Structural adaptation in initial collecting tubule following reduction in renal mass

Pathophysiology and clinical management of hyperkalemia in chronic kidney disease

Adaptive increases in kidney and gastrointestinal excretion of K+ help to prevent hyperkalemia in patients with chronic kidney disease (CKD) as long as the glomerular filtration rate (GFR) remains >15-20 mL/min. K+ balance is maintained by increased secretion per functioning nephron, which is mediated by elevated plasma K+ concentration, aldosterone, increased flow rate, and enhanced Na+-K+-ATPase activity. Fecal losses of potassium also increase in CKD. These mechanisms are effective in preventing hyperkalemia if urine output is in excess of 600 mL/day and the GFR exceeds 15 mL/min. Development of hyperkalemia with only mild to moderate reductions in GFR should prompt a search for intrinsic disease of the collecting duct, disturbances in mineralocorticoid activity, and/or decreased delivery of sodium to the distal nephron. The initial approach to treatment is to review the patient's medication profile and whenever possible discontinue drugs that impair kidney K+ excretion. Patients should be educated on sources of K+ in the diet and should be strongly encouraged to avoid the use of K+ containing salt substitutes as well as herbal remedies since herbs may be a hidden source of dietary K+. Effective diuretic therapy and correction of metabolic acidosis are effective strategies to minimize the potential for hyperkalemia. Discontinuation or use of submaximal doses of renin-angiotensin blockers should be discouraged given the cardiovascular protective effect these drugs provide. Potassium binding drugs can be useful to enable use of these drugs and potentially allow liberalization of the diet in CKD patients.

Seventy-five percent nephrectomy and the disposition of inorganic mercury in 2,3-dimercaptopropanesulfonic acid-treated rats lacking functional multidrug-resistance protein 2

In the present study, we evaluated the disposition of inorganic mercury (Hg(2+)) in sham-operated and 75% nephrectomized (NPX) Wistar and transport-deficient (TR(-)) rats treated with saline or the chelating agent meso-2,3-dimercaptosuccinic acid (DMSA). Based on previous studies, DMSA and TR(-) rats were used as tools to examine the potential role of multidrug-resistance protein 2 (MRP2) in the disposition of Hg(2+) during renal insufficiency. All animals were treated with a low dose (0.5 mumol/kg i.v.) of mercuric chloride (HgCl(2)). At 24 and 28 h after exposure to HgCl(2), matched groups of Wistar and TR(-) rats received normal saline or DMSA (intraperitoneally). Forty-eight hours after exposure to HgCl(2), the disposition of Hg(2+) was examined. A particularly notable effect of 75% nephrectomy in both strains of rats was enhanced renal accumulation of Hg(2+), specifically in the outer stripe of the outer medulla. In addition, hepatic accumulation, fecal excretion, and blood levels of Hg(2+) were enhanced in rats after 75% nephrectomy, especially in the TR(-) rats. Treatment with DMSA increased both the renal tubular elimination and urinary excretion of Hg(2+) in all rats. DMSA did not, however, affect hepatic content of Hg(2+), even in the 75% NPX TR(-) rats. We also show with real-time polymerase chain reaction that after 75% nephrectomy and compensatory renal growth, expression of MRP2 (only in Wistar rats) and organic anion transporter 1 is enhanced in the remaining functional proximal tubules. We conclude that MRP2 plays a significant role in the renal and corporal disposition of Hg(2+) after a 75% reduction of renal mass.

The physiological and pathophysiological roles of the GH/IGF-axis in the kidney: lessons from experimental rodent models

The growth hormone (GH)/insulin-like growth factor (IGF) system plays an important role in renal development, growth, function and pathophysiology. IGF-I has been associated with renal/glomerular hypertrophy and compensatory renal growth. Potential effects on glomerular size are of interest, since an increase in glomerular size may be permissive for the development of glomerulosclerosis. In an effort to abolish the decline of renal function and possibly to restore the renal structure, different approaches have been tested in experimental models of nephropathy, focusing mainly on early renal changes. The involvement of the GH/IGF system in renal pathophysiology has been studied in much detail in the rat. In view of the growing interest in murine physiology, occurring in large part by genetically modified animals, this review examines those aspects of GH, IGFs, their receptors and binding proteins that relate both to mouse kidney physiology and to a number of conditions characterized by pathophysiological renal changes. A deeper understanding of the role of the GH/IGF system in renal dysfunction may stimulate the development of novel therapeutic approaches aiming at preventing or retarding various kidney diseases.

Hyperkalemia: An adaptive response in chronic renal insufficiency

BACKGROUND

Hyperkalemia is a common feature of chronic renal insufficiency, usually ascribed to impaired K+ homeostasis. However, various experimental observations suggest that the increase in extracellular [K+] actually functions in a homeostatic fashion, directly stimulating renal K+ excretion through an effect that is independent of, and additive to, aldosterone.

