Defect in proximal and distal sodium transport in post-obstructive diuresis

Atypical Causes of Urinary Tract Obstruction

Acute kidney injury due to urinary tract obstruction invariably suggests lower urinary tract obstruction or bilateral ureteric obstruction since obstruction of a single kidney while the contralateral kidney is normal and not obstructed would not cause a perceptible rise in creatinine. Assuming a total body volume of 42 L, 70 kg male that generates approximately 1400 mg of creatinine daily (20 mg/kg/day) who has complete urinary tract obstruction would experience a 3.33 mg/dL per day increase in serum creatinine. Thus, for an individual who had prior normal renal function and who presents with a creatinine of 30 mg/dL, one could surmise that the obstructive pathology had lasted at least 10 days. However, the rise in serum creatinine is a poor marker of renal injury and subsequent prognosis. Urinary tract obstruction leading to AKI can be due to a variety of causes, and its management is tailored to the underlying etiology. This case series describes the varied clinical course of four patients at our center who experienced AKI from atypical causes of obstructive uropathy. Current and future diagnostic modalities and caveats in the treatment of this disease entity are also discussed.

The importance of the thick ascending limb of Henle's loop in renal physiology and pathophysiology

The thick ascending limb (TAL) of Henle’s loop is a crucial segment for many tasks of the nephron. Indeed, the TAL is not only a mainstay for reabsorption of sodium (Na⁺), potassium (K⁺), and divalent cations such as calcium (Ca²⁺) and magnesium (Mg²⁺) from the luminal fluid, but also has an important role in urine concentration, overall acid–base homeostasis, and ammonia cycle. Transcellular Na⁺ transport along the TAL is a prerequisite for Na⁺, K⁺, Ca²⁺, Mg²⁺ homeostasis, and water reabsorption, the latter through its contribution in the generation of the cortico-medullar osmotic gradient. The role of this nephron site in acid–base balance, via bicarbonate reabsorption and acid secretion, is sometimes misunderstood by clinicians. This review describes in detail these functions, reporting in addition to the well-known molecular mechanisms, some novel findings from the current literature; moreover, the pathophysiology and the clinical relevance of primary or acquired conditions caused by TAL dysfunction are discussed. Knowing the physiology of the TAL is fundamental for clinicians, for a better understanding and management of rare and common conditions, such as tubulopathies, hypertension, and loop diuretics abuse.

Sonography-Guided Pyelocentesis and Pyelography in Cats: The Sonographer’s Role

Cats are commonly afflicted with chronic renal dysfunction and ureteral obstruction. Concurrent disease can be catastrophic. Sonography-guided pyelocentesis and pyelography provide a method of evaluating potential ureteral obstruction without relying on renal excretory function but are technically demanding. The methodology for these procedures is described in detail to aid the sonographer faced with assisting in this challenge.

Implications of oxidative stress in the pathophysiology of obstructive uropathy

Although the functional and clinical alterations occurring in patients with obstructive uropathy are not well understood, it has been suggested that oxidative stress could contribute in the mechanism responsible for the impairment of sodium and water balance. This study aimed to test the hypothesis that red wine administration causes an amelioration of both the renal damage and impairment of renal Na(+), K(+)-ATPase activity occurring after ureteral obstruction in the rat. Twenty-four male Wistar adult rats weighting 200-250 g were used. Half of them received a 10-week treatment with wine as the sole fluid source, while the other group received water. Both groups were subjected to 24-h unilateral ureteral obstruction (UUO). Kidney tissue was collected following the relief of the ligature to perform the biochemical assessments. Urine and blood samples were taken at baseline and after the relief. Results show that the treatment with red wine significantly enhances the activity of antioxidant enzymes, and thus reduces renal lipid peroxidation secondary to UUO, which correlated negatively with Na(+), K(+)-ATPase activity. Based on this and other previous data, it could be suggested that red wine administration may prevent renal damage secondary to UUO by inducing enhanced antioxidant potential.

Altered expression of epithelial sodium channel in rats with bilateral or unilateral ureteral obstruction

The roles of epithelial sodium channel (ENaC) subunits (α, β, and γ) in the impaired renal reabsorption of sodium and water were examined in rat models with bilateral (BUO) or unilateral ureteral obstruction (UUO) for 24 h or with BUO followed by release of obstruction and 3 days of observation (BUO-3dR). In BUO rats, plasma osmolality was increased dramatically, whereas plasma sodium concentration was decreased. Immunoblotting revealed a significantly decreased expression of α-ENaC (57 ± 7%), β-ENaC (19 ± 5%), and γ-ENaC (51 ± 10%) as well as 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) in the cortex and outer medulla (C+OM) compared with sham-operated controls. This was confirmed by immunohistochemistry. BUO-3dR was associated with polyuria and impaired renal sodium handling. The protein abundance and the apical labeling of α-ENaC were significantly increased, whereas β- and γ-ENaC as well as 11β-HSD2 expression remained decreased. In UUO rats, expression of α- and β-ENaC and 11β-HSD2 decreased in the C+OM in the obstructed kidney. In contrast, the abundance and the apical labeling of α-ENaC in the nonobstructed kidneys were markedly increased, suggesting compensatory upregulation in this kidney. In conclusion, α-, β-, and γ-ENaC expression levels are downregulated in the obstructed kidney. The expression and apical labeling of α-ENaC were increased in BUO-3dR rats and in the nonobstructed kidneys from UUO rats. These results suggest that altered expression of α-, β-, and γ-ENaC may contribute to impaired renal sodium and water handling in response to ureteral obstruction.

Renal structural and functional repair in a mouse model of reversal of ureteral obstruction

The end point of immune and nonimmune renal injury typically involves glomerular and tubulointerstitial fibrosis. Although numerous studies have focused on the events that lead to renal fibrosis, less is known about the mechanisms that promote cellular repair and tissue remodeling. Described is a model of renal injury and repair after the reversal of unilateral ureteral obstruction (UUO) in male C57bl/6J mice. Male mice (20 to 25 g) underwent 10 d of UUO with or without 1, 2, 4, or 6 wk of reversal of UUO (R-UUO). UUO resulted in cortical tubular cell atrophy and tubular dilation in conjunction with an almost complete ablation of the outer medulla. This was associated with interstitial macrophage infiltration; increased hydroxyproline content; and upregulated type I, III, IV, and V collagen expression. The volume density of kidney occupied by renal tubules that exhibited a brush border was measured as an assessment of the degree of repair after R-UUO. After 6 wk of R-UUO, there was an increase in the area of kidney occupied by repaired tubules (83.7 +/- 5.9%), compared with 10 d UUO kidneys (32.6 +/- 7.3%). This coincided with reduced macrophage numbers, decreased hydroxyproline content, and reduced collagen accumulation and interstitial matrix expansion, compared with obstructed kidneys from UUO mice. GFR in the 6-wk R-UUO kidneys was restored to 43 to 88% of the GFR in the contralateral unobstructed kidneys. This study describes the regenerative potential of the kidney after the established interstitial matrix expansion and medullary ablation associated with UUO in the adult mouse.

alpha-MSH prevents impairment in renal function and dysregulation of AQPs and Na-K-ATPase in rats with bilateral ureteral obstruction

