Glomerular permselectivity is dependent on adequate serum concentrations of orosomucoid

Albumin interaction with the glomerular capillary wall in vitro

The binding of albumin to the glomerular capillary wall was studied using albumin-gold in perfused kidneys, the interaction of [3H]albumin with isolated glomeruli at 37 degrees C and 4 degrees C and the interaction at [3H]albumin with purified basement membrane. The albumin-gold was found to bind predominantly to the basement membrane and this interaction could be dissociated with high concentrations of albumin. There was binding of albumin to isolated rat glomeruli which exhibited temperature dependence. Glomeruli exhibited a binding site at both 37 degrees C and 4 degrees C with an association constant in the range of 1 to 3 x 10(4) M-1 that bound 7 x 10(13) molecules/glomerulus. At 37 degrees C, however, there was anomalous Scatchard binding behaviour at relatively higher concentrations of albumin (30 to 50 mg/ml) which could be due to either glomerular cell uptake or the appearance of multiple binding sites or both. The binding of albumin to isolated glomeruli and the glomerular albumin levels in isolated kidney perfusion could largely be accounted for by the binding of albumin to the glomerular basement membrane. The albumin binding to glomeruli at 37 degrees C was enhanced by Pronase digestion and heparinase digestion, but remained unchanged following trypsin treatment or neuraminidase treatment. Similarly, albumin was shown to bind to purified basement membrane preparations. This binding was also enhanced (approximately 80 times) by heparinase digestion but remained unchanged after digestion with chondroitinase ABC or hyaluronidase.(ABSTRACT TRUNCATED AT 250 WORDS)

Elevated plasma levels of acute phase proteins in mesangioproliferative glomerulonephritis, membranous nephropathy and IgA nephropathy

In order to study the possible role of active inflammatory processes in clinical indolent primary chronic glomerulonephritides, plasma concentrations of the acute phase proteins: alpha 1-antitrypsin, haptoglobin, orosomucoid and C-reactive protein were measured in 166 glomerulonephritis patients. The patients had a diagnosis of either mesangioproliferative glomerulonephritis, membranous nephropathy or immunoglobulin A nephropathy and were divided in two groups, one with heavy urinary albumin losses and one with moderate to slight urinary albumin excretion. The median plasma concentration values for alpha 1-antitrypsin, haptoglobin and orosomucoid were increased in all three kinds of the investigated glomerulonephritides with exception for orosomucoid in patients with heavy urinary albumin losses and in the membranous nephropathy group. The plasma concentration values for C-reactive protein were not elevated at all in the material. The increase of plasma levels of acute phase proteins could be the result of persistent inflammatory stimuli that occur in primary chronic glomerulonephritides. The finding of unchanging plasma levels of C-reactive protein in contrast to increased concentrations of the other acute phase proteins could be of significance in diagnosing infections or other inflammatory diseases in patients with chronic glomerulonephritis.

Stability of albumin, protein HC, immunoglobulin G, kappa- and lambda-chain immunoreactivity, orosomucoid and alpha 1-antitrypsin in urine stored at various conditions

Urine samples from 10 randomly selected patients with advanced renal disease were each divided into six aliquots and a preservative solution containing benzamidinium chloride, EDTA, tris(hydroxymethyl)-aminomethane and azide was then added to three of the aliquots. Aliquots with and without additive were then stored at room temperature for up to 7 days, at 4 degrees C for up to 30 days and at -20 degrees C for up to 6 months. The concentrations of albumin, protein HC, IgG, orosomucoid and alpha 1-antitrypsin as well as the kappa- and lambda-chain immunoreactivities in the samples were determined by automated immunoturbidimetry or by single radial immunodiffusion after 1, 3, 7, 14, 30, 90 and 180 days of storage. All investigated proteins, except alpha 1-antitrypsin in native urine, were stable for 7 days in the samples stored at room temperature both in the presence and absence of additives. All investigated proteins, except alpha 1-antitrypsin in native urine, were stable for 30 days in the samples stored at 4 degrees C both in the presence and absence of additives. A more complex pattern was observed for the stability of the proteins in the frozen samples. The IgG level decreased rapidly in several samples stored without additives but not in samples stored with additives. The alpha 1-antitrypsin concentration decreased rapidly to about 50% of the initial value in several samples stored both with and without additives. The rate of the decrease for both the IgG and the alpha 1-antitrypsin level varied between samples and the main decrease for several samples was seemingly caused by the freezing and/or thawing per se and not by the storage period in between.