METHODS

We have reviewed relevant studies in experimental animals and in human subjects that have examined the regulation of K+ excretion and its relation to plasma [K+].

RESULTS

Studies indicate that (1) extracellular [K+] in patients with renal insufficiency correlates directly with intracellular K+ content, and (2) hyperkalemia directly promotes K+ secretion in the principal cells of the collecting duct by increasing apical and basolateral membrane conductances. The effect of hyperkalemia differs from that of aldosterone in that K+ conductances are increased as the primary event. The changes in principal cell function and structure induced by hyperkalemia are indistinguishable from the effects seen in adaptation to a high K+ diet.

CONCLUSIONS

We propose that hyperkalemia plays a pivotal role in K+ homeostasis in renal insufficiency by stimulating K+ excretion. In patients with chronic renal insufficiency, a new steady state develops in which extracellular [K+] rises to the level needed to stimulate K+ excretion so that it again matches intake. When this new steady state is achieved, plasma [K+] remains stable unless dietary intake increases, glomerular filtration rate falls, or drugs are given that disrupt the new balance.

Limited urinary concentration and damaged tubules in rats with a syngeneic kidney graft

BACKGROUND

The underlying mechanisms of renal transplant dysfunction are poorly understood. There is little information on tubular function in kidney grafts. The cDNAs encoding kidney-specific cell surface proteins required for renal reabsorption of sodium (sodium cotransporter in thick ascending limb of Henle, rBSC1) and water (apical water channel in collecting duct, AQP2) have been recently identified. Since transcripts of these proteins are up-regulated in dehydration in association with maximal concentration of urine, we examined urinary concentrating ability and expression levels of mRNA of these proteins in kidney isografts.

METHODS

Male Sprague-Dawley rats underwent syngeneic renal transplantation or unilateral nephrectomy (UNX) and were deprived of water for 24 hours at six weeks after the operation when histological and functional compensation of the intact kidney was complete. Blood and urinary samples were collected before and after dehydration. The amount of rBSC1 or AQP2 mRNA was measured using competitive polymerase chain reaction (PCR) by inducing a point mutation at the middle of PCR product for rBSC1 or by deleting 180 bp from 780 bp PCR product for AQP2, respectively. The protein expression was examined by Western blot analysis.

RESULTS

Both groups of rats demonstrated the same levels of compensatory renal hypertrophy (approximately 60% weight increase) and plasma creatinine values. Histological examination revealed enlarged glomeruli and tubules, but no findings of ischemic damage, such as tubular atrophy or interstitial changes. Urinary concentration was noted in the UNX rats but not in rats with kidney grafts. Competitive PCR demonstrated that dehydration did not increase rBSC1 and AQP2 transcripts in rats with kidney transplantation. Immunoblot analysis confirmed that the marked increase of both rBSC1 and AQP2 proteins was noted only in the remnant kidney of dehydrated rats.

CONCLUSIONS

Rats with kidney isografts have a limited capacity to concentrate urine and, at the same time, fail to increase rBSC1 and AQP2 transcripts. This suggests that there is a prolonged damage of renal tubules by ischemia or denervation of the donor kidney, both of which are inevitable in the transplantation procedure.

Potassium transport in the mammalian collecting duct

The mammalian collecting duct plays a dominant role in regulating K(+) excretion by the nephron. The collecting duct exhibits axial and intrasegmental cell heterogeneity and is composed of at least two cell types: collecting duct cells (principal cells) and intercalated cells. Under normal circumstances, the collecting duct cell in the cortical collecting duct secretes K(+), whereas under K(+) depletion, the intercalated cell reabsorbs K(+). Assessment of the electrochemical driving forces and of membrane conductances for transcellular and paracellular electrolyte movement, the characterization of several ATPases, patch-clamp investigation, and cloning of the K(+) channel have provided important insights into the role of pumps and channels in those tubule cells that regulate K(+) secretion and reabsorption. This review summarizes K(+) transport properties in the mammalian collecting duct. Special emphasis is given to the mechanisms of how K(+) transport is regulated in the collecting duct.