The purpose of this study was to evaluate the effects of the anti-inflammatory hormone alpha-melanocyte-stimulating hormone (alpha-MSH) treatment on renal function and expression of aquaporins (AQPs) and Na-K-ATPase in the kidney in response to 24 h of bilateral ureteral obstruction (BUO) or release of BUO (BUO-R). In rats with 24-h BUO, immunoblotting revealed that downregulation of AQP2 and AQP3 was attenuated (AQP2: 38 +/- 5 vs. 13 +/- 4%; AQP3: 44 +/- 3 vs. 19 +/- 4% of sham levels; P < 0.05), whereas downregulation of Na-K-ATPase was prevented by alpha-MSH treatment (Na-K-ATPase: 94 +/- 7 vs. 35 +/- 5% of sham levels; P < 0.05). Immunocytochemistry confirmed the changes in AQP1 and Na-K-ATPase expression. Renal tubular cell apoptosis was confirmed in BUO kidneys, and alpha-MSH treatment virtually completely abolished apoptosis. Furthermore, we measured glomerular filtration rate (GFR) and effective renal plasma flow (ERPF), respectively. Forty-eight hours after BUO-R demonstrated that alpha-MSH treatment almost completely prevented the decrease in GFR (nontreated: 271 +/- 50; alpha-MSH: 706 +/- 85; sham: 841 +/- 105 microl x min(-1).100 g body wt(-1), P < 0.05) and ERPF (nontreated: 1,139 +/- 217; alpha-MSH: 2,598 +/- 129; sham: 2,633 +/- 457 microl x min(-1).100 g body wt(-1), P < 0.05). alpha-MSH treatment also partly prevented the downregulation of AQP1 and Na-K-ATPase expression in rats after BUO-R for 48 h. In conclusion, alpha-MSH treatment significantly prevents impairment in renal function and also prevents downregulation of AQP2, AQP3, and Na-K-ATPase during BUO or AQP1 and Na-K-ATPase after BUO-R, demonstrating a marked renoprotective effect of alpha-MSH treatment in conditions with urinary tract obstruction.

Altered expression of major renal Na transporters in rats with bilateral ureteral obstruction and release of obstruction

Urinary tract obstruction impairs urinary concentrating capacity and reabsorption of sodium. To clarify the molecular mechanisms of these defects, expression levels of renal sodium transporters were examined in rats with 24-h bilateral ureteral obstruction (BUO) or at day 3 or 14 after release of BUO (BUO-R). BUO resulted in downregulation of type 3 Na+/H+ exchanger (NHE3) to 41 +/- 14%, type 2 Na-Pi cotransporter (NaPi-2) to 26 +/- 6%, Na-K-ATPase to 67 +/- 8%, type 1 bumetanide-sensitive Na-K-2Cl cotransporter (BSC-1) to 20 +/- 7%, and thiazide-sensitive cotransporter (TSC) to 37 +/- 9%. Immunocytochemistry confirmed downregulation of NHE3, NaPi-2, Na-K-ATPase, BSC-1, and TSC. Consistent with this downregulation, BUO-R was associated with polyuria, reduced urinary osmolality, and increased urinary sodium and phosphate excretion. BUO-R for 3 days caused a persistant downregulation of NHE3 to 53 +/- 10%, NaPi-2 to 57 +/- 9%, Na-K-ATPase to 62 +/- 8%, BSC-1 to 50 +/- 12%, and TSC to 56 +/- 16%, which was associated with a marked reduction in the net renal reabsorption of sodium (616 +/- 54 vs. 944 +/- 24 micromol x min-1 x kg-1; P < 0.05) and phosphate (6.3 +/- 0.9 vs. 13.1 +/- 0.4 micromol x min-1. kg-1; P < 0.05) demonstrating a defect in renal sodium and phosphate reabsorption capacity. Moreover, downregulation of Na-K-ATPase and TSC persisted in BUO-R for 14 days, whereas NHE3, NaPi-2, and BSC-1 were normalized to control levels. In conclusion, downregulation of renal Na transporters in rats with BUO and release of BUO are likely to contribute to the associated urinary concentrating defect, increased urinary sodium excretion, and postobstructive polyuria.

Antegrade pyelography for suspected ureteral obstruction in cats: 11 cases (1995-2001)

OBJECTIVE

To determine sensitivity and specificity of radiography, ultrasonography, and antegrade pyelography for detection of ureteral obstructions in cats.

DESIGN

Retrospective study.

ANIMALS

11 cats.

PROCEDURE

Medical records of cats that had radiography, ultrasonography, and antegrade pyelography performed for suspected ureteral obstructions were examined. Ultrasound-guided pyelocentesis and fluoroscopic-assisted antegrade pyelography were performed on 18 kidneys in 11 cats. Obstructive ureteral lesions were confirmed in all cats by surgical or necropsy examination. Sensitivity and specificity of survey radiography, ultrasonography, and antegrade pyelography for identification of ureteral obstructions were calculated. Surgical or necropsy findings were used as the standard for comparison.

RESULTS

All cats were azotemic. Mean +/- SD serum creatinine and BUN concentrations were 10.2 +/- 6.1 and 149 +/- 82 mg/dL, respectively. Fifteen of 18 ureters were found to be obstructed at surgery or necropsy. Sensitivity and specificity were 60 and 100% for radiography and 100 and 33% for ultrasonography, respectively, in identification of ureteral obstructions. Leakage of contrast material developed in 8 of 18 kidneys during antegrade pyelography and prevented diagnostic interpretation in 5 of 18 studies. For the 13 diagnostic studies, specificity and sensitivity were 100% by use of the antegrade pyelography technique. Correct identification of the anatomic location of the ureteral obstruction was obtained in 100% of diagnostic antegrade pyelography studies and in 60% of radiography or ultrasonography studies.

CONCLUSIONS AND CLINICAL RELEVANCE

Antegrade pyelography can be a useful alternative in the diagnosis and localization of ureteral obstructions in azotemic cats, although leakage of contrast material may prevent interpretation of the study.

Renal water and sodium handling during gradated unilateral ureter obstruction

OBJECTIVE

Unilateral complete obstruction of the ureter (UUO) is associated with characteristic changes in renal function. To improve the understanding of how urine concentration directly is affected by changes in pelvic pressure, changes in renal salt and water handling along the nephron and collecting duct were examined.

MATERIAL AND METHODS

Pelvic pressure was raised stepwise using an adjustable lever inserted in the right ureter. Urine samples were collected from the tip of the catheter by way of an overflow system. Water and sodium handling in the distal and proximal tubules were measured by the lithium clearance technique. Renal blood flow (RBF) was measured with implanted ultrasonic flow probes. Catheters were placed in both renal veins and glomerular filtration rate (GFR) and filtration fraction were calculated using renal extraction of (51)Cr-EDTA independent of urine sampling.

