Confocal microscopic and other observations on the distal end of the thick limb of the human loop of Henle

Expression of renal 11beta-hydroxysteroid dehydrogenase type 2 is decreased in patients with impaired renal function

OBJECTIVE

Renal 11beta-hydroxysteroid dehydrogenase type 2 (11beta-HSD2) enables selective access of aldosterone to the mineralocorticoid receptor (MR). Impaired 11beta-HSD2 activity has been suggested in patients with hypertension as well as in patients with renal disease, where it may contribute to sodium retention, oedema and hypertension. To date, these studies have relied upon urinary cortisol (F) metabolite levels as surrogate markers of renal 11beta-HSD2 activity.

METHODS

We have directly analysed renal 11beta-HSD2 mRNA expression in 95 patients undergoing kidney biopsy using TaqMan real-time PCR. Serum and 24-h urine samples were used to document underlying renal function and endocrine parameters. Urinary F and cortisone (E) metabolites were analysed using gas chromatography/mass spectrometry.

RESULTS

Expression of 11beta-HSD2 did not correlate with blood pressure or urinary Na/K ratio, but a significant positive correlation with creatinine clearance was observed (r = 0.284; P < 0.01). Immunofluorescence and confocal laser microscopy confirmed decreased 11beta-HSD2 expression in patients with impaired renal function. For the first time, we showed that 11beta-HSD2 mRNA expression correlated negatively with the urinary free (UF) F/E (UFF/UFE) ratio (r = 0.276; P < 0.05) as well as with the urinary tetrahydrocortisol + 5alpha-tetrahydrocortisol/tetrahydrocortisone ((THF + alphaTHF)/THE) ratio (r = 0.256; P < 0.05). No difference in 11beta-HSD2 mRNA expression or in the UFF/UFE ratio was found between groups with no proteinuria, microalbuminuria, moderate or severe proteinuria. In contrast, the urinary (THF + alphaTHF)/THE ratio increased significantly (P < 0.05) in patients with severe albuminuria, suggesting increased hepatic 11beta-HSD1 in those patients.

CONCLUSIONS

These data suggest that renal 11beta-HSD2 expression may be represented only marginally better, if at all, by the UFF/UFE than by the (THF + alphaTHF)/THE ratio. Reduced renal 11beta-HSD2 expression may lead to occupancy of the MR by glucocorticoids such as cortisol and may contribute to the increased sodium retention seen in patients with impaired renal function.

Metanephric rat-mouse chimeras to study cell lineage of the nephron

The nephron is derived from the ureteric bud and metanephric mesenchyme and develops into a complex epithelial structure with a wide variety of phenotypes along its length. This segmental variation in expression of molecules provides an approach to understand the lineage of unique segments. The present study evaluated the expression of four relatively well-localized molecules--renin, Tamm-Horsfall protein (THP), oxytocin receptor (OTR), and the vasopressin type 2 receptor (V2R)--in cultured mouse-rat chimeric metanephric kidneys using reverse transcription-polymerase chain reaction (RT-PCR). Chimeric kidneys were formed by 1) separating the ureteric bud (U) from the metanephric mesenchyme (M) of mouse (m) at E11 and rat (r) at E13 days of gestation and 2) recombining the ureteric bud of one species with the metanephric mesenchyme of the other species (i.e., UrMm and UmM(r), followed by filter culture until differentiated. Species-specific restriction enzymes for all four genes were chosen to digest the PCR product from either rat or mouse. RT-PCR was performed for each mRNA species and the products digested. The V2R product from the UrMm chimera was cleaved by a restriction enzyme known to digest only rat product, suggesting the PCR product was produced predominantly by cells derived from the ureteric bud. The renin, OTR, and THP products from both chimeras were cleaved equally well by species-specific restriction enzymes, suggesting the products were made by cells originating from both the ureteric bud and the metanephric mesenchyme. These studies demonstrate that the cultured chimeric metanephric model is useful to study segment lineage. The results suggest that the lineage of at least certain portions of the nephron is heterogenous.