Influence of different degrees of reduced renal mass on the renal and hepatic disposition of administered cadmium

The present study was designed to evaluate, in rats, the effect of varying degrees of reduced renal mass on the disposition of administered cadmium. As part of this evaluation, the intrarenal, hepatic, and hematological disposition of cadmium and the urinary and fecal excretion of cadmium were studied and characterized in control, uninephrectomized (NPX), and 75% nephrectomized (75% NPX) rats 1 d, 2 d, and 7 d after the intravenous injection of a nonnephrotoxic 8.9 mumol/kg dose of cadmium chloride. Renal accumulation of cadmium, especially in the cortex and outer stripe of the outer medulla, was reduced significantly in the 75% NPX rats, but not in the NPX rats, between d 2 and 7 after the injection of cadmium. The diminution in the renal accumulation of cadmium in the 75% NPX rats was most likely due to diminished glomerular filtration rate and renal clearance of cadmium induced by 75% nephrectomy. Despite reduced glomerular filtration rate, the cumulative urinary excretion of cadmium in the 75% NPX rats was significantly greater than that in either the NPX rats or the control rats. It should be mentioned, however, that very little of the administered dose of cadmium was excreted in the urine by any of the three groups of rats. Interestingly, the content of cadmium in the liver was significantly greater in 75% NPX rats than in NPX or control rats between d 1 and 7 after the injection of cadmium. Moreover, the 75% NPX rats excreted significantly less cadmium in the feces over the 7 d of study than did the other 2 groups of rats, indicating that 75% nephrectomy causes a significant alteration in one or more of the mechanisms involved in the fecal excretion of cadmium. In summary, the findings from the present study indicate that the renal and hepatic handling of administered cadmium in rats changes significantly when renal mass is reduced by 75%. Further studies are needed to better characterize the effects of reductions of renal mass, which impair renal function significantly, on both the disposition and toxicity of cadmium in renal and hepatic tissues.

Reductions in renal mass and the nephropathy induced by mercury

The severity of renal injury induced by several graded doses of mercuric chloride and the disposition of mercury were evaluated and compared in control, uninephrectomized (50% NPX), and 75% nephrectomized (75% NPX) rats in an attempt to determine the effect of increased reductions of renal mass on the nephropathy induced by inorganic mercury. Consistent with previously published findings, proximal tubular necrosis (as assessed histopathologically and by the urinary excretion of lactate dehydrogenase (LDH) and total protein) was significantly more severe in 50% NPX rats than in control rats 24 hr after the administration of any of three lowest (1.0, 1.5, or 1.75 micromol/kg) doses of mercuric chloride used in the study. Interestingly, the severity of proximal tubular necrosis in the 75% NPX rats was not greater than that in control rats at these same doses. The reason for this appeared to be due to decreased renal accumulation of mercury, particularly in the renal cortex and outer stripe of the outer medulla. At the highest (8.0 micromol/kg) dose of mercuric chloride used, renal tubular injury was very extensive in all three groups of rats, with the level of injury being greatest in the 50% NPX rats. The injury was so severe in all three groups that acute renal failure was induced within the first 24 hr after the injection of mercury. An important finding that was made at this dose was that the level of blood urea nitrogen (BUN) was significantly greater in the 75% NPX rats than in either the 50% NPX or control rats, which indicates that 75% NPX rats may have entered into acute renal failure sooner than the 50% NPX or control rats. Overall, the findings from the present study indicate that as renal mass is reduced to a level at which renal function is not significantly impaired (50% NPX), the severity of the nephropathy induced by mercury is increased. By contrast, when the reduction of renal mass progresses to a level at which renal function begins to become impaired, the level of proximal tubular injury is not greatly different from that of animals with two kidneys, especially at low nephrotoxic doses of inorganic mercury. In addition, low nephrotoxic doses of inorganic mercury do not appear to affect significantly the reduced glomerular filtration rate in 75% NPX rats. However, it does appear that 75% NPX rats may be at greater risk of entering into acute renal failure at higher toxic doses of inorganic mercury than 50% NPX or control rats.

Modulation of salt transport rate affects DNA synthesis in vivo in rat renal tubules

In adult male Wistar rats we investigated whether cell proliferation contributes to salt load-induced hypertrophy of distal tubules. In one treatment group salt transport in the thick ascending limb (TAL) was inhibited by furosemide (7.5 mg/100 g body wt/24 hr, via osmotic minipump) and stimulated in the successive distal segments by simultaneous high salt intake (F + Salt). Controls without furosemide treatment had a standard salt intake. All animals received the thymidine analog bromodeoxyuridine (BrdU) during 24 and 72 hours, respectively. In cryostat sections of the perfusion-fixed kidneys DNA synthesis was assessed by immunohistochemistry for BrdU, and for endogenous proliferating cellular nuclear antigen (PCNA). Incidence of BrdU- and PCNA-labeled nuclei were quantified in proximal tubules, medullary TAL, and cortical distal segments downstream the TAL. In control animals low labeling indices were found in all investigated segments. After 24 and 72 hours of F + Salt, indices of labeled nuclei were markedly increased in distal segments downstream the TAL, whereas they were significantly reduced in TAL. In proximal tubules increased DNA synthesis rate was apparent only after 72 hours. The data demonstrate that (1.) DNA synthesis rate in nephron segments in vivo varies in parallel with changes of their salt transport activity; (2.) increased DNA synthesis, thus probably cellular proliferation, is a component of the structural response of nephron segments following increased salt transport activity.