RESULTS

The sequence of changes for each parameter is provided. The parameters did not show a uniform pattern from which specific threshold values could be derived. However, the mean value of the following parameters were markedly changed at specific pressures: (1) at 10 cm H(2)O ipsilateral urine output decreased rapidly and distal absolute reabsorption of sodium (DAR(H2O)) decreased, (2) at 20 cm H(2)O GFR started to decline rapidly, (3) at 30 cm H(2)O urine output was impaired, and (4) at 40 cm H(2)O proximal absolute reabsorption of water (PAR(H2O)) showed a decreasing tendency in all pigs together with impairment in tubular sodium handling. Furthermore, free water clearance was slightly impaired (-0.26 +/- 0.15 at baseline and -0.15 +/- 0.08 ml/min at maximum pressure) and ipsilateral RBF decreased from 171.1 +/- 12.4 ml/min at baseline to 136.3 +/- 12.3 ml/min at ureteral pressure of 80 cm H(2)O (p < 0.05). Consistent with that, ipsilateral renal vascular resistance increased with increasing pressure in the renal pelvis.

CONCLUSION

Water reabsorption and sodium handling is progressively impaired with increasing pelvic pressure. GFR and RBF are reduced in parallel. The study shows that the kidney responds to ureteral obstruction is unique and individual.

Increased expression of atrial natriuretic peptide in the kidney of rats with bilateral ureteral obstruction

BACKGROUND

Whether the postobstructive diuresis can be related to an altered regulation of local atrial natriuretic peptide (ANP) in the kidney was investigated.

METHODS

Three groups of rats had both of their ureters obstructed for 48 hours. The kidneys were taken without releasing the obstruction in one group [bilateral ureteral obstruction (BUO)]. The obstruction was released in the other two groups and the animals were kept for 4 and 24 hours thereafter to collect urinary data (BUR-4 and BUR-24, respectively). Plasma and urine ANP levels were measured by radioimmunoassay. The mRNA expression of ANP, natriuretic peptide receptor-A (NPR-A), and NPR-C was determined by reverse transcription-polymerase chain reaction. ANP receptors were also quantitated by in vitro autoradiography. The activity of guanylyl cyclase was determined by the amount of cGMP generated in response to ANP.

RESULTS

Urinary volume and sodium excretion increased in BUR-4, along with the ANP mRNA expression in the kidney and the urinary ANP excretion. The ANP excretion positively correlated with the urinary volume and sodium excretion. The mRNA expression of both NPR-A and NPR-C was decreased by BUO, the latter being far more prominently affected. The maximal binding capacity of radiolabeled ANP was decreased in the glomerulus and papilla in BUO. Not only the urinary parameters but also the mRNA expression of ANP, NPR-A, and NPR-C were comparable between BUR-24 and control rats. ANP-stimulated cGMP generation was reduced in the glomerulus and papilla in BUO animals, which was rapidly resumed following the release of the obstruction.

CONCLUSIONS

Postobstructive diuresis may be due partially to an increased ANP activity in the kidney.

Long-term renal effects of unilateral ureteral obstruction and the role of endothelin

BACKGROUND

Angiotensin II (Ang II) and endothelin (ET) are involved in the alteration of renal function in unilateral ureteral obstruction (UUO). The renal response to Ang II following the reversal of a 24-hour UUO and the effect of ET blockade by bosentan during the time of obstruction were investigated.

METHODS

Following blockade of the endogenous production of Ang II by captopril, the renal response to Ang II was studied in rats 15 to 18 days after a 24-hour UUO (N = 10) or a sham operation (N = 9) both with (N = 10) and without (N = 8) bosentan treatment in the periobstruction period. Similar studies were performed in another group (N = 9) two months following the reversal of obstruction.

RESULTS

In the sham-operated group, Ang II reduced renal blood flow (RBF) by 42 +/- 9% (P < 0.01), glomerular filtration rate (GFR) by 30 +/- 8% (P < 0.01), urine volume (UV) by 44 +/- 9% (P < 0.001), and absolute (UNaV) and fractional sodium excretion (FENa) by 52 +/- 9% (P < 0.001) and 33 +/- 9% (P = 0.054), respectively. In the previously obstructed kidney, Ang II did not change RBF but increased GFR by 106 +/- 40% (P < 0.01), UV by 75 +/- 21% (P < 0.001), UNaV by 190 +/- 60% (P < 0.001), and FENa by 40 +/- 13% (P < 0.05). Bosentan treatment in the obstructed group prevented these Ang II-induced effects and did not have any effect on the sham-operated kidney. Two months following reversal of the obstruction, the response of the kidney was similar to that of the control kidney.

CONCLUSION

Twenty-four-hour UUO results in a temporary abnormality in the renal response to Ang II, which is due, in part, to the actions of ET at the time of obstruction.

The pathophysiology of ureteral obstruction

Ureteral obstruction can have a variety of causes intrinsic or extrinsic to the kidney. The effects of obstruction are examined from the perspectives of duration, severity, totality, and the presence of complicating factors. There is a difference in the postobstructive pathophysiology depending on whether one or both ureters were obstructed. Atrial natriuretic peptide may be important in postobstructive diuresis, and preliminary evidence suggests a role for it as protection against nephron ischemia in acute obstruction. The potential for recovery of renal function after relief of obstruction depends on the duration and degree of obstruction, the condition of the contralateral kidney, and the presence or absence of infection. Ability to acidify the urine to pH < 6.0 preoperatively may be a good predictor of the recovery potential of an obstructed kidney. Urine concentrations of lysosomal enzymes such as N-acetylglucosaminidase also may be useful for this purpose, as may measurement of creatinine clearance in urine obtained from a nephrostomy tube.

The effect of stones on renal and ureteric physiology

The effect of calculi on renal and ureteric function is the result of a complex sequence of pathophysiological events triggered by obstruction. The degree of impairment of renal function resulting depends on whether the obstruction is partial or complete, is unilateral or bilateral, is complicated by infection or not and how and when it is relieved. This review will look at these interacting factors and particularly on the effects of various treatment modalities ranging from open techniques to minimally and non-invasive interventions.

Increased plasma prorenin but not renin after bilateral ureteral ligation in dogs

Plasma prorenin is normally higher than renin and usually changes in response to the same stimuli. In dogs, plasma prorenin and renin disappear after bilateral nephrectomy, indicating that both are of renal origin. It has been proposed that prorenin may mediate tissue renin systems via its reversible intrinsic renin-like activity. The renin-angiotensin system has been implicated in the changes in renal function that occur with bilateral ureteral obstruction, but plasma prorenin has not been investigated. We therefore studied the effect of 48-hour bilateral obstruction on plasma prorenin in two groups of dogs: one was volume expanded (N = 5), while the other group (N = 6) was euvolemic. Plasma prorenin concentration increased fourfold in both groups, angiotensinogen increased twofold, while plasma renin activity was unchanged. Following release of obstruction, plasma renin fell slightly while prorenin and angiotensinogen remained elevated. There was a positive relationship between plasma prorenin and renin before (r = 0.63, P less than 0.05) and after (r = 0.76, P less than 0.01) obstruction. Post-obstruction, ERPF and GFR were subnormal but filtration fraction was maintained; the higher the ERPF and GFR the higher the plasma prorenin post-obstruction (r = 0.83, P less than 0.01 and r = 0.77, P less respectively; N = 11). These results show that impairment of renal function during bilateral obstruction is associated with an increase in plasma prorenin but not renin. Nonetheless, there is a positive relationship between plasma prorenin and renin both pre- and post-obstruction. Thus, preferential impairment of clearance of prorenin relative to renin may occur during bilateral obstruction.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of leukocyte depletion on the function of the postobstructed kidney in the rat

