Rates of oxygen consumption and of anaerobic glycolysis in renal cortex and medulla of adult and new-born rats and guinea-pigs

The proximal tubule is the primary target of injury and progression of kidney disease: role of the glomerulotubular junction

There is an alarming global increase in the incidence of end-stage kidney disease, for which early biomarkers and effective treatment options are lacking. Largely based on the histology of the end-stage kidney and on the model of unilateral ureteral obstruction, current investigation is focused on the pathogenesis of renal interstitial fibrosis as a central mechanism in the progression of chronic kidney disease (CKD). It is now recognized that cumulative episodes of acute kidney injury (AKI) can lead to CKD, and, conversely, CKD is a risk factor for AKI. Based on recent and historic studies, this review shifts attention from the glomerulus and interstitium to the proximal tubule as the primary sensor and effector in the progression of CKD as well as AKI. Packed with mitochondria and dependent on oxidative phosphorylation, the proximal tubule is particularly vulnerable to injury (obstructive, ischemic, hypoxic, oxidative, metabolic), resulting in cell death and ultimately in the formation of atubular glomeruli. Animal models of human glomerular and tubular disorders have provided evidence for a broad repertoire of morphological and functional responses of the proximal tubule, revealing processes of degeneration and repair that may lead to new therapeutic strategies. Most promising are studies that encompass the entire life cycle from fetus to senescence, recognizing epigenetic factors. The application of techniques in molecular characterization of tubule segments and the development of human kidney organoids may provide new insights into the mammalian kidney subjected to stress or injury, leading to biomarkers of early CKD and new therapies.

Tubular obstruction leads to progressive proximal tubular injury and atubular glomeruli in polycystic kidney disease

In polycystic kidney disease (PKD), renal parenchyma is destroyed by cysts, hypothesized to obstruct nephrons. A signature of unilateral ureteral obstruction, proximal tubular atrophy leads to formation of atubular glomeruli. To determine whether this process occurs in PKD, kidneys from pcy mice (moderately progressive PKD), kidneys from cpk mice (rapidly progressive PKD), and human autosomal dominant PKD were examined in early and late stages. Integrity of the glomerulotubular junction and proximal tubular mass were determined in sections stained with Lotus tetragonolobus lectin. Development of proximal tubular atrophy and atubular glomeruli was determined in serial sections of individual glomeruli. In pcy mice, most glomerulotubular junctions were normal at 20 weeks, but by 30 weeks, 56% were atrophic and 25% of glomeruli were atubular; glomerulotubular junction integrity decreased with increasing cyst area (r = 0.83, P < 0.05). In cpk mice, all glomerulotubular junctions were normal at 10 days, but by 19 days, 26% had become abnormal. In early-stage autosomal dominant PKD kidneys, 50% of glomeruli were atubular or attached to atrophic tubules; in advanced disease, 100% were abnormal. Thus, proximal tubular injury in cystic kidneys closely parallels that observed with ureteral obstruction. These findings support the hypothesis that, in renal cystic disorders, cyst-dependent obstruction of medullary and cortical tubules initiates a process culminating in widespread destruction of proximal convoluted tubules at the glomerulotubular junction.

Responses of proximal tubular cells to injury in congenital renal disease: fight or flight

Most chronic kidney disease in children results from congenital or inherited disorders, which can be studied in mouse models. Following 2 weeks of unilateral ureteral obstruction (UUO) in the adult mouse, nephron loss is due to proximal tubular mitochondrial injury and cell death. In neonatal mice, proximal tubular cell death is delayed beyond 2 weeks of complete UUO, and release of partial UUO allows remodeling of remaining nephrons. Progressive cyst expansion develops in polycystic kidney disease (PKD), a common inherited renal disorder. The polycystic kidney and fibrosis (pcy)-mutant mouse (which develops late-onset PKD) develops thinning of the glomerulotubular junction in parallel with growth of cysts in adulthood. Renal insufficiency in nephropathic cystinosis, a rare inherited renal disorder, results from progressive tubular cystine accumulation. In the Ctns knockout mouse (a model of cystinosis), proximal tubular cells become flattened, with loss of mitochondria and thickening of tubular basement membrane. In each model, persistent obstructive or metabolic stress leads ultimately to the formation of atubular glomeruli. The initial "fight" response (proximal tubular survival) switches to a "flight" response (proximal tubular cell death) with ongoing oxidative injury and mitochondrial damage. Therapies should be directed at reducing proximal tubular mitochondrial oxidative injury to enhance repair and regeneration.

