henseleit buffer added with inulin was perfused at a constant flow in the isolated kidneys of Dahl salt-sensitive (DS) or Dahl salt-resistant (DR) rats fed a high-salt (HS) or low-salt (LS) diet for 3 weeks. Perfusion pressures (PP) were pre-adjusted to three levels ( approximately 100, approximately 150 or approximately 190 mmHg) with or without phenylephrine. Capsaicin, a selective TRPV1 agonist, in the presence or absence of capsazepine, a selective TRPV1 antagonist, was perfused. Basal GFR, urine flow rate (UFR) and Na(+) excretion (U(Na)V) were significantly lower in DS-HS than in DR-HS, DS-LS and DR-LS rats. Capsaicin caused pressure-dependent decreases in PP and increases in GFR, UFR and U(Na)V in all groups, with less magnitude of decreases in PP and increases in GFR, UFR and U(Na)V in DS-HS than in DR-HS, DS-LS and DR-LS rats. Capsazepine completely blocked the effect of capsaicin on PP, GFR, UFR and U(Na)V in all groups. Thus, these results show that TRPV1 function is impaired in the kidney of DS rats fed a high-salt diet, which may contribute to the decrease in GFR and renal excretory function in DS rats in the face of salt challenge.

Diagnosis and treatment of coronary artery disease in patients with chronic kidney disease

Premature cardiovascular disease (CVD) is the single largest cause of death in patients with progressive chronic kidney disease (CKD), accounting for 43% of all cause mortality and over one third...

Reduced renal responses to nitric oxide synthase inhibition in mice lacking the gene for gp91phoxsubunit of NAD(P)H oxidase

Both short-term and long-term nitric oxide (NO) blockade were shown to cause an increase in O(2)(-) activity. To assess the contribution of such enhanced O(2)(-) activity in the kidney, responses to administration of the NO synthase inhibitor nitro-L-arginine methyl ester (L-NAME; 200 microg.min(-1).kg body wt(-1)) were assessed in knockout mice the lacking NAD(P)H oxidase subunit gp91(phox) (KO; n = 10) and in wild-type (WT; n = 10) mice. Renal blood flow (RBF) and glomerular filtration rate (GFR) were determined by PAH and inulin clearances, respectively. Baseline RBF was higher in KO compared with WT mice (5.8 +/- 0.5 vs. 4.5 +/- 0.3 ml.min(-1).g(-1); P < 0.04) without significant differences in GFR (0.62 +/- 0.04 vs. 0.73 +/- 0.05 ml.min(-1).g(-1)) and in mean arterial pressure (MAP; 91 +/- 6 vs. 88 +/- 4 mmHg). L-NAME infusion for 60 min caused similar increases in MAP (114 +/- 6 vs. 113 +/- 3 mmHg) in both groups but resulted in a lesser degree of reduction in RBF in KO compared with WT mice (-7 +/- 3 vs. -17 +/- 3%; P < 0.02), although GFR remained unchanged in both groups. The natriuretic response to systemic L-NAME infusion was attenuated in KO compared with WT mice (Delta: 3.1 +/- 0.7 vs. 5.2 +/- 0.6 micromol.min(-1).g(-1)). L-NAME increased urinary 8-isoprostane excretion rate in WT (5.9 +/- 1 to 7.7 +/- 1 pg.min(-1).g(-1); P < 0.02) but not in KO mice (5.6 +/- 1 to 4.9 +/- 0.3 pg.min(-1).g(-1)). In contrast, responses to another vasoconstrictor, norepinephrine, were similar in both strains of mice. These data indicate that activation of NAD(P)H oxidase results in the enhancement of O(2)(-) activity that influences renal hemodynamics and excretory function in the condition of NO deficiency.

Nociceptin/Orphanin FQ (N/OFQ)-Evoked Bradycardia, Hypotension, and Diuresis Are Absent in N/OFQ Peptide (NOP) Receptor Knockout Mice