We have observed an influx of leukocytes, predominantly macrophages, into the cortex and medulla of the kidney following ureteral obstruction. To examine the potential contribution of these infiltrating cells to the decrease in GFR and RPF that occurs following ureteral obstruction, 16 male Lewis rats (wt 246.4 +/- 4.0 g) were studied in the awake state three hours after unilateral release of 24 hours of bilateral ureteral obstruction (BUO). Eight rats were not irradiated, and eight rats received 1315 rads one day prior to the obstruction. The leukocyte infiltrate following 24 hours of ureteral obstruction was quantified with and without prior irradiation in an additional eight rats. Irradiation reduced cortical infiltration (27.05 +/- 3.07 x 10(5) vs. 1.2 +/- 0.83 x 10(5) cells/g tissue) and medullary infiltration (13.6 +/- 1.79 x 10(5) vs. 0.86 +/- 0.45 x 10(5) cells/g tissue) of leukocytes following BUO (P less than 0.001 for both) and increased postobstruction GFR (1.58 +/- 0.12 vs. 2.97 +/- 0.15 ml/min/kg body wt, P less than 0.001). Eleven rats, six of which received irradiation, underwent sham laparotomy without BUO in order to assess the effect of irradiation alone on renal function. Irradiation had no effect on the renal function of non-obstructed rats. Urinary excretion of thromboxane B2 increased following BUO and this rise was significantly blunted by irradiation prior to BUO (9.53 +/- 2.14 vs. 32.46 +/- 4.95 vs. 19.03 +/- 1.94 pg/min). Fractional excretion of sodium and water was reduced by irradiation.(ABSTRACT TRUNCATED AT 250 WORDS)

Extracorporeal shock wave lithotripsy and its effect on renal function

Extracorporeal shock wave lithotripsy has become a major treatment modality for symptomatic upper tract renal stone disease. Although proved to be effective in disintegrating stones the short-term and long-term effects on renal function are not yet known. We evaluated several basic physiological parameters, namely creatinine clearance, fractional sodium excretion, protein excretion and urine osmolality before and after extracorporeal shock wave lithotripsy in 26 consecutive patients in an attempt to quantitate changes in renal function. In addition, a 3 to 6-month followup study of patients showing excessive protein excretion with extracorporeal shock wave lithotripsy also is reported. Our data suggest that with extracorporeal shock wave lithotripsy transient nephrotic range proteinuria occurs immediately after treatment, returning to normal values within 3 to 6 months after treatment without a change in the glomerular filtration rate. The glomerular filtration rate increases after successful extracorporeal shock wave lithotripsy in patients with kidneys obstructed by the treated stone before the start of the procedure, and the kidney appears to maintain its ability to dilute urine and to conserve sodium after treatment.

Effect of ureteral obstruction on proximal tubular functions of rat kidney

The effect of complete unilateral ureteral obstruction (CUUO) on proximal tubular functions was studied in rats, using the K+-sensitive microelectrode technique and split oil drop method. In the control kidneys peritubular membrane potential (EMperi) and intracellular potassium activity (aKi) were -70.8 +/- 7.0 mV and 81.2 +/- 22.0 mEq/liter (mean +/- SD), respectively. In the CUUO kidneys both EMperi and aKi were progressively reduced with the duration of obstruction. However, in all tubules aKi values were still above the electrochemical equilibrium. In the three days' CUUO kidneys EMperi and aKi were -51.5 +/- 11.7 mV and 53.8 +/- 22.8 mEq/liter, respectively. Rate of fluid absorption (JVL;nl./sec. mm.) across the proximal tubular epithelium from Ringer solution in the control and three days' CUUO kidneys was 0.029 and 0.0065 respectively. In the CUUO kidneys there were wide variations in JVL and EMperi, but there was a clear correlation between these two variables. JVL from choline chloride solution was negligible in both control and CUUO kidneys. From above results, it was suggested that the proximal tubular reabsorption primarily depending on the Na+-K+ pump might be reduced but still working in the CUUO kidney, and thus the proximal tubular reabsorption might take part in preservation of glomerular filtration during the obstruction.

Effects of obstruction on renal functions

Following ureteral obstruction there is a progressive fall in glomerular filtration rate (GFR) due to a reduction in single nephron glomerular filtration rate (SNGFR) and a reduced number of filtering nephrons. Renal plasma flow also declines after a transient, prostaglandin-dependent increase, due to afferent and efferent arteriolar vasoconstriction. The vasoactive hormones thromboxane A2 and angiotensin II are implicated in the pathogenesis of the vasoconstriction following ureteral obstruction and they also reduce the glomerular ultrafiltration coefficient by causing mesangial contraction. Ureteral obstruction also leads to profound changes in renal tubular cell function. These include altered sodium and water handling resulting in a post-obstructive diuresis and natriuresis and a failure to dilute or concentrate the urine. Potassium and divalent cation exchange is also affected, as is urinary acidification. Furthermore, the response of the tubule to hormones such as antidiuretic hormone and parathyroid hormone is impaired. The pathophysiology of these alterations in renal function is discussed.

The effect of E. coli infection on the prostaglandin synthesizing capacity of postobstructive rat kidney

The PGE2, PGI2, PGF2 alpha and TxA2 synthesizing activities were studied in an isolated microsomal fraction of rat kidney after temporary, unilateral ureter obstruction and E. coli infection. In the early phase of regeneration the synthesis of vasodilatory PGI2 was increased, whereas that of vasoconstrictory PGF2 alpha was decreased. An increased PGE2 synthesizing activity was observed when renal obstruction was associated with infection. The role of these changes in regenerating the haemodynamics and function of postobstructive kidney is discussed.

Acidification in the medullary collecting duct following ureteral obstruction

A defect in urine acidification has been described in obstructive uropathy. Since the collecting tubule from the inner stripe of the outer medulla (OMCTi) is the major site for distal acidification, isolated OMCTi nephron segments from control rabbits and from rabbits after 24 hr of unilateral (UUO) or bilateral (BUO) ureteral obstruction were studied. Tubules were perfused (4 nliter/min) and bathed with an artificial solution resembling rabbit serum ultrafiltrate, and 3H inulin was incorporated in the perfusate as a volume marker. Water absorption (Jv) was -0.03 +/- 0.03 nliter X mm-1 X min-1 in control tubules, and was significantly (P less than 0.05) negative in UUO (-0.48 +/- 0.12 nliter X mm-1 X min-1) and BUO (-0.29 +/- 0.07 nliter/mm-1 X min-1) tubules, as a result of an inulin leak. Bicarbonate absorption (JHCO3) in control tubules was 11.61 +/- 1.21 pmole X mm-1 X min-1 and was significantly lower in UUO tubules (7.59 +/- 1.09 pmole X mm-1 X min-1, P less than 0.05). JHCO3 in BUO tubules although lower than control (7.96 +/- 2.75 pmole X mm-1 X min-1) did not achieve statistical significance because of a high degree of heterogeneity among tubules. To determine whether the acidification disorder was due to a gradient or capacity defect, the ability of the tubules to lower HCO3- concentration (delta HCO3) at low rate of perfusion (1 nliter/min) was examined. No difference in delta HCO3 was found among the three groups being 8.98 +/- 0.54, 9.95 +/- 1.76, and 8.93 +/- 2.19 mmole in control, UUO and BUO tubules respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Hemodynamic effects of enalapril on neonatal chronic partial ureteral obstruction