Chronic unilateral ureteral obstruction in the neonatal mouse delays maturation of both kidneys and leads to late formation of atubular glomeruli

Unilateral ureteral obstruction (UUO) in the adult mouse is the most widely used model of progressive renal disease: the proximal tubule is the nephron segment most severely affected and atubular glomeruli are formed after only 7 days of UUO. To determine the proximal nephron response to UUO in the maturing kidney, neonatal mice were examined 7 to 28 days following complete UUO under general anesthesia. Proximal tubular mass and maturation were determined by staining with Lotus tetragolonobus lectin. Superoxide was localized by nitroblue tetrazolium and collagen by Sirius red. Cell proliferation, cell death, PAX-2, megalin, α-smooth muscle actin (α-SMA), renin, and fibronectin were identified by immunohistochemistry. During the first 14 days of ipsilateral UUO, despite oxidative stress (4-hydroxynonenal staining), glomerulotubular continuity was maintained and mitochondrial superoxide production persisted. However, from 14 to 28 days, papillary growth was impaired and proximal tubules collapsed with increased apoptosis, autophagy, mitochondrial loss, and formation of atubular glomeruli. Fibronectin, α-SMA, and collagen increased in the obstructed kidney. Oxidative stress was present also in the contralateral kidney: renin was decreased, glomerulotubular maturation and papillary growth were delayed, followed by increased cortical and medullary growth. We conclude that neonatal UUO initially delays renal maturation and results in oxidative stress in both kidneys. In contrast to the adult, proximal tubular injury in the neonatal obstructed kidney is delayed at 14 days, followed only later by the formation of atubular glomeruli. Antioxidant therapies directed at proximal tubular mitochondria during early renal maturation may slow progression of congenital obstructive nephropathy.

Cellular response to renal hypoxia is different in adolescent and infant rats

Immature renal tubules are more tolerant to ischemia than mature renal tubules. Here we compared the developmental pattern for some cellular responses evoked by hypoxia and reoxygenation in renal proximal tubules from 10- and 40-day-old rats. Redistribution of Na(+)-K(+)-ATPase from the plasma membrane was studied by confocal microscopy techniques in primary cultured renal proximal tubular cells. The developmental expression of Na(+)-K(+)-ATPase, micro-calpain and heme oxygenase-1 was measured by RT-PCR techniques in rat renal cortex. In response to hypoxia Na(+)-K(+)-ATPase redistribution from the plasma membrane was almost 2-fold increased in cells isolated from mature kidneys compared with cells isolated from immature kidneys. Reoxygenation resulted in a complete reestablishment of Na(+)-K(+)-ATPase in the plasma membrane in the immature but not in the mature cells. The dissociation of Na(+)-K(+)-ATPase from the plasma membrane was associated with a reduced activity and a reduced expression of Na(+)-K(+)-ATPase in the mature but not in the immature tubular cells. The expression of micro-calpain, a factor shown to induce ischemic injury to proximal tubular cells, was significantly lower in the immature compared with the mature kidney, whereas the expression of heme oxygenase-1, a factor shown to protect from renal ischemic injury, was significantly higher in the immature kidney. The results help to explain the increased tolerance of the immature kidney to injury caused by ischemia and reperfusion.

Neonatal rabbit proximal tubule basolateral membrane Na+/H+ antiporter and Cl-/base exchange

The present in vitro microperfusion study examined the maturation of Na+/H+ antiporter and Cl-/base exchanger on the basolateral membrane of rabbit superficial proximal straight tubules (PST). Intracellular pH (pHi) was measured with the pH-sensitive fluorescent dye 2', 7'-bis(2-carboxyethyl)-5(6)-carboxyfluorescein in neonatal and adult superficial PST. Na+/H+ antiporter activity was examined after basolateral Na+ addition in tubules initially perfused and bathed without Na+. Neonatal Na+/H+ antiporter activity was approximately 40% that of adult segment (9.7 +/- 1.5 vs. 23.7 +/- 3.2 pmol. mm-1. min-1; P < 0.001). The effect of bath Cl- removal on pHi was used to assess the rates of basolateral Cl-/base exchange. In both neonatal and adult PST, the Cl-/base exchange activity was significantly higher in the presence of 25 mM HCO-3 than in the absence of HCO-3 and was inhibited by cyanide and acetazolamide, consistent with Cl-/HCO-3 exchange. The proton flux rates in the presence of bicarbonate in neonatal and adult tubules were 14.1 +/- 3.6 and 19.5 +/- 3.5 pmol. mm-1min-1, respectively (P = NS), consistent with a mature rate of Cl-/HCO-3 exchanger activity in neonatal tubules. Basolateral Cl-/base exchange activity in the absence of CO2 and HCO-3, with luminal and bath cyanide and acetazolamide, was greater in adult than in neonatal PST and inhibited by bath DIDS consistent with a maturational increase in Cl-/OH- exchange. We have previously shown that the rates of the apical membrane Na+/H+ antiporter and Cl-/base exchanger were approximately fivefold lower in neonatal compared with adult rabbit superficial PST. These data demonstrate that neonatal PST basolateral membrane Na+/H+ antiporter and Cl-/base exchanger activities are relatively more mature than the Na+/H+ antiporter and Cl-/base exchangers on the apical membrane.