Intracerebroventricular administration of the opioid-like peptide nociceptin/orphanin FQ (N/OFQ) produces bradycardia, hypotension, and diuresis in mice. We hypothesized that these responses are solely caused by selective activation of central N/OFQ peptide (NOP) receptors. To test this premise, we first examined whether i.c.v. N/OFQ produced dose-dependent diuretic and cardiovascular depressor responses in commercially available C57BL/6 mice. Next, using doses established in these studies, we examined the renal excretory and cardiovascular responses to i.c.v. N/OFQ in conscious transgenic NOP receptor knockout mice (NOP(-/-)). In metabolic studies, i.c.v. N/OFQ, but not saline vehicle, dose-dependently increased urine output (V) in NOP(+/+); this response was significant at 3 nmol (N/OFQ, V = 0.39 +/- 0.10 ml/2 h; saline, 0.08 +/- 0.05 ml/2 h). The N/OFQ-evoked diuresis was absent in littermate NOP(-/-) (N/OFQ, V = 0.06 +/- 0.06 ml/2 h; saline, 0.03 +/- 0.03 ml/2 h). There were no significant changes in urinary sodium or potassium excretion or free water clearance in either group. In telemetry studies, i.c.v. N/OFQ dose dependently lowered heart rate (HR) and mean arterial pressure (MAP). At 3 nmol N/OFQ, both HR and MAP were reduced in NOP(+/+) (peak DeltaHR = -217 +/- 31 bpm; peak DeltaMAP =-47 +/- 7 mm Hg) compared with saline (peak DeltaHR =-14 +/- 5 bpm; peak DeltaMAP = 2 +/- 3 mm Hg). These N/OFQ-evoked bradycardic and hypotensive responses were absent in NOP(-/-) (peak DeltaHR =-13 +/- 17 bpm; peak DeltaMAP =-2 +/- 4 mm Hg, respectively). Basal 24-h cardiovascular and renal excretory function were not different between NOP(-/-) and NOP(+/+) mice. These results establish that the bradycardia, hypotension and diuresis produced by centrally administered N/OFQ are mediated by selective activation of NOP receptors.

Central G-alpha subunit protein-mediated control of cardiovascular function, urine output, and vasopressin secretion in conscious Sprague-Dawley rats.

The role(s) of central Galpha-proteins in the regulation of cardiovascular and renal function is unknown. We examined how inhibition/downregulation of central Galphai/Galphao, Galphaz or Galphaq proteins altered the characteristic cardiovascular (depressor), renal excretory (diuretic), and plasma AVP (inhibitory) responses to intracerebroventricular injection of nociceptin/orphanin FQ (N/OFQ) in rats. Before investigation, rats were pretreated intracerebroventricularly with saline vehicle (5 microl, 48 h, n=6), pertussis toxin (PTX; 48-h, 1 microg, n=6), or Galphaz, Galphaq, or scrambled oligodeoxynucleotide (ODN) (25 microg, 24 h, n=6 per group). On the study day, intracerebroventricular N/OFQ (5.5 nmol) or vehicle (5 microl) was injected into pretreated conscious rats. Mean arterial pressure (MAP) and heart rate (HR) were recorded, and urine was collected for 90 min. In vehicle or scrambled ODN groups, intracerebroventricular N/OFQ decreased MAP and HR and produced water diuresis (sensitive to UFP-101, N/OFQ receptor antagonist). The hypotension and bradycardia, but not diuresis, to N/OFQ were abolished in PTX-pretreated rats. In contrast, intracerebroventricular ODN pretreatment markedly blunted (Galphaz) or augmented (Galphaq) the diuresis to intracerebroventricular N/OFQ. In separate studies, the action of central N/OFQ to decrease plasma AVP levels in naïve water-restricted rats was differentially altered by intracerebroventricular Galphaz ODN (blunted) and Galphaq ODN (augmented) pretreatment. These studies demonstrate central Galphai/Galphao activity mediates intracerebroventricular N/OFQ's cardiovascular depressor function. Alternatively, central Galphaz (inhibitory) and Galphaq (stimulatory) activity differentially modulates AVP release to control the pattern of diuresis to intracerebroventricular N/OFQ. These findings highlight the novel selective central Galpha-subunit protein-mediated control of cardiovascular vs. renal excretory function.

An Eritrichium sericeum Lehm. (Boraginaceae) cell culture — a source of polyphenol compounds with pharmacological activity

Polyphenol compounds consisting of caffeic acid oligomers were detected in cell cultures from Eritrichium sericeum Lehm.: (−)-rabdosiin, (+)-rosmarinic acid, and eritrichin; the quantitative contents of individual polyphenols were determined. The total content of polyphenol compounds in biotechnological raw material was 6.9% of dry tissue weight, which was 26.5 times greater than the content in the roots of the native plant. Studies of the pharmacological activity of the experimental Eritrichium sericeum Lehm. preparation, containing a complex of polyphenol compounds, demonstrated increases in renal excretory function and suppression of the exudative stage of inflammation as a result of prolonged use of the cell culture phytocomplex at a dose of 100 mg/kg.