Short-term effects of uninephrectomy on electrical properties of the cortical collecting duct from rabbit remnant kidneys

Microelectrode techniques were used to assess the electrical properties of the collecting duct cell in the isolated perfused cortical collecting duct from remnant kidneys 3, 6, and 24 h after uninephrectomy (UNX); results were compared with those from sham-operated kidneys. Plasma aldosterone levels did not change during the time course after UNX. The lumen-negative transepithelial voltage was elevated significantly 3 h after UNX, and was increased further 24 h after UNX. The basolateral membrane voltage (VB) was elevated 6 h after UNX, and then was increased further at 24 h. Although the tight junction conductance and the fractional apical membrane resistance (fRA) were not altered at any time points after UNX, the apical membrane conductance as well as the transepithelial (GT) and basolateral membrane conductances increased 6 and 24 h after UNX. The changes in apical membrane voltage, GT, and fRA upon addition of luminal amiloride increased just 3 h after UNX, and then remained elevated at 6 and 24 h. The changes in apical membrane voltage and GT upon addition of luminal Ba2+, the changes in VB upon addition of bath ouabain, and the changes in VB, GT, and fRA upon raising bath K+ were not influenced 3 h after UNX, but increased at 6 and 24 h. At these latter periods after UNX, the transference number of Cl- of the basolateral membrane decreased significantly, whereas the transference number of K+ of the basolateral membrane increased significantly. Simultaneously, addition of Ba2+ to the bath caused the VB to hyperpolarize in parallel with decreases in GT and fRA. We conclude: (a) the initial effect of UNX (3 h) in the collecting duct cell is an increase in apical membrane Na+ conductance; (b) the delayed effects of UNX (6 and 24 h) are increases in apical membrane K+ conductance as well as basolateral membrane Na(+)-K+ pump activity and K+ conductance; (c) the hyperpolarization of VB at 6 and 24 h after UNX may result in the decrease of the ratio of the relative Cl- conductance to the relative K+ conductance of the basolateral membrane and also may increase passive K+ entry into the cell across the basolateral membrane; (d) these time-dependent electrical changes occur independently of plasma aldosterone levels.

Electrical properties of the rabbit cortical collecting duct from obstructed and contralateral kidneys after unilateral ureteral obstruction

Electrophysiological techniques were used to determine the electrical properties of the collecting duct (CD) cell in the isolated cortical collecting duct from obstructed (UUOOK) and contralateral (UUOCK) kidneys in rabbits 24 h after unilateral ureteral obstruction (UUO); results were compared with those from sham-operated kidneys. The lumen-negative transepithelial voltage and the basolateral membrane voltage (VB) were decreased in the UUOOK, and increased in the UUOCK. The transepithelial conductance (GT) was decreased in parallel with an increase in the fractional apical membrane resistance (fRA) and a decrease in apical membrane conductance in the UUOOK. By contrast, the GT was increased in parallel with increases in apical and basolateral membrane conductances in the UUOCK. The amiloride-sensitive changes in apical membrane voltage (VA), GT and fRA were lower in the UUOOK, but greater in the UUOCK. The changes in VA and GT upon raising the perfusate K+ concentration and upon addition of luminal Ba2+ were decreased in the UUOOK, and increased in the UUOCK. Addition of ouabain to the bath resulted in a smaller depolarization of VB in the UUOOK, but in a greater depolarization in the UUOCK. Upon lowering bath Cl-, the change in basolateral membrane electromotive force (delta EMF) was increased in the UUOOK, and decreased in the UUOCK. Reversely, upon raising bath K+, the delta EMF was decreased in the UUOOK, and increased in the UUOCK. We conclude: (a) the conductances of Na+ and K+ in the apical membrane, and active Na(+)-K+ pump activity and relative K+ conductance in the basolateral membrane are decreased in the UUOOK, and increased in the UUOCK; (b) the relative basolateral membrane Cl- conductance was increased in the UUOOK, and decreased in the UUOCK.

