Sodium, phosphate, glucose, bicarbonate, and alanine interactions in the isolated proximal convoluted tubule of the rabbit kidney

Different Effects of Empagliflozin on Markers of Mineral-Bone Metabolism in Diabetic and Non-Diabetic Patients with Stage 3 Chronic Kidney Disease

Background and objectives: Treatment with sodium-glucose co-transporter 2 (SGLT2) inhibitors decrease tubular reabsorption of phosphate, which may explain the reduction of bone mineral density and an excess of bone fractures observed in some studies with this class of drugs. Since an increased risk of bone fractures may also be a result of diabetes itself, our study aimed to compare the effect of empagliflozin on the markers of mineral-bone metabolism between diabetic (DKD) and non-diabetic (ND-CKD) patients with stage 3 chronic kidney disease (CKD). Materials and Methods: Forty-two patients with stage 3 CKD and A2 albuminuria, including 18 with DKD and 24 ND-CKD, were investigated. All subjects received 10 mg empagliflozin for 7 days. Serum calcium, phosphate, parathormone (PTH), calcitriol, bone alkaline phosphatase (BAP), FGF-23 and urine calcium, phosphate, albumin and the renal tubular maximum reabsorption rate of phosphate to the glomerular filtration rate (TmP-GFR) were measured before and after empagliflozin administration. Differences in biomarkers response to empagliflozin between DKD and ND-CKD were the main measures of outcome. Results: There was a significant increase of PTH, FGF-23 and phosphate in DKD but not in ND-CKD whereas BAP and TmP/GFR did not change in either group. The reduction of albuminuria was only significant in ND-CKD. Conclusions: The effect of SGLT2 inhibitor on serum mineral and bone markers and on albuminuria in patients with CKD may be differently modified by the presence of diabetes mellitus.

Canagliflozin triggers the FGF23/1,25-dihydroxyvitamin D/PTH axis in healthy volunteers in a randomized crossover study

BACKGROUND

Sodium glucose cotransporter-2 (SGLT2) inhibitors are the most recently approved class of drugs for type 2 diabetes and provide both glycemic efficacy and cardiovascular risk reduction. A number of safety issues have been identified, including treatment-emergent bone fractures. To understand the overall clinical profile, these safety issues must be balanced against an attractive efficacy profile. Our study was designed to investigate pathophysiological mechanisms mediating treatment-emergent adverse effects on bone health.

METHODS

We conducted a single-blind randomized crossover study in hospitalized healthy adults (n = 25) receiving either canagliflozin (300 mg/d) or placebo for 5 days. The primary end-point was the drug-induced change in AUC for plasma intact fibroblast growth factor 23 (FGF23) immunoactivity between 24 and 72 hours.

RESULTS

Canagliflozin administration increased placebo-subtracted mean levels of serum phosphorus (+16%), plasma FGF23 (+20%), and plasma parathyroid hormone (PTH) (+25%), while decreasing the level of 1,25-dihydroxyvitamin D (-10%). There was substantial interindividual variation in the magnitude of each of these pharmacodynamic responses. The increase in plasma FGF23 was correlated with the increase in serum phosphorus, and the decrease in plasma 1,25-dihydroxyvitamin D was correlated with the increase in plasma FGF23.

CONCLUSIONS

Canagliflozin induced a prompt increase in serum phosphorus, which triggers downstream changes in FGF23, 1,25-dihydroxyvitamin D, and PTH, with potential to exert adverse effects on bone health. These pharmacodynamic data provide a foundation for future research to elucidate pathophysiological mechanisms of adverse effects on bone health, with the objective of devising therapeutic strategies to mitigate the drug-associated fracture risk.

TRIAL REGISTRATION

ClinicalTrial.gov (NCT02404870).

FUNDING

Supported by the Intramural Program of NIDDK.

The role of glycine in regulated cell death

The cytoprotective effects of glycine against cell death have been recognized for over 28 years. They are expressed in multiple cell types and injury settings that lead to necrosis, but are still not widely appreciated or considered in the conceptualization of cell death pathways. In this paper, we review the available data on the expression of this phenomenon, its relationship to major pathophysiologic pathways that lead to cell death and immunomodulatory effects, the hypothesis that it involves suppression by glycine of the development of a hydrophilic death channel of molecular dimensions in the plasma membrane, and evidence for its impact on disease processes in vivo.