A young man with Propionibacterium acnes-induced shunt nephritis

SUMMARY This case illustrates in a striking manner the potential renalcomplications associated with chronic, unrecognized VAshunt infection. The diagnosis of shunt nephritis is challen-ging and, as exemplified by this case, may be overlooked forseveral years, resulting in significant morbidity in the form ofongoing renal injury with proteinuria and renal failure. Thefinding of hematuria, proteinuria and even mild renalinsufficiency in a patient with a VA shunt should promptan aggressive microbiologic diagnostic evaluation to excludesubacute infection. Renal biopsy should be considered todocument the pathognomonic membranoproliferative lesionand to assess the relative degrees of acute versus chronicinjury. Further, this case highlights the critical importance ofexcluding secondary forms of disease in any patient with anephritic presentation and biopsy findings demonstratingmembranoproliferative features, as identification and treat-ment of the underlying condition may lead to remission ofproteinuria and normalization of renal excretory function,even in patients with a baseline biopsy finding of significantsclerosis alongside ongoing active inflammation, as was thecase in this patient. Finally, in this exciting era where theelucidation of entire microbial genome sequences has becomepossible, future studies correlating bacterial genomes andproteomes with specific mechanisms of disease may holdpromise for identifying specific antigens involved in thepathogenesis of immune-mediated conditions, such as shuntnephritis.

Segmental Regulation of Sodium and Water Excretion by TRPV1 Activation in the Kidney

Our previous studies show that activation of the transient receptor potential vanilloid type 1 (TRPV1) channels by a selective agonist, capsaicin (CAP), given unilaterally into the renal pelvis leads to increases in urine flow rate (Uflow) and urinary sodium excretion (UNa) bilaterally, although the mechanisms underlying enhanced renal excretory function are unknown. The present study was designed to determine the contribution of each of the renal segments to enhanced renal excretory function when TRPV1 expressed in sensory nerve fibers innervating the renal pelvis is activated. To accomplish the goal, LiCl was given intravenously to male Wistar rats while the left renal pelvis (LRP) was perfused with vehicle or CAP with or without a selective TRPV1 antagonist, capsazepine (CAPZ). Uflow and clearance of creatinine, lithium, sodium, and water, either filtered or fractionally, were determined in both kidneys. LRP perfusion of CAP at 2.4 nmol increased Uflow (microL.ming; ipsilaterally from 6.6 +/- 0.6 to 14.6 +/- 2.2 and contralaterally from 7.4 +/- 0.7 to 13.9 +/- 1.8, P < 0.05) and UNa (micromol.ming; ipsilaterally from 0.6 +/- 0.2 to 1.8 +/- 0.3 and contralaterally from 0.7 +/- 0.2 to 1.9 +/- 0.4, P < 0.05). Ipsilateral blockade of the TRPV1 with CAPZ at 24 nmol prevented CAP-induced increases in Uflow and UNa bilaterally. Creatinine, lithium, sodium, and free water clearance (ml.min) were increased in CAP (1.47 +/- 0.27, 0.44 +/- 0.05, 0.026 +/- 0.004, 0.41 +/- 0.05, respectively) compared to vehicle (0.72 +/- 0.12, 0.25 +/- 0.05, 0.010 +/- 0.001, 0.24 +/- 0.05), CAPZ+CAP (0.83 +/- 0.13, 0.24 +/- 0.03, 0.014 +/- 0.002, 0.23 +/- 0.03), and CAPZ (0.88 +/- 0.05, 0.21 +/- 0.01, 0.010 +/- 0.001, 0.20 +/- 0.01) groups (P <or= 0.01). Filtered sodium load, distal delivery of sodium, and distal sodium reabsorption (muEq.min) were also increased in CAP (202.2 +/- 33.3, 61.3 +/- 7.4, 57.6 +/- 7.4, respectively) compared to vehicle (97.7 +/- 16.6, 33.6 +/- 5.8, 32.2 +/- 5.9), CAPZ+CAP (110.5 +/- 16.3, 32.5 +/- 4.5, 30.7 +/- 4.3), and CAPZ (118.0 +/- 4.5, 27.9 +/- 1.2, 26.8 +/- 1.2) groups (P <or= 0.01). In contrast, fractional lithium and sodium excretion, absolute proximal reabsorption, fractional proximal reabsorption, fractional distal sodium, and water reabsorption were not different among groups. Therefore, activation of the TRPV1 expressed in primary afferent nerves innervating the renal pelvis leads to diuresis and natriuresis in both kidneys. The TRPV1-induced sodium and water excretion appears to be mediated by increases in glomerular filtration rate and distal tubular delivery of sodium but not by suppression of renal proximal and distal tubular reabsorption, suggesting a key role of segmental regulation of renal function by TRPV1-positive primary sensory nerves in the maintenance of sodium and water homeostasis.