Quantitative immunogold localization of Na, K-ATPase along rat nephron

Ultrastructural localization of Na, K-ATPase alpha-subunit along rat nephron segments was investigated quantitatively by immunogold electron microscopy on LR-White ultrathin sections using affinity-purified antibody against alpha-subunit of the enzyme. Ultrathin sections were incubated with the antibody at a saturation level and the number of gold particles bound per micron of the plasma membrane (particle density) of the tubular epithelial cells from the proximal tubule to the collecting duct was determined. In all the tubular epithelial cells, gold particles were located exclusively on the basolateral surface, and no significant binding of gold particles to the apical surface was observed. Distribution of gold particles on the basolateral membranes was quite heterogeneous; lateral membranes and infolded basal membranes were highly labeled, whereas the basal membranes which are in direct contact with the basal lamina were scarcely labeled. The average particle density on the basal surface was highest in the distal straight tubule cells (11.4 units), very high in the distal convoluted tubule cells (9.8 units), intermediate in the proximal tubule cells (3.3 units), in the connecting tubule cells (4.3 units), and in the principal cells of the collecting duct (5.6-3.8 units), low in the thin limb of Henle's loop (1.0 unit), and at the control level in the intercalated cells in the connecting and collecting duct. The relative number of gold particles/mm nephron segment and the relative number of gold particles in the various nephron segments were calculated using quantitative morphological data. The estimated distribution profile of the former was in good agreement with the Na, K-ATPase activity profile in rat nephron, which was determined biochemically with a microenzymatic method.

Effects of uninephrectomy on electrical properties of the cortical collecting duct from rabbit remnant kidneys

Microelectrode techniques were used to determine the Na+ and K+ transport properties of the collecting duct cell in the isolated cortical collecting duct (CCD) from rabbits 14 d after uninephrectomy (UNX); results were compared with those from sham-operated rabbits (control). UNX had no effects on plasma aldosterone levels. The CCDs from UNX rabbits exhibited structural hypertrophy. The lumen negative transepithelial voltage and the basolateral membrane voltage (VB) were elevated in the UNX group. Although the transepithelial conductance (GT) and the fractional apical membrane resistance (fRA) were not different between the two groups, the conductances of the apical and the basolateral membranes were increased, and the tight junction conductance was decreased in the UNX group. The amiloride-sensitive changes in apical membrane voltage (VA), fRA, and GT were greater in the UNX group. The changes in VA upon raising the perfusate K+ concentration and the changes in VA and GT upon addition of Ba2+ to the perfusate were elevated in the UNX group. Upon raising K+ in the bath, a large depolarization of VB was observed in the UNX group. Lowering the bath Cl- resulted in a small depolarization of VB in the UNX group. Addition of Ba2+ to the bath in the UNX group caused the VB to hyperpolarize in parallel with decreases in GT and fRA whereas in the control group it had no effect on VB. Addition of ouabain to the bath resulted in a large depolarization of VB in the UNX group. We conclude that (a) UNX stimulates conductances of Na+ and K+ in the apical membrane, active Na(+)-K+ pump activity, and K+ conductance in the basolateral membrane, independently of plasma aldosterone; (b) The basolateral membrane in the tubules of UNX rabbits is more selective to K+; and (c) the hyperpolarization of VB upon UNX may increase passive K+ entry into the cell across the basolateral membrane.

Differential effects of calorie restriction on glomeruli and tubules of the remnant kidney

We have previously shown that 40% calorie restriction (CR) prevents renal injury 21 weeks after 5/6 nephrectomy (Nx) in rats, regardless of whether protein intake was concurrently restricted or not. Growth retardation appeared to be a necessary prerequisite for the protective effects of CR. To further study these mechanisms, we performed 5/6 Nx in male F344 rats and pair-fed them with a control diet (ad lib group) or a high protein diet restricted by 40% so that protein intake was similar, but calorie consumption was reduced (CR group). Four weeks after 5/6 Nx, when glomerulosclerosis had not yet developed, we compared various parameters as follows in both dietary groups and sham operated rats: urinary protein excretion (uPr), GFR (14C inulin clearance), mean nephron GFR (MNGFR; GFR divided by total number of glomeruli), glomerular volume (VG), tubulointerstitial index (TII), a measure of tubular damage kidney weight (kidney wt), kidney IGF-I content by RIA, and IGF-I immunohistochemistry. CR ameliorated the increase of MNGFR, but not glomerular hypertrophy. TII, kidney wt and kidney IGF-I content were increased in the ad lib Nx group; these changes were alleviated by CR. Two weeks after 5/6 Nx, immunohistochemistry for IGF-I showed increased staining in superficial distal nephrons in the ad lib group, and this was also suppressed by CR. The occurrence of tubulointerstitial pathology prior to glomerulosclerosis, and the beneficial effects of CR on all parameters except Vg indicate a dissociation of mechanisms which result in tubular versus glomerular hypertrophy and damage.(ABSTRACT TRUNCATED AT 250 WORDS)