To evaluate the role of angiotensin II (ANG II) in renal vasoconstriction due to ipsilateral CPUO, guinea pigs were subjected to incomplete left ureteral stenosis within the first 48 hr of life, and were given enalapril from the 14th day of life until study at 23 +/- 3 days or 8 weeks of age. Renal blood flow (RBF) was measured using radioactive microspheres, and glomerular filtration rate (GFR) was derived from inulin extraction. The number of perfused glomeruli per kidney was determined following in vivo India ink perfusion. Enalapril treatment resulted in an 83% rise in RBF of the obstructed kidney, from 2.58 +/- 0.26 to 4.73 +/- 0.48 ml/min (P less than 0.001), which was associated with a 26% increase in number of perfused glomeruli (P less than 0.01). Mean GFR of the hydronephrotic kidney increased from 0.13 +/- 0.02 to 0.37 +/- 0.10 ml/min (P less than 0.05). Enalapril had no effect on intraureteral pressure of the obstructed left kidney after 7 to 13 days of administration, and did not affect renal mass or ureteral diameter after 6 weeks of treatment. It is concluded that hemodynamic consequences of CPUO in the neonate may be attenuated by ANG converting enzyme inhibition. The primary effect of enalapril is most likely inhibition of intrarenal ANG II formation.

Long-term effects of 24-hr unilateral ureteral obstruction on renal function in the rat

To characterize the pattern of recovery following release of unilateral ureteral obstruction of 24-hr duration, rats were studied with whole kidney clearance techniques, 3 hrs, 8, 14, and 60 days after release. The single nephron glomerular filtration rate (SNGFR) of superficial and juxtamedullary nephrons was estimated with a modification of Hanssen's technique in rats studied 8 and 60 days after ureteral release. The whole kidney glomerular filtration rates (GFR) were decreased markedly 3 hrs after relief of obstruction, but gradually increased and by 14 days, the GFR of the postobstructed kidney (POK) and the contralateral kidney (CK) were comparable. This recovery of GFR was not a consequence of a homogeneous improvement in SNGFR. At 8 days, more than 15% of superficial and juxtamedullary nephrons were not filtering in the POK. This decrease in the percent of filtering nephrons persisted to 60 days post release, indicating a permanent loss of nephron units. The SNGFR of the residual nephrons of the POK was significantly greater than that of the CK at 8 and 60 days following ureteral release. Thus, acute unilateral ureteral obstruction results in a permanent loss of filtering nephrons, which is offset by hyperfiltration of those remaining. Abnormalities in renal tubule function persisted beyond the time (14 days) when whole kidney GFR had returned to normal. These abnormalities were in distal tubule function. Urine osmolality was consistently lower at all time intervals post release, as was net acid excretion. The results of the present study suggest that these abnormalities are a consequence of the reduction in the number of filtering juxtamedullary nephrons and/or to abnormalities in collecting duct function.

Renal blood flow and vasodilatory ability prior to and following release of 24 hours bilateral ureteral obstruction in rats

Increased renal vascular resistance (RVR) is evident after 24 hours of uni- and bilateral ureteral obstruction (UUO and BUO). However, to what extent the RVR increase is due to vascular damage versus functional vasoconstriction, or whether obstructed kidneys possess the ability to reduce RVR in response to vasodilatory stimuli, is not clear. During 24 hours of BUO renal blood flow (RBF), recorded electromagnetically, was reduced to about 70% of control and continued to fall by another 18% during 1/2-1 hour after release of BUO. Infusion of imidazole, a thromboxane A2 synthetase blocker, did not reduce RVR after release of BUO. Whereas RBF autoregulation in response to reduced perfusion pressure was impaired, maximal proportional renal vasodilation induced by acetylcholine was increased, both prior to and after release of BUO, as compared to control and UUO. These different renal vasodilatory responses indicate that the RVR increase during BUO is largely due to a functional vasoconstriction that impairs autoregulatory vasodilation. In contrast, the RVR increase during UUO is probably mainly due to structural damage which does not prevent autoregulation of the RBF level attained.

Post-obstructive diuresis

A patient with post-obstructive diuresis is described. Inappropriate losses of salt and water occurred, with urine volume exceeding half the glomerular filtration rate. Additionally, excessive urinary excretion of potassium, bicarbonate, calcium, phosphate, magnesium and urate took place in the presence of subnormal blood levels. Transient proteinuria was also observed. This case demonstrates that serious electrolyte disturbances can occur after relief of urinary tract obstruction and the evidence suggests these may be due to disordered proximal tubule function.

Regulation of renal blood flow by plasma chloride

Micropuncture studies have shown that glomerular filtration rate (GFR) falls in response to a rise in Na(+) or Cl(-) concentrations in the loop of Henle, whereas studies in isolated kidneys have shown that GFR falls in response to osmotic diuresis. To define the separate effects of an acute increase in plasma sodium (P(Na)), chloride (P(Cl)) or osmolality (P(osmol)), changes in renal blood flow (RBF) and GFR were measured during intrarenal infusions of hypertonic NaCl, NaHCO(3), Na acetate, dextrose, NH(4)Cl or NH(4)acetate to denervated kidneys. The infusions raised P(osmol) at the experimental kidney by 30-45 mosmol. RBF increased abruptly by 10-30% with all hypertonic infusions indicating that an acute increase in plasma tonicity causes renal vasodilatation. Renal vasodilatation persisted or increased further during infusion of dextrose, NaHCO(3) and Na acetate, but GFR was unchanged. In contrast, during infusion of the two Cl-containing solutions, vasodilatation was reversed after 1-5 min and RBF and GFR decreased (P < 0.01) below preinfusion levels. Prior salt depletion doubled the vasoconstriction seen with hypertonic NaCl infusions. Overall, changes in RBF were unrelated to changes in P(Na) or fractional Na or fluid reabsorption but correlated with changes in P(Cl) (r = -0.91) and fractional Cl(-) reabsorption (r = 0.94). The intrafemoral arterial infusion of the two Cl-containing solutions did not increase femoral vascular resistance. In conclusion, hyperchloremia produces a progressive renal vasoconstriction and fall in GFR that is independent of the renal nerves, is potentiated by prior salt depletion and is related to tubular Cl(-) reabsorption. Chloride-induced vasoconstriction appears specific for the renal vessels.