Disturbance of inorganic phosphate metabolism in diabetes mellitus: its relevance to the pathogenesis of diabetic retinopathy

Early in the progression of diabetes, a paradoxical metabolic imbalance in inorganic phosphate (Pi) occurs that may lead to reduced high energy phosphate and tissue hypoxia. These changes take place in the cells and tissues in which the entry of glucose is not controlled by insulin, particularly in poorly regulated diabetes patients in whom long-term vascular complications are more likely. Various conditions are involved in this disturbance in Pi. First, the homeostatic function of the kidneys is suboptimal in diabetes, because elevated blood glucose concentrations depolarize the brush border membrane for Pi reabsorption and lead to lack of intracellular phosphate and hyperphosphaturia. Second, during hyperglycemic-hyperinsulinemic intervals, high amounts of glucose enter muscle and fat tissues, which are insulin sensitive. Intracellular glucose is metabolized by phosphorylation, which leads to a reduction in plasma Pi, and subsequent deleterious effects on glucose metabolism in insulin insensitive tissues. Hypophosphatemia is closely related to a decrease in adenosine triphosphate (ATP) in the aging process and in uremia. Any interruption of optimal ATP production might lead to cell injury and possible cell death, and evidence will be provided herein that such cell death does occur in diabetic retinopathy. Based on this information, the mechanism of capillary microaneurysms formation in diabetic retinopathy and the pathogenesis of diabetic retinopathy must be reevaluated.

Calcium entry blocker nicardipine inhibits sodium and inorganic phosphate reabsorption independent of renal circulation in dogs

The effects of nicardipine on renal function were studied in anesthetized dogs. The changes in the tubular sodium (Na) and inorganic phosphate (PO(4)) reabsorption caused by the drug infusion into the renal artery without altered systemic and real circulation were especially evaluated. In dogs receiving a smaller dose of nicardipine (5 ng.kg(-1).min(-1)) into the left renal artery the blood pressure and renal circulation did not change, but urine volume and urinary Na and PO(4) excretion increased significantly. In dogs receiving a larger dose of nicardipine (50 ng.kg(-1).min(-1)) into the renal artery, renal plasma flow, urine volume and urinary Na and PO(4) excretion increased significantly, but creatinine clearance did not. The fractional distal Na reabsorption did not change with nicardipine infusion in either group. PO(4) reabsorption is considered to occur mainly in the proximal renal tubule, so its appearance in urine in increased quantities without the changes of systemic and renal circulation suggests proximal activity of the drug.

Proximal tubular phosphate reabsorption: molecular mechanisms

Renal proximal tubular reabsorption of P(i) is a key element in overall P(i) homeostasis, and it involves a secondary active P(i) transport mechanism. Among the molecularly identified sodium-phosphate (Na/P(i)) cotransport systems a brush-border membrane type IIa Na-P(i) cotransporter is the key player in proximal tubular P(i) reabsorption. Physiological and pathophysiological alterations in renal P(i) reabsorption are related to altered brush-border membrane expression/content of the type IIa Na-P(i) cotransporter. Complex membrane retrieval/insertion mechanisms are involved in modulating transporter content in the brush-border membrane. In a tissue culture model (OK cells) expressing intrinsically the type IIa Na-P(i) cotransporter, the cellular cascades involved in "physiological/pathophysiological" control of P(i) reabsorption have been explored. As this cell model offers a "proximal tubular" environment, it is useful for characterization (in heterologous expression studies) of the cellular/molecular requirements for transport regulation. Finally, the oocyte expression system has permitted a thorough characterization of the transport characteristics and of structure/function relationships. Thus the cloning of the type IIa Na-P(i )cotransporter (in 1993) provided the tools to study renal brush-border membrane Na-P(i) cotransport function/regulation at the cellular/molecular level as well as at the organ level and led to an understanding of cellular mechanisms involved in control of proximal tubular P(i) handling and, thus, of overall P(i) homeostasis.

Electrophysiological analysis of Na+/Pi cotransport mediated by a transporter cloned from rat kidney and expressed in Xenopus oocytes

Phosphate (Pi) reabsorption in renal proximal tubules involves Na+/Pi cotransport across the brush border membrane; its transport rate is influenced by the Na(+)-coupled transport of other solutes as well as by pH. In the present study, we have expressed a cloned rat renal brush border membrane Na+/Pi cotransporter (NaPi-2) in Xenopus laevis oocytes and have analyzed its electrophysiologic properties in voltage- and current-clamp studies. Addition of Pi to Na(+)-containing superfusates resulted in a depolarization of the membrane potential and, in voltage-clamped oocytes, in an inward current (IP). An analysis of the Na+ and/or Pi concentration dependence of IP suggested a Na+/Pi stoichiometry of 3:1. IP was increased by increasing the pH of the superfusate; this phenomenon seems to be mainly related to a lowering of the affinity for Na+ interaction by increasing H+ concentration. The present data suggest that known properties of Pi handling at the tubular/membrane level are "directly" related to specific characteristics of the transport molecule (NaPi-2) involved.