Altered membrane ionic permeability in a rat model of chronic renal failure

Acute elevations in intracellular adenosine 3',5'-cyclic monophosphate (cAMP) concentrations are known to increase ionic chloride permeability in diverse tissues. To determine if chronic endogenous increases in cAMP are associated with sustained alterations in membrane ionic permeabilities, renal cortical brush border membrane vesicles (BBMV) were prepared and red blood cells were harvested in a model of chronic renal failure, the 75% nephrectomized rat. Relative ionic permeabilities were determined using the potential-sensitive fluorescent probe 3,3'-dipropylthiadicarbocyanine iodide [diS-C3-(5)]. These studies demonstrate that renal cortical homogenate and RBC cAMP concentrations are increased in chronic renal failure animals. In the same animals relative ionic chloride permeability (PCl/PK) was significantly increased in renal cortical BBMV and RBC ghosts: PNa/PK was not affected. This selective change in permeability results in a significant increase in PCl/PNa and hyperpolarization of BBMV of sufficient magnitude to stimulate Na(+)-dependent glutamine transport. The change in glutamine uptake was not consequent to an alteration in the kinetics of glutamine transport or delayed dissipation of the inward Na+ gradient. Renal hypertrophy per se did not effect renal homogenate cAMP concentration or relative ionic permeability of renal cortical BBMV prepared from kidneys of uninephrectomized animals fed a 40% protein diet. These studies demonstrate that relative ionic chloride permeability and tissue [cAMP] are chronically increased in diverse cells (renal proximal tubule and RBCs) in a rat model of renal failure. These findings suggest that membrane ionic permeability may be altered and electrogenic transport secondarily perturbed in renal failure in association with hormonally-induced chronic elevations of intracellular cAMP concentrations.

Renal metallothionein metabolism after a reduction of renal mass. I. Effect of unilateral nephrectomy and compensatory renal growth on basal and metal-induced renal metallothionein metabolism

The effects of unilateral nephrectomy and compensatory renal growth on renal metallothionein metabolism were evaluated in the present study. In rats, the renal content of metallothionein increased in proportion to the increase in renal mass after unilateral nephrectomy and compensatory renal growth. However, when zinc was used to induce the synthesis of renal metallothionein, the remnant kidney in uninephrectomized (NPX) rats produced significantly greater amounts of metallothionein on a per gram kidney basis than a normal kidney in sham-operated (SO) rats. In both NPX and SO rats, zinc pretreatment caused metallothionein synthesis to increase primarily in the renal cortex and renal outer stripe of the outer medulla. Zinc pretreatment also changed the pattern for the intrarenal accumulation of inorganic mercury in NPX rats. After pretreatment with zinc, the accumulation of inorganic mercury predominated in the renal cortex rather than in the outer stripe of the outer medulla in the NPX rats. In addition, both NPX and SO rats were afforded complete protection against the nephrotoxic effects of a low, toxic dose of inorganic mercury when they were pretreated with inorganic zinc. The protection is postulated to be related to the alteration in the pattern of renal accumulation of inorganic mercury. In conclusion, the capacity to synthesize metallothionein increases significantly in rats after they have undergone unilateral nephrectomy and compensatory renal growth. The increased capacity of the remnant kidney to synthesize metallothionein may involve adaptive changes both in transcriptional and/or translational controls of metallothionein synthesis.

Renal accumulation and intrarenal distribution of inorganic mercury in the rabbit: effect of unilateral nephrectomy and dose of mercuric chloride

The effects of unilateral nephrectomy and dose of mercuric chloride on the short-term renal accumulation and intrarenal distribution of inorganic mercury were studied in the rabbit. The renal accumulation of inorganic mercury, on a per gram basis, was increased in uninephrectomized (NPX) rabbits compared with that in sham-operated (SO) rabbits 24 h after the animals received either a nontoxic 2.0 mumol/kg or nephrotoxic 4.0 mumol/kg dose of mercuric chloride. In the NPX rabbits given the 2.0 mumol/kg dose of mercuric chloride, the increased accumulation of inorganic mercury was due to increased accumulation of mercury in the outer stripe of the outer medulla. In the NPX rabbits given the 4.0 mumol/kg dose of mercuric chloride, the increased renal accumulation of mercury appeared to be due to increased accumulation of mercury in both the renal cortex and outer stripe of the outer medulla. Interestingly, no differences in the renal accumulation of inorganic mercury were found between NPX and SO rabbits given a low nontoxic 0.5 mumol/kg dose of mercuric chloride. As the dose of mercuric chloride was increased from 0.5 to 4.0 mumol/kg, the percent of the administered dose of mercury that accumulated in each gram of renal tissue decreased substantially. The findings in the present study indicate that the renal accumulation of inorganic mercury increases after unilateral nephrectomy when certain nontoxic and nephrotoxic doses of mercuric chloride are administered. In addition, they indicate that the percent of the administered dose of mercury that accumulates in the renal tissue of both NPX and SO rabbits decreases as the dose of mercuric chloride is increased.

