Reduction in renal blood flow following administration of norepinephrine and phenylephrine in septic rats treated with Kir6.1 ATP-sensitive and KCa1.1 calcium-activated K+ channel blockers

The role of nitric oxide in sepsis-associated kidney injury

Sepsis is one of the leading causes of acute kidney injury (AKI), and several mechanisms including microcirculatory alterations, oxidative stress, and endothelial cell dysfunction are involved. Nitric oxide (NO) is one of the common elements to all these mechanisms. Although all three nitric oxide synthase (NOS) isoforms are constitutively expressed within the kidneys, they contribute in different ways to nitrergic signaling. While the endothelial (eNOS) and neuronal (nNOS) isoforms are likely to be the main sources of NO under basal conditions and participate in the regulation of renal hemodynamics, the inducible isoform (iNOS) is dramatically increased in conditions such as sepsis. The overexpression of iNOS in the renal cortex causes a shunting of blood to this region, with consequent medullary ischemia in sepsis. Differences in the vascular reactivity among different vascular beds may also help to explain renal failure in this condition. While most of the vessels present vasoplegia and do not respond to vasoconstrictors, renal microcirculation behaves differently from nonrenal vascular beds, displaying similar constrictor responses in control and septic conditions. The selective inhibition of iNOS, without affecting other isoforms, has been described as the ideal scenario. However, iNOS is also constitutively expressed in the kidneys and the NO produced by this isoform is important for immune defense. In this sense, instead of a direct iNOS inhibition, targeting the NO effectors such as guanylate cyclase, potassium channels, peroxynitrite, and S-nitrosothiols, may be a more interesting approach in sepsis-AKI and further investigation is warranted.

Role of renal vascular potassium channels in physiology and pathophysiology

The control of renal vascular tone is important for the regulation of salt and water balance, blood pressure and the protection against damaging elevated glomerular pressure. The K⁺ conductance is a major factor in the regulation of the membrane potential (V_m ) in vascular smooth muscle (VSMC) and endothelial cells (EC). The vascular tone is controlled by V_m via its effect on the opening probability of voltage-operated Ca²⁺ channels (VOCC) in VSMC. When K⁺ conductance increases V_m becomes more negative and vasodilation follows, while deactivation of K⁺ channels leads to depolarization and vasoconstriction. K⁺ channels in EC indirectly participate in the control of vascular tone by endothelium-derived vasodilation. Therefore, by regulating the tone of renal resistance vessels, K⁺ channels have a potential role in the control of fluid homoeostasis and blood pressure as well as in the protection of the renal parenchyma. The main classes of K⁺ channels (calcium activated (K_Ca ), inward rectifier (K_ir ), voltage activated (K_v ) and ATP sensitive (K_ATP )) have been found in the renal vessels. In this review, we summarize results available in the literature and our own studies in the field. We compare the ambiguous in vitro and in vivo results. We discuss the role of single types of K⁺ channels and the integrated function of several classes. We also deal with the possible role of renal vascular K⁺ channels in the pathophysiology of hypertension, diabetes mellitus and sepsis.

Extracellular superoxide dismutase is necessary to maintain renal blood flow during sepsis development

Background

Extracellular superoxide dismutase (ECSOD) protects nitric oxide (NO) bioavailability by decreasing superoxide levels and preventing peroxynitrite generation, which is important in maintaining renal blood flow and in preventing acute kidney injury. However, the profile of ECSOD expression after sepsis is not fully understood. Therefore, we intended to evaluate the content and gene expression of superoxide dismutase (SOD) isoforms in the renal artery and their relation to renal blood flow.

Methods

Sepsis was induced in Wistar rats by caecal ligation and perforation. Several times after sepsis induction, renal blood flow (12, 24 and 48 h); the renal arterial content of SOD isoforms, nitrotyrosine, endothelial and inducible nitric oxide synthase (e-NOS and i-NOS), and phosphorylated vasodilator-stimulated phosphoprotein (pVASP); and SOD activity (3, 6 and 12 h) were measured. The influence of a SOD inhibitor was also evaluated.

Results

An increase in ECSOD content was associated with decreased 3-nitrotyrosine levels. These events were associated with an increase in pVASP content and maintenance of renal blood flow. Moreover, previous treatment with a SOD inhibitor increased nitrotyrosine content and reduced renal blood flow.

Conclusions

ECSOD appears to have a major role in decreasing peroxynitrite formation in the renal artery during the early stages of sepsis development, and its application can be important in renal blood flow control and maintenance during septic insult.

Increased diuresis, renal vascular reactivity, and blood pressure levels in young rats fed high sodium, moderately high fructose, or their association: a comparative evaluation

Excessive intakes of sodium or fructose have been described as risk factors for hypertension. We hypothesized that even a moderately high fructose diet (6% fructose), either alone or in combination with high sodium (4% NaCl), may impair diuresis and renal and systemic vascular reactivity, contributing to the onset of high blood pressure in rats. Male Wistar rats were fed chow containing 4% NaCl (HS), 6% fructose (MHF), or both 4% NaCl and 6% fructose (HSMHF) for 6 weeks and had their diuresis, plasma creatinine, vascular reactivity of perfused kidneys and systemic arterial pressure evaluated. We found no differences in augmented diuresis among animals given HS, MHF, or HSMHF diets. After 6 weeks both the HS and HSMHF groups had increased weight in their left kidneys, but only the HSMHF group showed augmented plasma creatinine. The effects of phenylephrine on renal vascular perfusion pressure were similarly enhanced in kidneys from the HS, MHF, and HSMHF groups, but not on the systemic arterial pressure. Although when evaluated in anesthetized rats, only the HSMHF group presented augmented blood pressure, evaluation in conscious animals revealed that both the MHF and HSMHF diets, but not the HS alone, were able to induce tachycardia and hypertension. In conclusion, a MHF diet containing 6% fructose was enough to render the renal vascular bed hyperreactive to phenylephrine and to induce both hypertension and tachycardia. The combination of 6% fructose with 4% NaCl led to plasma accumulation of creatinine and accelerated the development of tachycardia.