Role of heat stress response in the tolerance of immature renal tubules to anoxia

The stress response was studied in suspensions of tubules from immature (IT) and mature (MT) rats after noninjury, heat, oxygen, and anoxia. Under all conditions, IT exhibited more exuberant activation of heat shock transcription factor (HSF) than MT. Characterization of activated HSF in immature cortex revealed HSF1. Also, 2 h after each condition, heat shock protein-72 (HSP-72) mRNA was twofold in IT. As the metabolic response to 45 min of anoxia, 20-min reoxygenation was assessed by measuring O2 consumption (O2C). Basal O2C was manipulated with ouabain, nystatin, and carbonylcyanide p-chloromethyoxyphenylhydrazone (CCCP). Basal O2C in IT were one-half the value of MT. After anoxia, basal O2C was reduced by a greater degree in MT. Ouabain reduced O2C to half the basal value in both noninjured and anoxic groups. Basal O2C was significantly stimulated by nystatin but not to the same level following anoxia in MT and IT. Basal O2C was also stimulated by CCCP, but after anoxia, CCCP O2C was significantly less in MT with no decrease in IT, suggesting mitochondria are better preserved in IT. Also, O2C devoted to nontransport activity was better maintained in IT.

The relationship between renal metabolism and proximal tubule transport during ontogeny

The proximal tubules of newborn and adult animals reabsorb a similar fraction of the filtered load of Na+ and H2O (65%-70%). In tubules from adult animals, transcellular, active Na+ reabsorption accounts for one-third of the total, while two-thirds occur passively through the paracellular pathway, driven by hydrostatic and oncotic forces (one-third) and by cell-generated effective osmotic and ionic gradients (one-third). Since two-thirds of the Na+ is reabsorbed passively and does not require energy, the mature proximal tubule has a high Na+/O2 molar ratio (48 Eq of Na+/mol of O2). Measurements of ouabain-sensitive oxygen consumption in suspensions of proximal tubules indicate that in newborn, aerobic metabolism can support about 50% of the net Na+ transport rate compared with the 33% in tubules from adult animals. Independent confirmation of the direct and proportional relationship between active Na+ transport and ouabain-sensitive O2 consumption exists for the adult but not for the newborn. However, measurements of epithelial conductances and of transepithelial hydrostatic and oncotic pressure differences indicate that passive paracellular fluxes can account for the remaining 50% of the proximal Na+ reabsorption in newborn. The high permeability of the proximal tubules of newborn animals to small molecular weight solutes suggests that cell-generated osmotic and ionic transepithelial gradients are minimal in the tubules of newborn animals. Yet in the newborn, the osmolality of the end proximal tubule fluid was found to exceed that in plasma. This indicates that osmotic gradients due to differences in reflection coefficients for preferentially reabsorbed solutes and Cl- do exist across the proximal tubules of the newborn and suggests that these gradients may contribute to Na+ and H2O reabsorption. If this is indeed the case, then the contribution of active and of hydrostatic and oncotic pressure-driven flows to the overall reabsorption of Na+ and fluid has been overestimated. Resolution of this discrepancy requires measurements of the reflection coefficients for HCO3- and Cl- in the proximal tubule of the newborn. The metabolic processes by which energy is supplied to renal proximal cells during development are also incompletely characterized. There is evidence that maturation of aerobic metabolism, Krebs cycle enzymes activity, and of the mitochondrial membrane surface area precede the development of net reabsorptive transport (Na+, H2O, HCO3, glucose). By contrast, maturation of Na(+)-K(+)-ATPase activity at the basolateral cell membrane follows that in reabsorptive transport and does not limit its development.(ABSTRACT TRUNCATED AT 400 WORDS)

