Effect of ethanol on the Na(+)- and the Na+,K(+)-ATPase activities of basolateral plasma membranes of kidney proximal tubular cells

Fanconi Syndrome in an Adult With Chronic Alcohol Use Disorder: A Rare Etiology

Fanconi syndrome is described as a defect in the proximal tubular reabsorption of glucose, amino acids, uric acid, phosphate, and bicarbonate, falling under type 2 renal tubular acidosis (RTA). Some common causes include drugs, heavy metals, infections, and genetics (particularly mitochondrial disorders). 

We present a case of a 33-year-old Caucasian female with chronic alcohol use disorder. She was treated for acute kidney injury (AKI) but had persistent hypophosphatemia, hypokalemia, hypouricemia, low bicarbonate, along with glycosuria consistent with Fanconi syndrome. An exhaustive workup ruled out the most common causes. Alcohol abstinence proved to correct the underlying abnormality. 

Alcohol is a mitochondrial toxin, and its role in the pathophysiology of Fanconi syndrome is under investigation. Early diagnosis of Fanconi is imperative to avoid complications such as rickets and osteomalacia. Therefore, testing for markers of alcohol abuse should be considered when determining the etiology of Fanconi syndrome. 

Alcohol use disorder is a common disorder, with more than 3 million cases annually in the US alone. Clinicians should have a high index of suspicion for Fanconi syndrome in a patient with similar anomalous labs considering the high prevalence of alcohol use disorder. More research regarding this topic is warranted.

A review on renal toxicity profile of common abusive drugs

Drug abuse has become a major social problem of the modern world and majority of these abusive drugs or their metabolites are excreted through the kidneys and, thus, the renal complications of these drugs are very common. Morphine, heroin, cocaine, nicotine and alcohol are the most commonly abused drugs, and their use is associated with various types of renal toxicity. The renal complications include a wide range of glomerular, interstitial and vascular diseases leading to acute or chronic renal failure. The present review discusses the renal toxicity profile and possible mechanisms of commonly abused drugs including morphine, heroin, cocaine, nicotine, caffeine and alcohol.

Alcohol induced effects on kidney

After administration ethanol and its metabolites go through kidneys and are excreted into urine, and its content in the urine is higher than that of the blood and the liver. Chronic ethanol administration decreases the renal tubular reabsorption and reduces renal function. Multiple functional abnormalities of renal tubules may be associated with ethanol-induced changes in membrane composition and lipid peroxidation. The vulnerability of the kidney to oxidative damage has been partly attributed to its high content of long-chain polyunsaturated fatty acids. Renal ultra structural abnormalities due to ethanol exposure may be important in the genesis of functional disturbances. Increased oxidative stress and endothelial dysfunction with their complex interrelationships are relevant aspects of atherogenesis in chronic renal failure. Antioxidants, particularly polyphenols are expected to decrease the vulnerability of the kidney to oxidative challenges.

Alcohol misuse and renal damage

Recent clinical and experimental studies have demonstrated that the habitual consumption of large amounts of ethanol has deleterious effects on the kidney. A variety of tubular defects have been described in patients with chronic alcoholism. Evidence is emerging that tubular dysfunction has an important pathophysiological role in a wide range of electrolyte and acid-base disturbances commonly observed in these patients, and possibly in alcohol-induced bone disease. These renal abnormalities are often reversible, disappearing with abstinence. However, since 1990 a few cases of a syndrome of acute tubular necrosis due to binge drinking of ethanol in the absence of other evident nephrotoxic mechanisms, or in association with the use of nonsteroidal anti-inflammatory drugs, have been reported. A link between glomerulonephritis and alcoholism has become evident. IgA nephropathy has been demonstrated at autopsy in 64% of chronic alcoholics and, more recently, the association between alcoholism and postinfectious glomerulonephritis has been described. Structural and functional abnormalities of the kidney are reported with increasing frequency in the fetal alcohol syndrome seen in children who have been prenatally exposed to ethanol. In addition, over the last few years experimental studies in vitro or in animal models have provided information about the biochemical and molecular basis of alcohol-induced injury to kidney. It is hoped that future experimental and clinical research will provide us with a more comprehensive knowledge of the mechanisms of renal damage in alcohol misuse.

