Renal response to volume depletion and expansion in Milan hypertensive rats

Tubuloglomerular feedback response in the prenatal and postnatal ovine kidney

The tubuloglomerular feedback mechanism (TGF) plays an important role in regulating single-nephron glomerular filtration rate (GFR) by coupling distal tubular flow to arteriolar tone. It is not known whether TGF is active in the developing kidney or whether it can regulate renal vascular tone and thus GFR during intrauterine life. TGF characteristics were examined in late-gestation ovine fetuses and lambs under normovolemic and volume-expanded (VE) conditions. Lambs and pregnant ewes were anesthetized and the fetuses were delivered via a caesarean incision into a heated water bath, with the umbilical cord intact. Under normovolemic conditions, mean arterial pressure of the fetuses was lower than lambs (51 ± 1 vs. 64 ± 3 mmHg). The maximum TGF response (ΔPSFmax) was found to be lower in fetuses than lambs when tubular perfusion was increased from 0 to 40 nl/min (5.4 ± 0.7 vs. 10.6 ± 0.4 mmHg). Furthermore, the flow rate eliciting half-maximal response [turning point (TP)] was 15.7 ± 0.9 nl/min in fetuses compared with 19.3 ± 1.0 nl/min in lambs, indicating a greater TGF sensitivity of the prenatal kidney. VE decreased ΔPSFmax (4.2 ± 0.4 mmHg) and increased TP to 23.7 ± 1.3 nl/min in lambs. In fetuses, VE increased stop-flow pressure from 26.6 ± 1.5 to 30.3 ± 0.8 mmHg, and reset TGF sensitivity so that TP increased to 21.3 ± 0.7 nl/min, but it had no effect on ΔPSFmax. This study provides direct evidence that the TGF mechanism is active during fetal life and responds to physiological stimuli. Moreover, reductions in TGF sensitivity may contribute to the increase in GFR at birth.

Extracellular volume and glomerular filtration rate in children with chronic kidney disease

BACKGROUND AND OBJECTIVES

Extracellular volume (ECV) is the fluid contained in all noncellular compartments of the body and is a quantity tightly controlled by the kidney. Thus, there is a strong link between ECV and kidney function.

DESIGN, SETTING, PARTICIPANTS & MEASUREMENTS

The Chronic Kidney Disease in Children (CKiD) study uses injected iohexol to obtain direct measures of GFR. Direct calculation of ECV was viable from GFR studies using descriptors of the disappearance curves. Using linear regression methods on the log-transformed variables, markers of size (height and weight) and biomarkers of kidney disease (serum creatinine, blood urea nitrogen, and cystatin C) were assessed for their relationships with ECV normalized to body weight (ECV/wt). The relationship to hypertension (systolic BP >95th percentile for age, sex, and height) was also assessed.

RESULTS

Data from 790 iohexol studies with medians for GFR=43.4 ml/min per 1.73 m(2), weight=35 kg, and height=1.4 m were used. The median ECV was 8.6 L, and the median ECV/wt was 0.23 L/kg. ECV was found to be a function of height (m) and weight (kg) according to the relationship ECV=√weight×height. Biomarkers of kidney disease yielded significant relationships with ECV/wt, but the strength of association was small. No significant association between ECV/wt and hypertension was found.

CONCLUSIONS

ECV has relevance to studies of chronic kidney disease, is related to biomarkers, and can be easily estimated from the square root of weight and height.

Mechanisms of renal blood flow autoregulation: dynamics and contributions

Autoregulation of renal blood flow (RBF) is caused by the myogenic response (MR), tubuloglomerular feedback (TGF), and a third regulatory mechanism that is independent of TGF but slower than MR. The underlying cause of the third regulatory mechanism remains unclear; possibilities include ATP, ANG II, or a slow component of MR. Other mechanisms, which, however, exert their action through modulation of MR and TGF are pressure-dependent change of proximal tubular reabsorption, resetting of RBF and TGF, as well as modulating influences of ANG II and nitric oxide (NO). MR requires < 10 s for completion in the kidney and normally follows first-order kinetics without rate-sensitive components. TGF takes 30-60 s and shows spontaneous oscillations at 0.025-0.033 Hz. The third regulatory component requires 30-60 s; changes in proximal tubular reabsorption develop over 5 min and more slowly for up to 30 min, while RBF and TGF resetting stretch out over 20-60 min. Due to these kinetic differences, the relative contribution of the autoregulatory mechanisms determines the amount and spectrum of pressure fluctuations reaching glomerular and postglomerular capillaries and thereby potentially impinge on filtration, reabsorption, medullary perfusion, and hypertensive renal damage. Under resting conditions, MR contributes approximately 50% to overall RBF autoregulation, TGF 35-50%, and the third mechanism < 15%. NO attenuates the strength, speed, and contribution of MR, whereas ANG II does not modify the balance of the autoregulatory mechanisms.