Some effects of glucose concentration and anoxia on glycolysis and metabolite concentrations in the perfused liver of fetal guinea pig

Effects of glucose concentration and anoxia upon the metabolite concentrations and rates of glycolysis and respiration have been investigated in the perfused liver of the fetal guinea pig. In most cases the metabolite concentrations in the perfused liver were similar to those observed in vivo. Between 50 days and term there was a fall in the respiratory rate and in the concentration of ATP and fructose 1,6-diphosphate and an increase in the concentration of glutamate, glycogen and glucose. Reducing the medium glucose concentration from 10 mM to 1 mM or 0.1 mM depressed lactate production and the concentration of most of the phosphorylated intermediates (except 6-phosphogluconate) in the liver of the 50-day fetus. This indicates a fall in glycolytic rate which is not in accord with the known kinetic properties of hexokinase in the fetal liver. Anoxia increased lactate production by, and the concentrations of, the hexose phosphates ADP and AMP in the 50-day to term fetal liver, while the concentration of ribulose 5-phosphate, ATP and some triose phosphates fell. These results are consistent with an activation of glycolysis, particularly at phosphofructokinase and of a reduction in pentose phosphate pathway activity, particularly at 6-phosphogluconate dehydrogenase. The calculated cytosolic NAD+/NADH ratio for the perfused liver was similar to that measured in vivo and evidence is presented to suggest that the dihydroxyacetone phosphate/glycerol 3-phosphate ratio gives a better indication of cytosolic redox than the lactate/pyruvate ratio. The present observations indicate that phosphofructokinase hexokinase and possibly pyruvate kinase control the glycolytic rate and that glyceraldehyde-3-phosphate dehydrogenase is at equilibrium in the perfused liver of the fetal guinea pig.

Evidence of induction of new nephrons in immature kidneys undergoing hypertrophy

Unilateral nephrectomy performed during the first days or weeks of life may or may not induce the development of new nephrons in the remaining kidney. Such an increase has been reported to occur, as discussed in this review, in newborn rats and mice, but not in guinea pigs. These observations are consistent with other data suggesting different patterns of compensatory adaptation in young and in old animals.

Number of glomeruli in normal and hypertrophied kidneys of mice and guinea-pigs

1. In mice and guinea-pigs, the number of glomeruli was counted in kidneys during normal growth and in hypertrophy induced by unilateral nephrectomy. 2. In mice, the number of glomeruli increased sharply during the first 2 weeks in life, and more slowly afterwards. Unilateral nephrectomy, when performed during this period of natural increase, induced the formation of supplementary nephrons in the contralateral kidney. 3. In guinea-pigs, the number of glomeruli was almost complete at birth. No evidence of a supplementary increase in the number of nephrons was found in hypertrophied kidneys following unilateral nephrectomy. 4. These results, together wit previous data obtained in the rat, suggest that the ability to induce new nephrons after unilateral nephrectomy in different species would depend more on the state of kidney maturity at birth than on differences in the renal mechanisms which lead to hypertrophy.

Morphometric and enzyme histochemical behaviour of the kidney of young rats before and after unilateral nephrectomy

Four week old male Wistar rats were unilaterally nephrectomized, and one, two, four, fourteen, and twenty-eight days after the operation the remaining kidneys were removed for morphological examination--including measurement of diameters of the tubules--and for histochemical investigation of enzymatic activities in the nephrons. The following enzymes were examined: succinate DH, lactate DH, alpha-glycerophosphate DH, isocitrate DH, glucose-6-phosphate DH, cytochrome oxidase, adenosine triphosphatase, alkaline and acid phosphatases. In comparison with kidneys of control animals of the same age and sex, the hypertrophy of the remaining kidney was found to be, even in these young rats, entirely due to enlargement of preexisting nephrons. The measurements have indicated that the hypertrophy was most distinct between the second and fourth day after uninephrectomy. Four weeks after the operation the diameters of proximal and distal tubules were about 21% and 18% respectively bigger in the uninephrectomized animals than in the corresponding controls. This increase in size was accompanied by some changes in intensity of enzymatic staining reactions; after an initial diminishment, a graduate increase in activity of almost all the observed tubular enzymes was found; this seems to be the expression of the functional compensation by the remaining kidney.