Reduced permselectivity in isolated perfused rat kidneys following small elevations of glomerular capillary pressure

A modified rat kidney preparation was used to explore how changes in hydrostatic pressure affect the permselective properties of the glomerular capillary bed. The maximally vasodilated kidneys of 18 rats were perfused with albumin solutions (16.7 g l-1) at different flow rates and hence arterial pressures (PA). One kidney in each rat was exposed to pressure elevations with the other kidney serving as a control perfused at constant PA of about 100 mmHg. Both the vascular resistance to flow and the glomerular filtration rate (GFR 34.6 +/- 2.9 ml min-1 100 g-1) were similar in the two kidneys at equal PA and remained constant throughout the experiment. The ratio of albumin clearance over GFR (theta) was initially around 0.4% at constant PA and gradually increased during 1.5 h to reach 0.7% at the end of the experiment. A direct increase of PA from 100 to 200 mmHg for 15 min resulted in a calculated increase of the effective glomerular filtration pressure gradient of 10-15 mmHg and in a two-fold increase of theta when measured at an identical PA of 100 mmHg. Albumin clearance was almost fully normalized within 20 min similar to that observed in e.g. skeletal muscle. However, the glomerular capillary barrier seemed to be far more sensitive to elevations of hydrostatic pressure than other capillary walls which require capillary pressure increments of 60 mmHg in order to induce similar reversible changes in permeability. Therefore, we conclude that an elevated PGC per se induces changes of glomerular permselectivity, which may have important pathophysiological implications during conditions of proteinuria.

Analysis of the pressure-flow characteristics of isolated perfused rat kidneys with inhibited tubular reabsorption

The renal hemodynamics were studied in an isolated perfused rat kidney model modified for investigations of the glomerular permeability characteristics. The tubular reabsorptive activity was inhibited by perfusion at low temperature (8 degrees C) in the presence of furosemide and nitroprusside resulting in a dramatic increase in the filtered load of fluid and solute reaching the tubules and hence in tubular pressure. The glomerular filtration rate (GFR), arterial pressure (PA) and needle pressure (intrarenal tissue pressure, PiR) were continuously recorded and the glomerular hydrostatic pressure was estimated by an arterial occlusion technique. The pre- to postglomerular resistance ratio was calculated from the pressure vs. GFR relationships for two perfusates having differing oncotic pressures (pi = 5.5 and pi = 20 mmHg), from which estimations of glomerular hydrostatic pressures (PGC) were concomitantly made. Thus, increases in delta pi could be exactly counterbalanced by equally large increases in PGC for any given GFR, the needle and Bowman's capsule pressures being dependent on GFR but not on plasma colloid oncotic pressure. The experimental interventions resulted in a pronounced elevation of PiR as compared with in vivo conditions, while the PGC values were in a normal range, resulting in reduced glomerular filtration pressures. Furthermore, the clearance of albumin varied with the oncotic pressure in agreement with the notion of heteroporosity.