Interdependent Regulation of Afferent Renal Nerve Activity and Renal Function: Role of Transient Receptor Potential Vanilloid Type 1, Neurokinin 1, and Calcitonin Gene-Related Peptide Receptors

Our previous studies have shown that the activation of the transient receptor potential vanilloid type 1 (TRPV1) expressed in the renal pelvis leads to an increase in ipsilateral afferent renal nerve activity (ARNA) and contralateral renal excretory function, but the molecular mechanisms of TRPV1 action are largely unknown. This study tests the hypothesis that activation of receptors of neurokinin 1 (NK1) or calcitonin gene-related peptide (CGRP) by endogenously released substance P (SP) or CGRP following TRPV1 activation, respectively, governs TRPV1-induced increases in ARNA and renal excretory function. Capsaicin (CAP; 0.04, 0.4, and 4 nM), a selective TRPV1 agonist, administered into the renal pelvis dose-dependently increased ARNA. CAP (4 nM)-induced increases in ipsilateral ARNA or contralateral urine flow rate (Uflow) and urinary sodium excretion (UNa) were abolished by capsazepine (CAPZ), a selective TRPV1 antagonist, or 2-[1-imino-2-(2-methoxyphenyl)ethyl]-7,7-diphenyl-4-perhydroisoindolone (3aR,7aR) (RP67580) or cis-2-(diphenylmethyl)-N-[(2-iodophenyl)-methyl]-1 azabicyclo[2.2.2]octan-3-amine (L703,606), selective NK1 antagonists, but not by CGRP8-37, a selective CGRP receptor antagonist. Both SP (7.4 nM) and CGRP (0.13 muM) increased ARNA, Uflow, or UNa, and increases in these parameters induced by CGRP but not SP were abolished by CAPZ. CAP at 4 nM perfused into the renal pelvis caused the release of SP and CGRP, which was blocked by CAPZ but not by RP67580, L703,606, or CGRP8-37. Immunofluorescence results showed that NK1 receptors were expressed in sensory neurons in dorsal root ganglion and sensory nerve fibers innervating the renal pelvis. Taken together, our data indicate that NK1 activation induced by SP release upon TRPV1 activation governs TRPV1 function and that a TRPV1-dependent mechanism is operant in CGRP action.

Impact of pneumoperitoneum on renal perfusion and excretory function: beneficial effects of nitroglycerine

Increased intra-abdominal pressure (IAP) (pneumoperitoneum) during laparoscopic surgery may result in adverse effects on kidney function. The mechanisms underlying this phenomenon have not been fully determined. The present study was designed to: (1) investigate the effects of incremental increases in IAP on renal function in normal rats and (2) evaluate whether the nitric oxide (NO) system is involved in renal dysfunction characterizing pneumoperitoneum. Male rats were organized into two groups. The first group was subjected to IAP of 0 (baseline), 7 or 14 mmHg, over 1 h for each pressure, followed by a deflation period of 60 min (recovery). Two additional groups were pretreated with: (1) non-depressor dose of nitroglycerine (NTG) and (2) nitro-L-arginine-methylester (L-NAME), an NO synthase inhibitor, before applying 14 mmHg for 1 h. Urine flow rate (V), Na+ excretion (U(Na)V), glomerular filtration rate (GFR), renal plasma flow (RPF), and blood pressure were determined throughout the experiments. There were no significant changes in V, U(Na)V, GFR, and RPF during 7 mmHg insufflation. However, significant reductions in these parameters were observed during 14 mmHg: V from 8.49 +/- 0.92 to 6.12 +/- 0.54 microl/min, U(Na)V from 1.29 +/- 0.28 to 0.39 +/- 0.09 microEq/min, and FE(Na) from 0.37 +/- 0.11 to 0.27 +/- 0.04%. These alterations in excretory functions were associated with a considerable decline in GFR from 1.85 +/- 0.09 to 0.88 +/- 0.09 ml/min, p < 0.05, (-46.3 +/- 5.2% from baseline) and RPF from 8.66 +/- 0.62 to 4.33 +/- 0.49 ml/min, p < 0.05, (-51.93 +/- 5.24% from baseline), without a significant change in mean arterial blood pressure (MAP). When the animals were pretreated with NTG, the adverse effects of pneumoperitoneum on V, U(Na)V, GFR, and RPF were substantially improved, suggesting that NO system plays a beneficial counter-regulatory role during laparoscopy. In line with this notion, pretreatment with L-NAME remarkably aggravated pneumoperitoneum-induced renal hypoperfusion and dysfunction. Decreased renal perfusion and function are induced by IAP pressure of 14 mmHg. These adverse effects are probably related to interference with the NO system, and could be partially ameliorated by pretreatment with NTG.