Compensatory renal growth after unilateral nephrectomy in the new-born rat

1. The right kidney in a series of control rats aged between 5 days and 115 days was weighed. The kidney weight/body weight ratio was greater in young than in older rats, but decreased linearly with increasing age.2. After unilateral nephrectomy of rats 5 days old, the remaining kidney underwent compensatory growth. The rate and extent of this growth were greater than in adult rats.3. The concentrations of RNA and DNA in the renal cortex and medulla of rats 5 days old were higher than in adult animals. The concentrations of the two nucleic acids fell with age, and reached adult levels after approximately 6 weeks.4. After unilateral nephrectomy of rats 5 days old, the concentrations of RNA and DNA in the medulla were not significantly different from those in control animals. In the cortex, however, there was a delayed increase in the RNA/DNA ratio, which reached a level some 12% higher than that in control rats. This increase was smaller than that observed in unilaterally nephrectomized adult rats.5. The cortical Q(O2) of the remaining kidney of unilaterally nephrectomized new-born rats was elevated by some 20% within 1 day of unilateral nephrectomy. Cortical Q(O2)'s remained higher than those of control animals for 3-4 weeks.6. Since after unilateral nephrectomy, the increase in renal mass in new-borns was greater than that in adults, whereas the degree of cortical cellular hypertrophy (as estimated by the RNA/DNA ratio) was smaller than in adults, it is likely that in new-born animals a significant contribution to compensatory growth comes from cellular hyperplasia.

Inhibition of compensatory renal growth in rats

1. Compensatory renal hypertrophy in unilaterally nephrectomized rats was measured by estimation of dry weight, protein content, RNA and DNA changes and rate of oxygen consumption. Inulin clearances (= GFR) and water and solute excretions were estimated in animals given by stomach tube either 5 ml. water or 5 ml. 0.6% NaCl solution/100 g body wt.2. Kidneys removed when animals were unilaterally nephrectomized were homogenized in 0.25 M sucrose and fractions containing mitochondria or microsomes were obtained by centrifugation. Renal cortex and medulla were similarly treated.3. Intraperitoneal injections of microsomes and/or supernatant fluid from a kidney homogenate or from the renal cortex usually inhibited compensatory growth of the contralateral kidney and prevented any increase of its protein content.4. Injections of microsomes and/or supernatant fluid from the renal medulla had no significant effect on the rate of compensatory hypertrophy.5. After I.P. injection of microsomes and supernatant fluid from a homogenate from the renal cortex there was no rise of the RNA/DNA ratio in the contralateral kidney and the rate of oxygen uptake of its cortex decreased, while that of anaerobic glycolysis increased.6. Injections of microsomes and supernatant fluid from kidney homogenate did not affect glomerular filtration rate which increased as in control unilaterally nephrectomized rats.7. In unilaterally nephrectomized rats, injected with microsomes and supernatant fluid from a kidney homogenate, there was a decrease of osmolal clearance, in spite of the raised glomerular filtration rate. The decrease of osmolal clearance lasted for several days, and was most pronounced when the animals had been given by stomach tube 5 ml. 0.6% NaCl solution/100 g body wt.

Mechanism of compensatory renal hypertrophy

1. Adult rats were unilaterally nephrectomized and the weight of the remaining kidney up to 42 days after the operation compared with that of rats of comparable weight which underwent a sham operation.2. After unilateral nephrectomy the rate of renal hypertrophy varied with the protein content of the diet: it was faster when animals were fed on a high protein diet (22% casein) and lowest in animals fed on a low protein diet (7% casein).3. In rats fed on a standard diet (18% casein), after unilateral nephrectomy there was a sharp increase in glomerular filtration rate (G.F.R.), as measured by inulin clearance estimations; this was accompanied by an enhanced oxygen uptake and by an increase of RNA/DNA ratios in the renal cortex. Changes in rate of oxygen uptake and of RNA/DNA ratios in the medulla were negligible.4. A marked increase in mitotic activity of cells of the cortex occurred only 48 hr after the operation. It lasted for about 2 days. No significant changes in mitotic activity of cells in the medulla were observed.5. After its initial marked rise glomerular filtration rate in the renoprival kidney settled down to about 30-40% above its pre-operative level, and remained at that level for the whole period of observation (6 weeks), while the increase of oxygen uptake returned to its control level in some 10-14 days. RNA/DNA ratios in the cortex remained high, but did not increase further.6. The increase of RNA/DNA ratios in the renal cortex was correlated with a steady increase in the dry weight of the renoprival kidney.7. Water and solutes excretion were restored to normal in about 3-5 days after the operation.8. Though the increase in glomerular filtration rate may be the prime mover in the mechanism of compensatory renal hypertrophy, it does not explain why there is an increase in the size of tubules.