Treatment of intraoperative hypertension with enflurane, nicardipine, or human atrial natriuretic peptide: haemodynamic and renal effects

The purpose of this study was to assess the effects of the calcium entry blocker nicardipine and alpha human atrial natriuretic peptide (hANP) on antihypertensive and diuretic activity in hypertensive surgical patients. The site of the diuretic actions of these drugs along the nephron were also investigated by measuring the excretion rate of inorganic phosphate (PO4). Hypertension during gastrectomy was treated by increasing the concentration of enflurane, by nicardipine infusion (0.5-2.0 micrograms.kg-1 x min-1), or by hANP infusion (0.05-0.2 microgram.kg-1 x min-1) under general anaesthesia. Enflurane, nicardipine and hANP all decreased arterial pressure to the same extent. Urine flow, Na and PO4 excretion increased following the administration of nicardipine or hANP. Fractional distal reabsorption of sodium was suppressed from 89.7 +/- 2.8% to 82.1 +/- 5.0% by the hANP, but not by the nicardipine infusion. Creatinine clearance was increased by hANP infusion, but did not change in the nicardipine group. It is concluded that nicardipine and hANP can be used safely for the treatment of hypertension during surgery. Both drugs induced phosphaturic diuresis, but the site of action of the two drugs on the nephron may be different. Phosphate reabsorption is considered to occur largely in the renal proximal tubule, so that its appearance in the urine in increased quantities without the change of renal circulation in the nicardipine group suggests a proximal tubular action of this drug. However, the site of action of hANP in the kidney was not determined because GFR increased and distal sodium reabsorption was suppressed due to the drug infusion.

Protection of human umbilical vein endothelial cells by glycine and structurally similar amino acids against calcium and hydrogen peroxide-induced lethal cell injury

Cultured human umbilical vein endothelial cells treated with either the calcium ionophore, ionomycin, or ionomycin plus cyanide-m-chlorophenylhydrazone had immediate severe depletion of adenosine triphosphate, (ATP) and increases of cytosolic free calcium (Caf) and then sustained lethal cell injury as manifested by release of lactate dehydrogenase and failure to exclude vital dyes within 15 minutes. Inclusion of glycine in the experimental medium prevented the enzyme leakage for at least 60 minutes without altering the ATP depletion or increases of Caf. The physiologic glycine concentration of 0.25 mmol/l gave 50% protection, and protection was complete at 1 mmol/l. Several other small neutral amino acids, L- and D-alanine, beta-alanine, 1-aminocyclopropane-1-carboxylate, alpha-aminoisobutyrate, and L-serine, had effects similar to glycine, but other amino acids and metabolic substrates did not. The endothelial cells were relatively resistant to damage from hydrogen peroxide, but sensitivity could be increased by preloading with Fe2+. In both non-loaded and Fe(2+)-loaded cells, hydrogen-peroxide-induced lactate dehydrogenase (LDH) release developing over 180 minutes was prevented by glycine in a fashion analogous to that seen with ionomycin damage. Mn2+ also partially protected against hydrogen peroxide injury but was not required for glycine's effects. These data demonstrate that striking modulatory effects of glycine and structurally similar amino acids that have previously been characterized in most detail using kidney tubule cells are strongly expressed in human umbilical vein endothelial cells and are involved in their response to Ca2+ and oxidant-mediated damage. These amino acid effects must be considered in the design of in vitro studies of endothelial cell injury and may contribute to endothelial cell pathophysiology in vivo.

Electrogenicity of phosphate transport by renal brush-border membranes

Phosphate uptake by rat renal brush-border membrane vesicles was studied under experimental conditions where transmembrane electrical potential (delta psi) could be manipulated. Experiments were performed under initial rate conditions to avoid complications associated with the dissipation of ion gradients. First, phosphate uptake was shown to be strongly affected by the nature of Na+ co-anions, the highest rates of uptake being observed with 100 mM-NaSCN (1.010 +/- 0.086 pmol/5 s per micrograms of protein) and the lowest with 50 mM-Na2SO4 (0.331 +/- 0.046 pmol/5 s per micrograms of protein). Anion substitution studies showed that potency of the effect of the co-anions was in the order thiocyanate greater than nitrate greater than chloride greater than isethionate greater than gluconate greater than sulphate, which correlates with the known permeability of the membrane to these anions and thus to the generation of transmembrane electrical potentials of decreasing magnitude (inside negative). The stimulation by ion-diffusion-induced potential was observed from pH 6.5 to 8.5, indicating that the transport of both monovalent and divalent phosphate was affected. In addition, inside-negative membrane potentials were generated by valinomycin-induced diffusion of K+ from K+-loaded vesicles and showed a 57% stimulation of phosphate uptake, at pH 7.5. Similar experiments with H+-loaded vesicles, in the presence of carbonyl cyanide m-chlorophenylhydrazone gave a 50% stimulation compared with controls. Inside-positive membrane potentials were also induced by reversal of the K+ gradient (outside greater than inside) in the presence of valinomycin and gave 58% inhibition of phosphate uptake. The membrane-potential dependency of phosphate uptake was finally analysed under thermodynamic equilibrium, and a stimulation by inside-negative potential was observed. The transport of phosphate was thus driven against a concentration gradient by a membrane potential, implicating the net transfer of a positive charge during the translocation process. These results indicate a major contribution of electrical potential to phosphate uptake in renal brush-border membranes.