Regulation of renal blood flow by plasma chloride

Micropuncture studies have shown that glomerular filtration rate (GFR) falls in response to a rise in Na(+) or Cl(-) concentrations in the loop of Henle, whereas studies in isolated kidneys have shown that GFR falls in response to osmotic diuresis. To define the separate effects of an acute increase in plasma sodium (P(Na)), chloride (P(Cl)) or osmolality (P(osmol)), changes in renal blood flow (RBF) and GFR were measured during intrarenal infusions of hypertonic NaCl, NaHCO(3), Na acetate, dextrose, NH(4)Cl or NH(4)acetate to denervated kidneys. The infusions raised P(osmol) at the experimental kidney by 30-45 mosmol. RBF increased abruptly by 10-30% with all hypertonic infusions indicating that an acute increase in plasma tonicity causes renal vasodilatation. Renal vasodilatation persisted or increased further during infusion of dextrose, NaHCO(3) and Na acetate, but GFR was unchanged. In contrast, during infusion of the two Cl-containing solutions, vasodilatation was reversed after 1-5 min and RBF and GFR decreased (P < 0.01) below preinfusion levels. Prior salt depletion doubled the vasoconstriction seen with hypertonic NaCl infusions. Overall, changes in RBF were unrelated to changes in P(Na) or fractional Na or fluid reabsorption but correlated with changes in P(Cl) (r = -0.91) and fractional Cl(-) reabsorption (r = 0.94). The intrafemoral arterial infusion of the two Cl-containing solutions did not increase femoral vascular resistance. In conclusion, hyperchloremia produces a progressive renal vasoconstriction and fall in GFR that is independent of the renal nerves, is potentiated by prior salt depletion and is related to tubular Cl(-) reabsorption. Chloride-induced vasoconstriction appears specific for the renal vessels.

Renal structural and functional changes after unilateral ureteral obstruction in rabbits

Renal structural and functional changes following unilateral ureteral ligation for periods of 3 days to 6 weeks were studied in rabbits. The renal pelvic pressure increased to 20 cm H2O within 3 days of obstruction and in contrast to some previous investigations it was still raised after 6 weeks. Interstitial oedema, collapse of proximal tubules and dilatation of distal tubules were the earliest observed histological changes. Later findings were interstitial fibrosis, widespread atrophy of proximal tubules and, in the latest stages, dilatation of the collecting duct system. Thus, the distal tubules appeared considerably less resistant than the collecting ducts, to the increased pressure. Renal functional changes were studied one hour after release of obstruction of 3 days, 1-2-4 or 6 weeks' duration. In comparison to the contralateral kidney a rapid decrease of blood flow and glomerular filtration occurred in spite of a normal glomerular structure and collapsed proximal tubules and were probably related to haemodynamic disturbances such as arteriolar constriction. Although absolute electrolyte excretion was much reduced, the fractional excretion of several electrolytes, especially magnesium was increased already after 3 days of obstruction. These findings can presumably be correlated to the dilatation and early epithelial alterations in the distal tubules in which magnesium is predominantly reabsorbed.

Kidney pressures after the release of 24 hours of bilateral ureteral ligation in the rat

Kidney function was studied in rats after the release of 24 hours of bilateral ureteral ligation (BUL). After deligation, natriuresis was observed for 1 day while diuresis persisted up to 4 days. The possible defective collecting tubule to reabsorb sodium may improve within 1 day, since the urinary sodium concentration was well below the sham value. During the early phase of deligation, the glomerular filtration rate (GFR) averaged only 15 per cent of the sham value. Heterogeneity of the surface nephrons was apparent. About 17 per cent of the observed surface nephrons had no tubular fluid flow, suggesting possibly that these nephrons may not contribute to the kidney GFR. In the other 83 per cent of the nephrons, the stop-flow pressure, 29.0 mm. Hg, was lower than the sham value, 33.6 mm. Hg, whereas the proximal tubular pressure of 15.1 mm. Hg was significantly above the sham value of 13.2 mm. Hg. Both these factors may have induced a reduction in the effective filtration pressure, from 20.1 to 13.9 mm. Hg, and may have contributed to the reduction in GFR in those functioning nephrons. Four days later, a similar proportion of the surface nephrons still showed a marked reduction in function, whereas others had improved significantly. The proximal tubular pressure, the stop-flow and the effective filtration pressures approached the sham values. These improvements may be associated with an increase in GFR to 42 per cent of the sham value. It is suggested that the prolong suppression of the kidney GFR may not be due to the drastic change in the glomerular capillary pressure of the surface nephrons, at this latter period.

Isolated nephron segments from rabbit models of obstructive nephropathy

Micropuncture and microcatheterization studies have been used extensively to investigate the pathophysiologic alterations in renal function induced by urinary tract obstruction. The present isolated tubule microperfusion studies were designed to examine the intrinsic alterations in segmental nephron function induced by 24 h of bilateral (BUO) and unilateral (UUO) urinary tract obstruction. Following UUO superficial proximal convoluted tubule reabsorption rate (J(v)) was not different from contralateral control (0.75+/-0.08 vs. 0.73+/-0.11 nl/mm per min, NS). Following UUO J(v) in juxtamedullary proximal convoluted tubules (JMPCT) was reduced 32% (0.69+/-0.06 vs. 0.47+/-0.04 nl/mm per min, P < 0.02). Following UUO J(v) in proximal straight tubules (PST) was reduced 52% (0.25+/-0.02 vs. 0.12+/-0.03, P < 0.01). Thick ascending limb (T-ALH) function was assessed by measurement of ability to lower perfusate chloride ion concentration (DeltaCl). Following UUO DeltaCl was reduced 76% (-39+/-9 vs. -9+/-1 meq/liter, P < 0.001). Cortical collecting tubule (CCT) function was assessed by measurement of antiduiretic hormone (ADH)-dependent osmotic water flow. Following UUO osmotic water flow was reduced 76% (0.90+/-0.08 vs. 0.22+/-0.04 nl/mm per min, P < 0.01) and this ADH resistance could not be overcome by cAMP. Nephron segments were then examined following relief of BUO. There were no differences in intrinsic function following relief of BUO when compared with UUO. We conclude that in UUO and BUO (a) the intrinsic tubular defects are identical, (b) the natriuresis noted is due, in part, to disordered JMPCT, PST, and T-ALH NaCl reabsorption, (c) the impaired concentrating ability is due, in part, to depressed function in T-ALH and ADH resistance of the CCT, and (d) the ADH resistance occurs at a site distal to the intracellular generation of cAMP.

Glomerular hemodynamics before and after release of 24-hour bilateral ureteral obstruction

Glomerular hemodynamics were studied, by micropuncture, in Munich-Wistar rats submitted to 24-hour bilateral ureteral ligation (BUL). Glomerular capillary pressure (PG), intratubular pressure (PT), and pressure in the first order peritubular capillaries (EAP) were measured with a servonulling device. Single nephron filtration fraction (SNFF) was calculated from arterial and peritubular blood protein concentrations. Single nephron glomerular filtration rate (SNGFR) was both measured by conventional micropuncture techniques and calculated from efferent arteriole blood flow and SNFF. Afferent arteriole blood flow (AABF) and resistance of afferent (Ra) and efferent (Re) arteriole were calculated. Measurements were repeated in the left kidney after releasing the ureter. Sham operated rats were used as control. BUL caused a fall in SNGFR (from 101.8 +/- 9.7 to 40.7 +/- [SEM] 6.0 nl/min/kg body wt), accounted for by a rise in PT (from 14.1 +/- 0.7 to 28.9 +/- 3.1 mm Hg), glomerular hemodynamics (particularly PG and AABF) being unchanged. A marked increase in Ra (from 6.6 +/- 0.7 to 10.8 +/- 1.5 dynes. sec. cm-5) occurred after releasing the ureter, lessening both PG and AABF. Therefore, a low SNGFR was maintained despite the concomitant normalization of PT.