Kidney in Hypertension

Regulation of blood pressure is a complex integrated response involving a variety of organ systems including the central nervous system (CNS), cardiovascular system, kidneys, and adrenal glands. These systems modulate cardiac output, fluid volumes, and peripheral vascular resistance, the key determinants of blood pressure. More than 40 years ago, Guyton and Coleman1 developed computer models of arterial pressure control, attempting to incorporate the known variables impacting blood pressure homeostasis. The conclusion of this analysis was that regulation of sodium excretion by the kidney and consequent effects on body fluid volumes made up the critical pathway determining the chronic level of intra-arterial pressure. Our own studies of the physiology of blood pressure regulation have focused on the renin-angiotensin (Ang) system (RAS) using genetically modified mouse models. Highly conserved through phylogeny, the RAS is an essential regulator of blood pressure and fluid balance. This biological system is a multienzymatic cascade in which angiotensinogen, its major substrate, is processed in a 2-step reaction by renin and Ang-converting enzyme (ACE), resulting in the sequential generation of Ang I and Ang II. Along with its importance in maintaining normal circulatory homeostasis, abnormal activation of the RAS can contribute to the development of hypertension and target organ damage. The importance of the RAS in clinical medicine is highlighted by the impressive efficacy of pharmacological agents that inhibit the synthesis or activity of Ang II.2–5 At the cellular level, responsiveness to Ang II is conferred by expression of Ang receptors. Ang receptors can be divided into 2 pharmacological classes: type 1 (AT1) and type 2, based on their differential affinities for various nonpeptide antagonists.6,7 Studies using these antagonists suggested that most of the classically recognized functions of the RAS are mediated by AT1 receptors. Gene targeting studies confirmed these conclusions.8 AT …

Increased GFR and renal excretory function by activation of TRPV1 in the isolated perfused kidney

To test the hypothesis that activation of the transient receptor potential vanilloid type 1 (TRPV1) channels leads to natriuresis and diuresis via an increase in glomerular filtration rate (GFR), recirculating Krebs–Henseleit buffer added with inulin was perfused in the isolated perfused kidney of male Wistar rat at a constant flow, and perfusion pressures (PPs) were pre-adjusted to three different levels (∼100, ∼150, and ∼190 mmHg) with phenylephrine. Capsaicin (Cap), a selective TRPV1 agonist, was perfused in the presence or absence of capsazepine (Capz), a selective TRPV1 antagonist, CGRP 8–37, a selective calcitonin gene-related peptide (CGRP) receptor antagonist, or spantide II (Spa), a selective substance P (SP) receptor antagonist. At the higher (150 and 190 mmHg) but not baseline (100 mmHg) PP levels, Cap at 10 μM significantly decreased PP and increased GFR, urine flow rate (UFR) and Na + excretion (U NaV). At the highest (190 mmHg) PP level, Cap (2, 10, 30 μM) dose-dependently decreased PP and increased GFR, UFR, U NaV, and the release of CGRP and SP. Capz or CGRP 8–37 combined with Spa fully blocked the effect of Cap on PP, GFR, UFR, U NaV, and the release of CGRP and SP. In conclusion, activation of TRPV1 in the isolated kidney decreases renal PP and increases GFR and water/sodium excretion possibly via simultaneous activation of CGRP and SP receptors upon their enhanced release, suggesting that TRPV1 plays a key role in modulating renal hemodynamics and excretory function.