Effects of chronic ethanol consumption on extramitochondrial fatty acid oxidation and ethanol metabolism by rat kidney

1. We evaluated the effects of chronic ethanol consumption on microsomal and peroxisomal fatty acid oxidation and on ethanol oxidation by the kidney. 2. When mature rats were fed 20% ethanol for 10 weeks, an increase in alcohol dehydrogenase and catalase activities were observed in the kidney. 3. Renal microsomal and peroxisomal oxidation of fatty acids also increased by the treatment, but total cytochrome P450 content did not. 4. We concluded that chronic ethanol consumption results in an increased extramitochondrial disposition of fatty acids and ethanol oxidation by the kidney.

Persistence of the effects of ethanol in vitro on the lipid order and enzyme activities of chick-liver membranes

Results demonstrate for the first time that ethanol exerts two different effects on the lipid order of chick-liver mitochondria and microsomes: a fluidizing effect both in the core and at the surface of the membrane, which depends on its physical presence, and a rigidization of the surface of these membranes which occurs after its removal. In addition, and directly related to the reduction in fluidity produced in the membrane surface after ethanol removal, we have detected a persistent alteration in different enzyme activities involved in the hepatic mitochondrial and microsomal electron-transport systems. The persistence of the alterations in the lipid order and enzyme activities may result from a structural rearrangement of the lipid and protein components produced in the lipid bilayer surface when ethanol is no longer present in the membrane.

Stimulatory effect of ethanol on weak organic acid uptake in rat renal tubules

Ethanol at relatively low concentrations (10-40 mM) significantly stimulated the uphill uptake of a weak organic acid, fluorescein, in the superficial proximal tubules of rat renal cortex slices, but it did not affect the rate of glucose production from lactate or pyruvate in rat renal cortex fragment suspension. In a low Na+ medium, ethanol failed to stimulate fluorescein uptake, although under the conditions employed in the present study, the baseline weak organic acid uptake was not dependent on external Na+. The stimulation of fluorescein uptake by ethanol (20 mM) was abolished by an inhibitor of alcohol dehydrogenase (EC 1.1.1.1), pyrazole (1 mM), or an inhibitor of aldehyde dehydrogenase (EC 1.2.1.3), cyanamide (0.3 mM), suggesting that oxidation of ethanol mediated its effect on the uptake. Among gluconeogenesis inhibitors tested, only D-malate (2 mM) abolished the stimulatory effect of ethanol, while the rest either did not affect (quinolinate) or even slightly augmented (alpha-cyano-4-hydroxycinnamate and phenylpyruvate) it. The effect of ethanol was markedly increased by an inhibitor of the tricarboxylic acid cycle, fluoroacetate. It was concluded that the stimulation by ethanol of weak organic acid uptake in rat renal tubules was mediated by the production of acetate.

Renal tubular dysfunction in chronic alcohol abuse--effects of abstinence

BACKGROUND

Alcohol abuse may be accompanied by a variety of disorders of electrolyte and acid-base metabolism. The role of the kidney in the pathogenesis of these disturbances is obscure. We sought to evaluate the alcohol-induced abnormalities of renal function and improvement during abstinence and to assess the relation between renal dysfunction and electrolyte and acid-base disorders.

METHODS

We measured biochemical constituents of blood and renal function before and after four weeks of abstinence in 61 patients with chronic alcoholism who had little or no liver disease.

RESULTS

On admission, 18 patients (30 percent) had hypophosphatemia and hypomagnesemia, 13 patients (21 percent) had hypocalcemia, and 8 patients (13 percent) had hypokalemia. Twenty-two patients (36 percent) had a variety of simple and mixed acid-base disorders. Twenty of these patients had metabolic acidosis, and among them, 80 percent had alcoholic acidosis. A wide range of defects in renal tubular function, with normal glomerular filtration rate, were detected in these patients. The defects included decreases in the threshold and maximal reabsorptive ability for glucose (38 percent of patients) and in the renal threshold for phosphate excretion (36 percent); increases in the fractional excretion of beta 2-microglobulin (38 percent), uric acid (12 percent), calcium (23 percent), and magnesium (21 percent); and aminoaciduria (38 percent). Seventeen patients (28 percent) had a defect in tubular acidification, and five an impairment in urinary concentrating ability. Urinary excretion of N-acetyl-beta-D-glucosaminidase and alanine aminopeptidase were increased in 41 and 34 percent of patients, respectively. The abnormalities of blood chemistry and renal tubular function disappeared after four weeks of abstinence.

CONCLUSIONS

Transient defects in renal tubular function are common in patients with chronic alcoholism and may contribute to their abnormalities of serum electrolyte and blood acid-base profiles.