Lipoprotein(a) in nephrotic syndrome

Lipoprotein(a) [LP(a)] is an independent risk factor for cardiovascular disease, and it has also been speculated that it promotes thrombosis. Recent studies have shown that patients with gross proteinuria have greatly increased plasma levels of Lp(a), but the genesis is obscure. In the present study, plasma Lp(a) levels were measured in 31 patients with nephrotic syndrome (NS), 24 patients with IgA nephropathy and 43 healthy control subjects. Lp(a) levels were significantly elevated in NS (median 49.0 mg/dl), in contrast to the control subjects and patients with IgA nephropathy (median 7.0 and 9.7 mg/dl, respectively). Plasma Lp(a) levels fell markedly in 10 of 10 NS patients after remission. In NS, Lp(a) levels correlated directly with serum cholesterol levels (P < 0.05) and indirectly with plasma orosomucoid levels (P < 0.05), but not with serum albumin, triglycerides, HDL cholesterol, urinary protein excretion or GFR. In addition, Lp(a) tended to be higher in NS patients with edema (median 54.3 mg/dl) than in patients without edema (19.0 mg/dl; P = 0.06). Nine NS patients were further evaluated with plasma ANP levels and urinary sodium excretion. Plasma Lp(a) correlated directly with ANP (P < 0.01) and indirectly with urinary sodium excretion (P < 0.05). Excellent correlations were found between Lp(a) and VLDL cholesterol and VLDL triglycerides, respectively, suggesting a close link between Lp(a) and triglyceride-rich lipoproteins in nephrosis.

Addition of purified orosomucoid preserves the glomerular permeability for albumin in isolated perfused rat kidneys

The serum protein, orosomucoid has been shown to be essential for the maintenance of normal capillary permeability in several different organs, including the kidney. Thus, the clearance of albumin was found to be almost fivefold higher in the absence of orosomucoid in a previous study on isolated rat kidneys, perfused with either of two commercially available human albumin solutions of similar composition, but differing in their content of orosomucoid (0.21 g l-1 vs. < 0.005 g l-1). The following experiments were performed in order to verify the hypothesis that this effect on glomerular permselectivity was due to orosomucoid per se and not to other ingredients in the two solutions. Both kidneys of 12 rats were isolated and perfused with identical albumin solutions without orosomucoid, but with the addition of purified orosomucoid (0.25 g l-1) to one of the kidneys. No significant differences in vascular resistance, urine flow or glomerular filtration rate (GFR), which was found to be 27 +/- 2 ml min-1 100 g-1, were observed between the two groups of kidneys. The fractional clearance of albumin (theta) was initially similar for both kidneys (0.0022 +/- 0.0002). In the absence of orosomucoid, theta gradually increased to 0.0076 +/- 0.0013 after 1 h of perfusion compared to 0.0040 +/- 0.0006 for the kidneys with orosomucoid added to the perfusate (P < 0.001, n = 12). We conclude that the plasma glycoprotein orosomucoid indeed plays an important role in regulating the dynamic properties of the glomerular capillary wall by reducing the permeability towards macromolecules such as albumin.

An isolated perfused rat kidney preparation designed for assessment of glomerular permeability characteristics

The aim of the present investigation was to modify the widely used isolated perfused rat kidney preparation to make it more suitable for studies of glomerular permeability to macromolecules. Both kidneys were perfused in situ using separate pumps in two of each other independent systems with Tyrode-solution containing human serum albumin (18.2 g l-1). Sodium nitroprusside was administered to induce dilatation and to maintain constant vascular resistance (PRU100) during the experiments. The addition of sodium nitroprusside decreased vascular resistance from 0.17 +/- 0.05 to 0.09 +/- 0.02 mmHg min-1 100 g-1 ml-1 and increased urine flow and glomerular filtration rate. The temperature of the perfusate was reduced from 37 degrees C to 8 degrees C to inhibit tubular reabsorption of protein and fluid, resulting in a urine to plasma concentration ratio of [51Cr]EDTA of 1.26 +/- 0.07. Furosemide reduced the urine to plasma concentration ratio for [51Cr]EDTA further to 1.15 +/- 0.02 and increased glomerular filtration rate. Moreover, by performing the studies at low temperatures (8 degrees C) in the presence of sodium nitroprusside and furosemide it was possible to achieve low and stable albumin fractional clearance values close to those prevailing in vivo. Thus, the described technique, allowing simultaneous perfusions of both kidneys with different solutions, pressures and flows, seem to be well suited for studies of macromolecular transport across glomerular capillaries.