Temporal Constraints in Renal Perfusion Imaging With a 2-Compartment Model

To assess the required temporal resolution and total acquisition time for renal perfusion and filtration measurements with a 2-compartment model. Saturation-recovery TurboFLASH perfusion measurements of 15 healthy volunteers were acquired at 1.5 T, with a temporal resolution of 1 second during the first pass and a total acquisition time of 270 seconds. The time courses were then regridded and truncated to yield new data sets with temporal resolutions from 1 to 30 seconds in 1-second increments and with total acquisition times from 30 to 270 seconds in 5-second increments, respectively. Each new dataset was postprocessed by fitting the time courses to a 2-compartment model producing measures of perfusion and filtration: plasma volume (PV), plasma flow (PF), tubular volume (TV), and tubular flow (TF). The effect of reducing the temporal resolution or the total acquisition time was investigated by comparing the model parameters with those obtained at full temporal resolution and acquisition time and quantified by defining a discretization error (DE) and a truncation error (TE), respectively. For each parameter, the required temporal resolution and total acquisition times were defined by demanding a DE and TE of less than 10%. It can be concluded from the analysis of the DE and TE that the acquisition of the parameters PF and TF requires a temporal resolution of at least 4 and 5 seconds, respectively. For the other 2 parameters, a temporal resolution of at least 9 seconds is sufficient. The required total acquisition times for PF and PV were 35 and 85 seconds, whereas for the parameters TF and TV, 230 and 255 seconds, respectively, are required. Renal perfusion measurements should be acquired with a temporal resolution of at least 4 seconds. To evaluate the renal excretory function adequately, the total acquisition time should be at least 255 seconds.

MINIMAL CHANGE DISEASE AND ACUTE TUBULAR NECROSIS CAUSED BY DICLOFENAC

Renal side-effects of anti-inflammatory drugs (NSAID) can be diveded in five clinical syndromes: acute renal failure, acute intersticial nephritis with nephrotic syndrome, electrolyte and fluid disorders, hypertension and analgetic nephropathy.We described one unusual combination of acute tubular necrosis (ATN) and minimal change disease (MCD). Reports of ATN and MCD with nephrotic syndrome caused by NSAID exposure are very rare. This is the first reported case of MCD associated with ATN by Diclofenac. A 53-year-old woman with acute renal failure (creatinine was 716 μ mol/L) and nephrotic syndrome (she was in generalizied oedema and protein excretion was 6.0g/day) was admitted to our hospital. She also had eosinophilia. Her medical history was unremarkable except for nontreated hypertension for five years. Only medication she has been taking was Diclofenac for chronic muscular pain and knee arthropathy. NSAID drugs exert their toxic effect on the kidney by ihibition of prostaglandin synthesis and causing an acute allergic interstitial nephritis. The pathogenesis of NSAID-associated MCD is unclear. NSAID drugs cause inhibiton of cyclooxigenase and shift arachidonic acid toward lipooxygenase pathway, which may result in enhanced production of proinflammatory leukotriens. In addition, lypooxigenase products increase vascular permeability and may contribute by altering glomerular-cappilary barrier. The patient was treated with steroides. The response was excellent with remission of nephrotic syndrome and the normalization of renal excretory function within 6 weeks.

Adverse effects of pneumoperitoneum on renal function: involvement of the endothelin and nitric oxide systems

Increased intra-abdominal pressure (IAP) during laparoscopy adversely affects kidney function. The mechanism underlying this phenomenon is largely unknown. This study was designed to investigate the involvement of endothelin (ET)-1 and nitric oxide (NO) systems in IAP-induced renal dysfunction. Rats were subjected to IAP of 14 mmHg for 1 h, followed by a deflation for 60 min (recovery). Four additional groups were pretreated with 1) ABT-627, an ET(A) antagonist; 2) A-192621, an ET(B) antagonist; 3) nitroglycerine; and 4) N(G)-nitro-L-arginine methyl ester, a NO synthase inhibitor, before IAP. Urine flow rate (V), absolute Na+ excretion (U(Na)V), glomerular filtration rate (GFR), and renal plasma flow (RPF) were determined. Significant reductions in kidney function and hemodynamics were observed when IAP was applied. V decreased from 8.1 +/- 1.0 to 5.8 +/- 0.5 microl/min, U(Na)V from 1.08 +/- 0.31 to 0.43 +/- 0.10 microeq/min, GFR from 1.84 +/- 0.12 to 1.05 +/- 0.06 ml/min (-46.9 +/- 2.7% from baseline), and RPF from 8.62 +/- 0.87 to 3.82 +/- 0.16 ml/min (-54 +/- 3.5% from baseline). When the animals were pretreated with either ABT-627 or A-192621, given alone or combined, the adverse effects of IAP on GFR, RPF, V, and U(Na)V were significantly augmented. When the animals were pretreated with nitroglycerine, the adverse effects of pneumoperitoneum on GFR and RPF were substantially improved. In contrast, pretreatment with N(G)-nitro-L-arginine methyl ester remarkably aggravated pneumoperitoneum-induced renal dysfunction. In conclusion, decreased renal excretory function and hypofiltration are induced by increased IAP. These effects are related to impairment of renal hemodynamics and could be partially ameliorated by pretreatment with nitroglycerine and aggravated by NO and ET blockade.