Potassium tolerance

The maintenance of potassium homeostasis with an increased potassium intake or decreased renal function is dependent in part on the renal adaptation observed in 'potassium tolerance'. However other factors, including control of ingestion, and increased distal delivery of fluid, also play a role.

Increased sodium transport by cortical collecting tubules from remnant kidneys

To determine whether intrinsic changes in cortical collecting tubule (CCT) transport contribute to the maintenance of sodium and acid-base balance after loss of renal mass, we studied transport functions in isolated perfused CCT from rabbit remnant kidneys. The rabbits were sacrificed three weeks after surgical reduction of renal mass (by 3/4 to 7/8) at which time they were mildly azotemic but had no systemic electrolyte or acid-base disturbances. When perfused by standard methods in vitro, CCT from remnant kidneys exhibited sodium transport rates (lumen-to-bath 22Na-flux) approximately twice as high as those in CCT from control animals (111 +/- 19 vs. 54 +/- 7 pmol/min mm, P less than 0.02). A similar difference was present in the ouabain-sensitive sodium fluxes (81 +/- 16 vs. 39 +/- 8 pmol/min mm, P less than 0.05). In contrast, there were no significant differences in net bicarbonate transport. Significant hypertrophy of the remnant kidney CCT was reflected by 30 to 45% increases in tubule diameters. To examine the possible role of differences in food intake, we studied a separate group of weight-matched, pair-fed sham-operated and remnant kidney rabbits. Similar differences in total and ouabain-sensitive 22Na-flux, and in tubule size persisted in the pair-fed animals. A dissociation between active sodium transport and tubule hypertrophy was documented in the outer medullary collecting tubule: despite the lack of active sodium transport, hypertrophy was present. Our studies show that loss of renal mass results in a selective augmentation of certain transport processes in the CCT, implying selective or specific signals and mechanisms.

Potassium excretion in renal failure in the rat: the role of distal tubule flow and aldosterone

1. This study examines the contribution of an increased distal tubule flow and of aldosterone to the handling of a potassium load in conscious rats with renal failure induced by subtotal nephrectomy or by gentamicin on a control of high K+ diet. 2. Glomerular filtration rate was reduced by subtotal nephrectomy to 40% and by gentamicin treatment to 60% of control. Subtotal nephrectomy induced significant hypertrophy of glomeruli and proximal and distal tubules, but gentamicin did not. Both experimental groups had a normal iothalamate space and plasma potassium after a 20 h fast. 3. Two hours after an acute KCl load rats with renal failure excreted less potassium than control rats. There was also a lesser natriuretic effect of KCl in the renal failure groups. 4. A high K+ diet, given for 5-7 days, increased excretion of an acute KCl load in control rats and rats with renal failure. 5. (UNaV + UKV) was used as an estimate of distal tubule flow. Potassium excretion, related to distal tubule flow, was similar in the renal failure and control rats when on the same diet. This is consistent with potassium excretion being strongly, but not necessarily solely, dependent on distal flow. 6. Adrenalectomy reduced, and aldosterone restored, potassium excretion in the renal failure and control groups. This suggests a role for aldosterone in excretion of an acute potassium load with this degree of renal failure.

Mercuric chloride-induced nephrotoxicity in the rat following unilateral nephrectomy and compensatory renal growth

The nephropathy induced by mercuric chloride was assessed in unilaterally nephrectomized (NPX) and sham-operated (SO) rats using histological and urinalysis techniques. This assessment was carried out in order to test whether or not rats are more susceptible to the nephrotoxic effects of mercuric chloride after unilateral nephrectomy and a period allowing for compensatory renal growth. Twelve days after surgery both NPX and SO rats were given a single 1.5, 2.0 or 2.5 mumol/kg dose of mercuric chloride (i.v.). Twenty-four hours after the 1.5 or 2.0 mumol/kg dose of mercuric chloride was administered, cellular and tubular necrosis in the pars recta segments of proximal tubules in the outer medulla was more severe in NPX rats than in SO rats. Moreover, the urinary excretion of a number of cellular enzymes (e.g. lactate dehydrogenase) and plasma solutes (e.g. albumin) was greater in NPX rats than in SO rats. At the 2.5 mumol/kg dose of mercuric chloride, renal tubular damage was quite extensive in both groups of rats; to such an extent that possible differences in renal tubular damage between the NPX and SO rats could not be determined histologically. However, the urinary excretion of alanine aminopeptidase was greater in the NPX rats than in the SO rats. Therefore, based on the aforementioned findings, rats that have undergone and adapted to a reduction in renal mass (i.e. unilateral nephrectomy) appear to be more vulnerable to the nephrotoxic effects of mercuric chloride than rats with two normal kidneys.