Immunodetection of 11 beta-hydroxysteroid dehydrogenase type 2 in human mineralocorticoid target tissues: evidence for nuclear localization

11 beta-Hydroxysteroid dehydrogenase (11 beta HSI) is an enzyme complex responsible for the conversion of hormonally active cortisol to inactive cortisone; two isoforms of the enzyme have been cloned and characterized. Clinical observations from patients with the hypertensive syndrome apparent mineralocorticoid excess, recently explained on the basis of mutations in the human 11 beta HSD2 gene, suggest that it is the 11 beta HSD2 isoform that serves a vital role in dictating specificity upon the mineralocorticoid receptor (MR). We have raised a novel antibody in sheep against human 11 beta HSD2 using synthetic multiantigenic peptides and have examined the localization and subcellular distribution of 11 beta HSD2 in mineralocorticoid target tissues. The immunopurified antibody recognized a single band of approximately 44 kDa in placenta, trophoblast, and distal colon. In kidney tissue, two bands of approximately 44 and 48 kDa were consistently observed. No signal was seen in decidua, adrenal, or liver. Immunoperoxidase studies on the mineralocorticoid target tissues, kidney, colon, and parotid gland indicated positive staining in epithelial cells known to express the MR: respectively, renal collecting ducts, surface and crypt colonic epithelial cells, and parotid duct epithelial cells. No staining was seen in these tissues in other sites. The intracellular localization of 11 beta HSD2 in kidney and colon epithelial cells was addressed using confocal laser microscopy. Parallel measurements of 11 beta HSD2 and nuclear propidium iodide fluorescence on sections scanned through an optical section of approximately 0.1 micron indicated significant 11 beta HSD2 immunofluorescence in the nucleus. In human kidney, colon, and salivary gland, 11 beta HSD2 protects the MR from glucocorticoid excess in an autocrine fashion. Furthermore, within these tissues, 11 beta HSD2, which had been considered to be a microsomal enzyme, is also found in the nucleus, suggesting that the interaction between the MR and aldosterone or cortisol is in part a nuclear event.

Tamm-Horsfall protein in reflux nephropathy

The distribution of Tamm-Horsfall protein, the main protein in normal urine, was studied immunohistologically in the kidneys of 70 pigs with unilateral vesico-ureteric reflux but without outflow obstruction. Strains of Escherichia coli were inoculated in the bladder. Inflammatory changes of reflux nephropathy (chronic pyelonephritis) were found in 52 pigs. There were extra-tubular deposits of Tamm-Horsfall protein in the kidneys of only 26 pigs. These deposits were small, increased in prevalence as the size of inflamed areas increased, and were not associated with deposits of the protein in glomeruli. These findings suggest that escape of Tamm-Horsfall protein from tubules and backwash into glomeruli are not major features of low pressure reflux nephropathy, unlike the findings in outflow obstruction of the lower urinary tract. There was no evidence that a reaction to Tamm-Horsfall protein was important in the pathogenesis of reflux nephropathy.

Tamm-Horsfall glycoprotein in streptozotocin diabetic rats: a study of kidney in situ hybridization, immunohistochemistry, and urinary excretion

Tamm-Horsfall glycoprotein, present only in the kidney thick ascending limb of Henle's loop, was studied here in streptozotocin diabetic rats. Tamm-Horsfall glycoprotein mRNA in situ hybridization was performed on snap-frozen left kidneys; the right kidneys were perfusion-fixed with 4% paraformaldehyde and embedded either in paraffin, for Tamm-Horsfall glycoprotein immunohistochemistry, or in Epon for stereologic measurements. The length of the thick ascending limb of Henle's loop and the amount of glycogen were measured and the ultrastructure of the cells was evaluated. Urinary excretion of Tamm-Horsfall glycoprotein, calcium, magnesium and albumin was measured. After 10 and 50 days' duration of diabetes, kidney weight increased 20 and 41%, respectively and the length of the thick ascending limb of Henle's loop increased 28 and 56%, respectively, compared with controls. Substantial glycogen accumulations were present in the thick ascending limb of Henle's loop, and electron microscopy revealed a significant decrease in organelles and basolateral membranes. After 10 and 50 days' duration of diabetes, in situ hybridization of Tamm-Horsfall glycoprotein mRNA revealed a fourfold decrease, and the immunostaining for Tamm-Horsfall glycoprotein showed a threefold decrease as measured by densitometry. However, urinary Tamm-Horsfall glycoprotein excretion rate was increased fivefold and urinary concentration about twofold. Urinary calcium excretion increased three-fold and magnesium twofold, but urinary albumin excretion was not significantly increased. The increased amount of Tamm-Horsfall glycoprotein, calcium and magnesium in the urine in diabetes occurs here concomitant with severe cellular damage in the thick ascending limb of Henle's loop.