Erythropoietin Supplementation in Patients with Refractory Anemia and Mild Renal Insufficiency - MDS Meets Renal Anemia.

Introduction Even mild renal dysfunction (e.g. creatinine 100 to 140 μmol/l) can be related to inadequate erythropoietin (EPO) response in patients with refractory anemia and bone marrow features compatible with dysplasia (Korte, Cogliatti et al. 2000). Overall, this seems not an infrequent mechanism (Fehr, Ammann et al. 2004) Therefore, patients with MDS bone marrow morphology and secondary bone marrow dysfunction due to EPO deficiency may be diagnosed as having a myelodysplatic syndrome (refracory anemia [RA] or even refractory anemia with ringed sideroblasts [RARS]).Patients and Methods We performed a single center, prospective, non-randomized pilot study to evaluate the potential benefit of EPO therapy in patients with refractory anemia, mild renal insufficiency and low EPO levels.Eligibility criteria were: hemoglobin (hb) concentrations <110g/l, bone marrow features of RA or RARS (according to FAB classification) normal levels of folate, cobalamin, ferritin, TSH and C-reactive protein, mild renal insufficiency (creatinine of 100 to 180 μmol/l) and EPO < 60 U/ml.Exclusion criteria were: active solid malignant tumors, evidence of chronic inflammatory disease, evidence of hemoglobinopathies or haemolytic anemia. Patients received EPO (epoetin beta, Recormon®) for 6 weeks with the aim to increase the hb concentrations to a steady state level of 120g/l. Epo was started at a fixed dose of 150 U/kg subcutaneously three times per week (tiw) and as soon as an improvement in hemoglobin was seen, the dose was reduced as needed to keep the hemoglobin at 120 g/l. With the targetd hb increase of 10 g/l, an estimated standard deviation of 5 g/l and alpha = 0.05 (power 80%), a statistically significant differences were expected with 4 patients treated.Results 5 patients were included in the study. One had a transient renal insufficiency, with excretory renal function normalizing during the study period, whereas the other four patients had persisting mild renal insufficiency. The patients received 150 U/kg tiw of epoetin beta for the first 4 weeks and all reached the target hb of 120g/l after this time (increase significant, p<0.05). Patents showed significantly (p<0.05) increasing levels of soluble transferrin receptor (sTFR) under EPO therapy.Discussion Our data indicate an excellent response to epoetin beta in patients with signs of myelodysplasia and mild renal insufficiency. The response rate (5/5, 100%) was much higher than described in other low risk MDS patients. Increasing levels of soluble sTfR reflect the improved erythropoietic activity and erythroid maturation. From these results, it can be speculated that anemia in low grade MDS with (even mild) renal insufficiency might in fact include aspects of renal anemia. EPO therapy seems an excellent treatment opportunity in anemic patients with marrow MDS morphology, renal dysfunction and low EPO levels. However, this observation and the question whether at least some of this myelodysplasias are direct consequences of inadequate erythropoietin levels warrant larger studies.

Superoxide and its interaction with nitric oxide modulates renal function in prehypertensive Ren-2 transgenic rats

The present study was performed to examine the role of superoxide (O2*) and its interaction with nitric oxide (NO) in the regulation of renal function in prehypertensive heterozygous Ren-2 transgenic rats (TGR). Renal responses to the O2* scavenger, tempol (150 microg/min per 100 g), and/or the NO synthase inhibitor, nitro-L-arginine methylester (L-NAME; 5 microg/min per 100 g), infused alone or in combination directly into the renal artery were evaluated in anesthetized heterozygous male TGR and aged-matched Hanover Sprague-Dawley rats (HanSD). There were no differences in arterial pressure (122 +/- 3 versus 115 +/- 2 mmHg), renal plasma flow (RPF; 2.09 +/- 0.1 versus 2.07 +/- 0.1 ml/min per g), glomerular filtration rate (GFR; 0.73 +/- 0.1 versus 0.74 +/- 0.1 ml/min per g) or sodium excretion (0.63 +/- 0.13 versus 0.67 +/- 0.16 micromol/min per g) between TGR and HanSD. Tempol alone caused significant increases in RPF and GFR (10 +/- 4% and 12 +/- 2%, respectively) in TGR but not in HanSD. Tempol also caused greater sodium excretory responses in TGR compared to HanSD (112 +/- 16% versus 43 +/- 7%; P < 0.05). 8-Isoprostane excretion was significantly higher in TGR than in HanSD (10.2 +/- 0.8 versus 6.5 +/- 0.7 pg/min per g), which was attenuated by tempol. L-NAME caused greater decreases in RPF and GFR in TGR (-34 +/- 4% and -22 +/- 4%, respectively) than in HanSD (-19 +/- 3% and -10 +/- 4%, respectively). Co-infusion of tempol partially attenuated the renal hemodynamic and excretory responses to L-NAME in TGR. These data suggest that the enhanced O2* activity and its interaction with NO during the prehypertensive phase in TGR modulates renal hemodynamic and excretory function, which may contribute to the development of hypertension in this transgenic rat model.