Acute adaptative changes to unilateral nephrectomy in humans

Renal function was monitored in 20, living-related kidney donors before and after uninephrectomy. Urinary protein excretion and retinoid metabolism respectively were studied in 10 and 6 of these donors. The functional adaptation was characterized by an increase in glomerular filtration rate and tubular function, which began in the first two days after uninephrectomy. Changes in tubular function were also demonstrated by significant increases in the urinary excretion of beta 2 microglobulin (beta 2M), retinol binding protein (RBP), kappa and lambda light chains of immunoglobulins. In addition, a protein identical to or homologous to cellular retinoic acid binding protein (CRABP), appeared in the urine after nephrectomy. We did not find CRABP in serum samples either before or after nephrectomy, suggesting that urinary CRABP was synthesized by the remaining kidney. Increases in serum levels of Vitamin A and RBP were also observed in the post-nephrectomy period. These modifications in retinol metabolism suggest that these substances could have a role as renotropic growth factors in compensatory hypertrophy.

Enhanced accumulation of injected inorganic mercury in renal outer medulla after unilateral nephrectomy

The effects of unilateral nephrectomy on renal accumulation and intrarenal distribution of mercury following a single injection of mercuric chloride (HgCl2, 0.5 mumol Hg/kg body wt, ip) were evaluated in the rat. In rats injected with HgCl2 immediately after nephrectomy or 10, 28, or 43 days after nephrectomy, the accumulation of mercury in the renal outer medulla was significantly greater than in respective sham-operated control rats. The increased accumulation of mercury in renal outer medulla was evident at 24 hr after injection of HgCl2 and persisted for at least 72 hr. The effect appeared to be a phenomenon associated specifically with the renal outer medulla in that elevated concentrations of mercury in the outer medulla were observed in the absence of similar elevations in the renal cortex, inner medulla, liver, and blood or in the whole body mercury content. Urinary excretion of mercury was unaffected by nephrectomy. Thus, associated with unilateral nephrectomy are changes in the renal accumulation and intrarenal distribution of systemically administered inorganic mercury that persist long after the rapid phase of compensatory renal growth (0-7 days) is completed.

Potassium homeostasis and hypokalemia

Potassium, largely an intracellular cation, contributes to the regulation of cellular volume, to tissue growth and metabolic synthesis of proteins and nucleic acids, and to the integrity of electrical properties of excitable tissues as well as nonexcitable, transporting epithelia. Potassium balance is closely regulated by a variety of nonrenal and renal mechanisms. When potassium losses are sufficient to induce hypokalemia, either through nonrenal or renal causes, profound adverse effects on neuromuscular, cardiac, vascular, and renal tissues may ensue. The diagnostic approach is straightforward, and therapy must be directed to replenish losses without inducing a rapid, excessive, and potentially fatal increase in the potassium concentration of the serum.

Ultrastructure of distal nephron cells in rat renal cortex

Distal nephron segments in the rat renal cortex contain distal convoluted tubule cells (DCT cells), connecting tubule cells (CNT cells), intercalated cells (I cells), and principal cells (P cells). The present study was carried out to expand present knowledge on the ultrastructure of these cells. The cells were sampled from superficial cortex and analyzed by electron microscopy. Several morphometric parameters were determined and statistical comparison between cell types was performed. Significant structural differences between the cell types were demonstrated. DCT cells showed the highest volume density of mitochondria whereas the amplification of basolateral membranes was higher in CNT cells than in I and P cells. The surface density of the membrane that bounds intermediate vesicles in the apical cytoplasm was twofold higher in I cells than in the other cell types. The morphological differentiation found in the present study adds to available evidence indicating a functional differentiation between the cell types and provides a reference for structure-function correlations in these cells.

Structural adaptation of intercalated cells in rat renal cortex to acute metabolic acidosis and alkalosis

The structural responses of cells in the distal convoluted, connecting, and collecting tubule to acute acid/base changes were investigated by electron microscopy. Acute metabolic acidosis was induced by administration of ammonium chloride, and acute metabolic alkalosis by potassium or sodium bicarbonate. Morphometric analyses were performed on micrographs of randomly selected distal nephron cells. No structural responses were found in distal convoluted tubule cells, connecting tubule cells, or principal cells but prominent changes were observed in intercalated cells (I cells). Thus, the surface density of the luminal membrane in I cells was significantly higher in acidotic animals and lower in KHCO3 alkalotic animals than in controls. On the contrary, the surface density of the membrane that bounds apical vesicles was higher in KHCO3 alkalotic and lower in acidotic animals than in controls. These results suggest that the luminal membrane is internalized during alkalosis and that the membrane that bounds apical vesicles is transferred to the luminal membrane during acidosis. Since a proton translocating ATPase may be present in the luminal membrane the observations are consistent with the possibility that cortical I cells participate in the maintenance of acid/base homeostasis.