Renal blood flow after bilateral ureteral ligation in the rat

Renal blood flow (RBF) in rat was measured by using a noncannulating electromagnetic flowmeter. In the sham control rats, anesthetized with Inactin, RBF averaged 7 ml/min/g KW when arterial blood pressure was above 110 mm Hg. Autoregulation of RBF was observed when the arterial blood pressure was in the range of 110-150 mm Hg. Glomerular filtration rate (GFR), measured by polyfructosan clearance, averaged 1.08 ml/min/g KW. In experimental rats with 24 h of bilateral ureteral ligation (BUL), RBF averaged 38% of control value. During 1/2-3 h following release of the left ureteral occlusion, RBF increased to 60% of control value. The autoregulatory ability of the damaged kidney was reduced during BUL and did not improve after releasing occlusion. During the post-obstructive period arterial blood pressure remained stable. Thus, a high total renal vascular resistance was responsible for the depressed RBF. GRF in these rats averaged only 9% of control value. The reduction in RBF alone does not explain the drastic reduction in GFR in this model of renal failure.

Deep nephron function after release of acute unilateral ureteral obstruction in the young rat

The effects of acute unilateral ureteral obstruction (UUO) of 18 h duration on deep nephron function was evaluated in 14 weanling rats with the technique of micropuncture. After release of UUO, 3.4 +/- 0.66% (SE) of the filtered water remained at the tip of the collecting duct nearly fivefold greater than in controls (0.75 +/- 0.10%). Similar differences were seen in fractional sodium that remained at this site. The ratio of tubular fluid osmolality to that of plasma was also reduced in the UUO group (1.53 +/- 0.06 vs. 4.60 +/- 0.26 in controls, P less than 0.001). Single nephron glomerular filtration rate of cortical and deep nephrons was significantly less (P less than 0.001) after release of UUO. Although the percentage of filtering nephrons was significantly reduced in both nephron populations, the decline in glomerular filtration rate was greater in cortical than in juxtamedullary nephrons (cortical:juxtamedullary nephrons = 27.6 +/- 4.5% vs. 53.3 +/- 5.2% in controls, P less than 0.005) which suggests that single nephron glomerular filtration rate is redistributed to deep nephrons after release of UUO. In contrast to cortical nephrons, the amount of tubular fluid which remains near the bend of the loop of Henle of deep nephrons was greater after release of UUO. This appeared to be the result of a decrease in the reabsorption of both water (tubular fluid:plasma inulin = 2.41 +/- 0.16 vs. 7.94 +/- 0.69 in controls, P less than 0.001) and sodium (52.3 +/- 4% vs. 40.7 +/- 2.9% of the filtered sodium in controls, P less than 0.02). It is suggested that this altered reabsorption occurs along both the proximal tubule and descending limb of the loop of Henle of juxtamedullary nephrons. Inner medullary plasma flow (IMPF), as measured with the [125I]albumin-accumulation technique, was significantly depressed before release of UUO, but exceeded control values 90 min postrelease. Such changes imply that the filtration fraction of deep nephrons is decreased and that physical factors in the proximal tubular reabsorption of sodium have been altered. When papillary solute content was measured before release of UUO it was low (428 +/- 23 vs. 1,205 +/- 106 mosmol/kg in controls, P less than 0.001) which indicates that the decline in papillary osmolality is not a consequence of the increased IMPF seen after ureteral release, but rather precedes it. In fact, the decline in papillary osmolality may contribute to the increase in IMPF after release of UUO and to the decreased reabsorption of fluid along the descending limb of the loop of Henle.

The renal perfusion/excretion determination renogram: a new method of individual renal function determination in obstructive renal disease

The divided renal function of 10 patients with unilateral renal obstruction was measured with the renal perfusion/excretion determination renogram, a computerized radioisotope function study, and with endogenous creatinine clearances. Functional impairment of the obstructed kidney when estimated by the effective renal plasma flow determination of the renal perfusion/excretion determination renogram correlated closely with that measured by creatinine clearance. The clinical applications of the renal perfusion/excretion determination renogram in unilateral renal obstruction include the preoperative evaluation of individual renal function and serial estimates of individual renal function in chronic obstructive processes.

Effects of acute bilateral ureteral obstruction on deep nephron and terminal collecting duct function in the young rat

The effects of acute bilateral ureteral obstruction (BUO) of 18-h duration on deep nephron and collecting duct function were studied by micropuncture in 11 weanling rats. After release of BUO glomerular filtration rate was reduced (178+/-15 vs. 1,343+/-119 mul/min per g kidney weight in shams), while urine flow was increased averaging 17.5+/-1.3 vs. 6.8+/-0.72 mul/min per g kidney weight in controls. There was a marked increase in the absolute and fractional excretion of Na. Single nephron glomerular filtration rate of deep nephrons was reduced in the BUO group, mean 19.4+/-3.5 vs. 77.0+/-7.7 nl/min per g kidney weight in shams. Single nephron glomerular filtration rate of superficial nephrons fell to the same extent after relief of BUO. Mean tubular fluid to plasma inulin ratio of fluid from Henle's loop was 2.46+/-0.20 after relief of BUO vs. 8.23+/-0.85 in shams. This suggested a reduction in the reabsorption of Na and water before the bend of the loop of Henle, most likely in both the proximal tubule and descending limb. Fluid osmolality was depressed due to a decline in both Na and nonelectrolyte solute content. After release of BUO the percentage of filtered water remaining in the collecting duct (CD) at the base of the papilla was greater than in controls (13.3+/-2.0 and 1.72+/-0.01%, respectively) but fell significantly by the tip of the papilla to 7.92+/-1.12 vs. 1.17+/-0.02% in controls. These results indicate that water was reabsorbed along the terminal CD after relief of ureteral obstruction. In fact, a greater fraction was reabsorbed in this segment after release of BUO (5.37+/-1.58%) than after sham operation (0.55+/-0.15%). Similar changes were seen in Na excretion. Thus alterations in deep nephron function appear to contribute to the natriuresis and diuresis which follow release of BUO while terminal CD function in this model appears intact.

Intrarenal distribution of blood flow and glomerular filtration during chronic unilateral ureteral obstruction

Paired hydronephrotic (HN) and hypertrophic (HT) rat kidneys were studied after 6 days with complete unilateral ureteral obstruction without exposing the kidneys. Total HN renal blood flow (RBF), estimated by total microsphere (MS) uptake and from local 125I-antipyrine (Ap) uptake, averaged about 3/4 of control. HN kidney GFR was reduced to about 1/2 of control level as estimated from inulin clearance of HT kidney times the HN to HT ratio for mean single nephron filtration rate, determined by 14C-ferrocyanide. Whereas blood flow (Ap) was proportionately reduced in outer and inner cortex (OC and IC), fractional flow to the outer medulla (OM) was doubled as compared to controls (p less than 0.01). Filtration was well preserved in deep as compared to superficial glomeruli with a smaller deep nonfiltering fraction (p less than 0.02). Thus the results oppose the current concept that HN is characterized by disproportionate circulatory damage to IC and OM with little or no filtration in deep nephrons. In HT kidneys average RBF (MS) and GFR rose by about 1/2. Whereas total blood flow (Ap) rose proportionately in OC and IC, it remained at control level in OM, indicating dissociation between the total RBF and GFR and the effective blood flow to the OM zone.