Distinct roles for renal particulate and soluble guanylyl cyclases in preserving renal function in experimental acute heart failure

Worsening renal function in the setting of human acute heart failure (AHF) predicts poor outcomes, such as rehospitalization and increased mortality. Understanding potential renoprotective mechanisms is warranted. The guanylate cyclase (GC) enzymes and their second messenger cGMP are the target of two important circulating neurohumoral systems with renoprotective properties. Specifically, natriuretic peptides (NP) released from the heart with AHF target particulate GC in the kidney, while the nitric oxide (NO) system is an activator of renal soluble GC. We hypothesized that both systems are essential to preserve renal excretory and hemodynamic function in AHF but with distinct roles. We investigated these roles in three groups of anesthetized dogs (6 each) with AHF induced by rapid ventricular pacing. After a baseline AHF clearance, each group received intrarenal vehicle (control), N(G)-monomethyl-l-arginine (l-NMMA), a competitive NO inhibitor (50 microg.kg(-1).min(-1)) or a specific NP receptor antagonist, HS-142-1 (0.5 mg/kg). We observed that intrarenal l-NMMA decreased renal blood flow (RBF) without significant decreases in glomerular filtration rate (GFR), urinary sodium excretion (UNaV), or urinary cGMP. In contrast, HS-142-1 resulted in a decrease in UNaV and cGMP excretion together with a reduction in GFR and an increase in distal fractional tubular sodium reabsorption. We conclude that in AHF, the NP system plays a role in maintaining sodium excretion and GFR, while the function of NO is in the maintenance of RBF. These studies have both physiological and therapeutic implications warranting further research into cardiorenal interactions in this syndrome of AHF.

Renal responses to acute reflex activation of renal sympathetic nerve activity and renal denervation in secondary hypertension

We tested whether the responsiveness of the kidney to basal renal sympathetic nerve activity (RSNA) or hypoxia-induced reflex increases in RSNA, is enhanced in angiotensin-dependent hypertension in rabbits. Mean arterial pressure, measured in conscious rabbits, was similarly increased (+16 +/- 3 mmHg) 4 wk after clipping the left (n = 6) or right (n = 5) renal artery or commencing a subcutaneous ANG II infusion (n = 9) but was not increased after sham surgery (n = 10). Under pentobarbital sodium anesthesia, reflex increases in RSNA (51 +/- 7%) and whole body norepinephrine spillover (90 +/- 17%), and the reductions in glomerular filtration rate (-27 +/- 5%), urine flow (-43 +/- 7%), sodium excretion (-40 +/- 7%), and renal cortical perfusion (-7 +/- 3%) produced by hypoxia were similar in normotensive and hypertensive groups. Hypoxia-induced increases in renal norepinephrine spillover tended to be less in hypertensive (1.1 +/- 0.5 ng/min) than normotensive (3.7 +/- 1.2 ng/min) rabbits, but basal overflow of endogenous and exogenous dihydroxyphenolglycol was greater. Renal plasma renin activity (PRA) overflow increased less in hypertensive (22 +/- 29 ng/min) than normotensive rabbits (253 +/- 88 ng/min) during hypoxia. Acute renal denervation did not alter renal hemodynamics or excretory function but reduced renal PRA overflow. Renal vascular and excretory responses to reflex increases in RSNA induced by hypoxia are relatively normal in angiotensin-dependent hypertension, possibly due to the combined effects of reduced neural norepinephrine release and increased postjunctional reactivity. In contrast, neurally mediated renin release is attenuated. These findings do not support the hypothesis that enhanced neural control of renal function contributes to maintenance of hypertension associated with activation of the renin-angiotensin system.