Asymmetrical atrophy of the renal medulla: a previously unreported abnormality

Investigation of the smaller of a pair of unequal kidneys showed a band of atrophy in the inner medulla, sparing the papillary tip, which was viable and contained collecting ducts. The kidney had extensive cortical atrophy with glomerulocystic disease and multiple tiny renal cell neoplasms. These changes were considered secondary to the medullary lesion. Study of 85 other kidneys taken a autopsy and surgery showed 8 other cases with similar band-like atrophy in the medulla to various degrees. All 9 cases had severe vascular disease. This asymmetrical or band-like atrophy of the renal medulla seemed to be fairly common but previously unreported, could be differentiated from renal papillary necrosis, and was most likely due to an episode of severe ischaemia, possibly in kidneys with pre-existing vascular narrowing.

Distinctive patterns of renal neoplasms containing Tamm-Horsfall protein

Sections of 114 renal neoplasms from adults, and 2 renal rhabdoid tumours from children, were examined by an indirect immunoperoxidase method using two antibodies to Tamm-Horsfall protein. Forty-five of the adult neoplasms were also examined with an antibody to proximal tubular brush border. Tamm-Horsfall protein is normally only found in the cells of the thick limb of the loop of Henle, and there are widely divergent reports on its occurrence in renal neoplasms. In the present series, Tamm-Horsfall protein was detected in parts of 31 neoplasms. Four distinctive patterns of cell contained the protein: cells with a paranuclear inclusion typical of rhabdoid tumours; 'plasma rich' cells, which were large cells with cytoplasm that was centrally dense and peripherally clear; eosinophilic cells forming one type of papillary structure; and giant cells. The areas containing Tamm-Horsfall protein did not express markers of proximal tubular brush border, and appeared white to the naked eye, rather than the yellow of typical clear cell carcinomas. Tamm-Horsfall protein can therefore be found in renal neoplasms. The four distinctive patterns of positive cells appear to represent neoplastic phenotypes of thick limb cells. This has implications for the classification of renal neoplasms and for theories of their origin.

Heterogenous distribution of glycoconjugates in the kidney of dogfish Scyliorhinus caniculus (L.) with reference to changes in the glycosylation pattern during ontogenetic development of the nephron

Eight fluorochrome-coupled lectins with different sugar specificities were applied to cryosections of dogfish kidney. Despite profound differences in renal architecture between elasmobranch fish and other vertebrates, the sequence of nephron segments as revealed by the lectin-binding pattern was rather similar to that of tetrapodes. Wheat germ agglutinin (WGA) bound to cell membranes of epithelial cells of glomeruli, proximal and distal tubules, their basement membranes, the collecting tubule, and epithelial cells. Among other broadly binding lectins were Ricinus communis agglutinin I (RCA-I), soybean agglutinin (SBA), peanut agglutinin (PNA), Lycopersicon esculentum agglutinin (LEA), and Jacalin, all of which marked proximal as well as distal portions of the renal tubule. Dolichos biflorus agglutinin (DBA) did not react with any renal structure. Ulex europaeus agglutinin I (UEA-I), which indicates the presence of alpha-L-fucose, very strongly and specifically marked single epithelial cells of the early distal nephron, all epithelial cells of the late distal tubule, the beginning of the collecting tubule in the mesial tissue zone, and single cells in the end portion of the collecting tubule in the lateral bundles. Binding of UEA-I to receptors of distal nephron cells could be useful for the identification of these cells in functional studies employing teased tubule and/or isolated cell preparations. Binding of UEA-I to dogfish kidney structures resembles staining with UEA-I conjugates of late distal tubules and collecting tubules in the kidneys of frog and other, higher vertebrates. Epithelial cells of early developmental stages showed, very rarely, binding sites for most lectin-fluorochrome conjugates. A large number of lectin binding sites was observed in the extracellular matrix of fibroblast layers surrounding the early anlage and the S-shaped body. Lectin binding sites of the nephron epithelia appeared in a sequential manner in the next stages of development of the nephron. Ontogenetic and phylogenetic aspects of the merging region between nephron proper (late distal tubule) and collecting system (collecting tubule) are discussed.