Renal cortical blood flow distribution in obstructive nephropathy in rats

To examine the role of intrarenal hemodynamics in in obstructive nephropathy, we determined cortical blood flow distribution (CBFD) in rats with bilateral ureteral occlusion (BUO) and unilateral ureteral occlusion (UUO) during and after release of obstruction. Prior to release of obstruction of 24 hours' duration, we found that outer cortical perfusion decreased by 20+/-5% in both BUO and UUO rats. Furthermore, one hour after release of BUO, there was rapid normalization of CBFD associated with a modest return of glomerular filtration rate (GFR), an almost complete return of renal blood flow (RBF), and a marked postobstructive diuresis. In contrast, after release of UUO, we observed that outer cortical perfusion remained decreased by 21+/-31%, both GFR and RBF remained markedly depressed, and no diuresis occurred. These data demonstrate (1) marked ischemia of the outer cortex in both BUO and UUO during obstruction, (2) a rapid return of CBFD to a normal pattern after release of BUO, but (3) persistent outer cortical ischemia following release of UUO.

The role of the medullary collecting ducts in postobstructive diuresis

Medullary collecting duct function was studied by direct microcatheterization techniques in rats undergoing postobstructive diuresis. Significant net addition of water and sodium to the duct was demonstrated during postobstructive diuresis after relief of 24-h bilateral ureteral ligation. This striking abnormality in function was associated with reduced delivery of sodium and water to the collecting duct compared to sham-operated controls. To examine the role of circulating factors in this phenomenon, another group of rats was studied that underwent 24 h of total urine reinfusion into the femoral vein. Natriuresis and diuresis were similar to the postobstructive group, but absolute collecting duct reabsorption of sodium and water was normal. The natriuresis and diuresis in rats with urine reinfusion resulted from increased delivery of fluid and sodium to the medullary collecting duct. A third group of rats was studied with 24-h unilateral ureteral ligation as well as urine reinfusion from the contralateral normal kidney. Without urine reinfusion there was no diuresis-natriuresis but with urine reinfusion the diuresis and natriuresis after relief of unilateral obstruction was similar to that after relief of bilateral obstruction. Moreover, net addition of sodium and no significant water reabsorption were demonstrated in the medullary collecting duct of such animals. The results indicate that (a) the medullary collecting duct is the critical nephron segment affected by ureteral obstruction, since postobstructive diuresis occurred despite reduced delivery of fluid from the more proximal nephron; (b) the net addition of sodium to the medullary collecting duct observed during postobstructive diuresis is probably a direct effect of obstruction, since it was found during postobstructive diuresis after relief of bilateral or unilateral ureteral ligation, but not with urine reinfusion alone; and (c) blood-borne factors are important in the development of postobstructive natriuresis and diuresis, and probably act by increasing the fraction of filtered sodium and water delivered from the proximal and distal tubule to the collecting duct.

Tubular dimensions and juxtaglomerular granulation index in rat kidneys after unilateral obstruction of the ureter. A study of the morphogenesis of hydronephrosis

The effect of ligation of a ureter on the tissues in the kidneys in male Wistar rats was studied by morphometry. Dilation of the lumen in the obstructed kidney persisted after ligation only in distal convolutions and collecting ducts. Swelling of epithelial cells in the obstructed kidney was noted only in the distal convolutions and collecting ducts. The Juxtaglomerular Granulation Index (JGI) in the obstructed kidney increased to a maximum 7 days after ligation of the ureter. In the control kidney the lumen of Bowman's space was expanded, epithelial cells in both proximal and distal parts of the nephron were swollen, and the JGI was increased after ligation of the contralateral ureter. The morphological findings support the assumption that reduced cortical blood flow and decreased intratubular flow are the cause of proximal tubular atrophy rather than a persisting increase of proximal intratubular pressure.

The pathogenesis of post-obstructive diuresis. The role of circulating natriuretic and diuretic factors, including urea

To investigate the pathogenesis of post-obstructive diuresis, a state of functional "anuria" during ureteral obstruction was created in awake rats by (a) bilateral obstruction (BO); (b) unilateral obstruction and contralateral nephrectomy (UO-Nx); or (c) unilateral obstruction and continuous i.v. reinfusion of urine from the intact contralateral kidney (UO-reinf). These groups were compared with unilaterally obstructed (UO) and sham-operated control (sham) rats. After release of obstruction of 24 h duration, mean urine flows (V) and sodium excretion rates (UNaV) were significantly elevated above those of sham rats in BO, UO-Nx, and UO-reinf animals, but slightly decreased in UO rats. Glomerular filtration rates were comparably depressed in UO, BO, UO-Nx, and UO-reinf rats. These results suggest that post-obstructive diuresis is due to one or more circulating diuretic factors that are normally excreted in the urine, and which, when retained )as in BO or UO-Nx rats) or returned to the circulation (as in UO-reinf rats), exert a diuretic affect. In additional experiments, UO rats infused with urea exhibited post-obstructive diuresis, if extracellular volume contraction was prevented. This result suggests that urea may be an important diuretic factor in post-obstructive diuresis, but does not exclude possible roles for other humoral factors. The intact kidney of UO-reinf rats displayed a massive unilateral diuresis and natriuresis, further suggesting the presence of potent diuretic factors in the urine. A marked increase in the fractional excretion of glomerular filtrate (V/GFR) by the intact kidney suggests that this diuresis may be attributable, in part, to impaired proximal reabsorption.

Renal functional abnormalities in post-unilateral ureteral obstruction in man: a comparison of these defects to post-obstructive diuresis

The failure of fluid and electrolyte conservation in post-obstructive diuresis has not been demonstrated after release of unilateral ureteral obstruction. Despite this, balance and renal function studies in patients with this disorder indicate similar renal defects. The clinical difference is caused by a markedly low glomerular filtration rate in unilateral problems that prevents the excessive losses found with total obstruction.

Nature of the acidifying defect after the relief of ureteral obstruction

Nature of the acidifying defect observed after relief of ureteral obstruction. The acidifying capacity of the normal and experimental kidney was studied in rats three hours after release of complete unilateral ureteral obstruction or after unilateral release of unilateral ureteral obstruction, mean plasma bicarbonate concentration was 23.5 mEq/liter, and plasma pH, 7.45. Urine pH from the postreleased kidney was 7.47 and 6.01 from the control side. Net acid escretion averaged 0.97 muEq/min in the experimental kidney. Fractional excretion of bicarbonate averaged 0.02% in the control and 3.17% in the experimental kidney. In eight animals with unilateral release of bilateral ureteral obstruction, mean plasma bicarbonate was 16.9 mEq/min and plasma pH was7.35. Mean urine pH in the postreleased Kidney was 6.11, net acid excretion averaged 2.01 plus or minus 0.69 muEq/min and fractional bicarbonate excretion averaged 0.84%.