Modulation of phosphate absorption by calcium in the rabbit proximal convoluted tubule

Proximal convoluted (S2) and straight (S3) renal tubule segments were studied to determine the effect of Ca on lumen-to-bath phosphate flux (JlbPO4). Increasing bath and perfusate Ca from 1.8 to 3.6 mM enhanced JlbPO4 from 3.3 +/- 0.7 to 6.6 +/- 0.6 pmol/mm per min in S2 segments (P less than 0.001) but had no effect in S3 segments. Decreasing bath and perfusate Ca from 1.8 to 0.2 mM reduced JlbPO4 from 3.7 +/- 0.6 to 2.2 +/- 0.6 in S2 segments. These effects were unrelated to changes in fluid absorption and transepithelial potential difference. Increasing cytosolic Ca with a Ca ionophore, inhibiting the Ca-calmodulin complex with trifluoperazine, or applying the Ca channel blocker nifedipine had no effect on JlBPO4 in S2 segments. Increasing only bath Ca from 1.8 to 3.6 mM did not significantly affect JlbPO4. However, increasing only perfusate Ca enhanced JlbPO4 from 3.4 +/- 0.7 to 6.1 +/- 0.7 pmol/mm per min (P less than 0.005). Inhibition of hydrogen ion secretion, by using a low bicarbonate, low pH perfusate, both depressed base-line JlbPO4 and abolished the stimulatory effect of raising perfusate Ca. Net phosphate efflux (JnetPO4) also increased after ambient calcium levels were raised, ruling out a significant increase in PO4 backflux. When net sodium transport was abolished by reducing the bath temperature to 24 degrees C, JnetPO4 at normal ambient calcium was reduced and increasing ambient calcium failed to increase it, ruling out a simple physicochemical reaction wherein phosphate precipitates out of solution with calcium. The present studies provide direct evidence for a stimulatory effect of Ca on sodium-dependent PO4 absorption in the proximal convoluted tubule, exerted at the luminal membrane. It is postulated that Ca modulates the affinity of the PO4 transporter for the anion.

Reduced tubular reabsorption of phosphate during post-operative glucose infusions in humans

It is well-known that serum phosphate concentration decreases considerably during post-operative glucose infusions. The purpose of this study was to elucidate whether the renal handling of phosphate could be responsible for this fall. Twelve patients were studied during glucose and saline infusions on the 2 first post-operative days. The maximal tubular capacity for reabsorption of phosphate per litre of glomerulus filtrate (TmP/GFR) was significantly reduced during glucose infusions in relation to saline infusions. The glucose induced fall in serum phosphate concentration was correlated to the change in TmP/GFR (r2 = 0.71). This study did not explain the reduced TmP/GFR during the glucose infusions, but a high correlation was found between TmP/GFR and the changes in plasma glucose concentration during the infusions (r = -0.91).

Phosphate uptake by kidney epithelial (LLC-PK1) cells

Phosphate uptake by the cultured kidney epithelial cell (LLC-PK1) was studied. The uptake was Na+ dependent, saturable with respect to phosphate and Na+, and energy dependent. The characteristics of the cell uptake system resembled the properties of phosphate transport in the kidney. Parathyroid hormone, dibutyryl cyclic AMP, and forskolin decreased Na+-dependent phosphate uptake. These agonists did not affect Na+-dependent alpha-methylglucoside uptake. Vasopressin and isoproterenol, which do not affect renal phosphate transport, did not inhibit phosphate uptake by the cell. These findings suggest that the cultured cell system may be a useful experimental model for studies of renal phosphate transport and its regulation.

Responses of chick renal cell to parathyroid hormone: effect of vitamin D

The in vitro incubation of chick renal cells with parathyroid hormone (PTH) resulted in the inhibition of Na+-dependent phosphate uptake when the cells were isolated from 1,25-dihydroxycholecalciferol 1,25-dihydroxycholecalciferol [1,25-(OH)2D3]-repleted chicks but not when the cells came from vitamin D-deficient animals. Na+-independent phosphate and Na+-dependent alpha-methylglucoside uptakes were not affected by PTH and the vitamin D status of the bird. The activation of chick renal cell adenylate cyclase by PTH was significantly blunted when the enzyme was from vitamin D-deficient animals relative to the activation of the enzyme from repleted cockerels. This alteration was due to a change in maximum velocity of the system rather than an effect on the affinity for hormone. The response of adenylate cyclase to other hormones, e.g., prostaglandin E2, and activators, e.g., 5' -guanylyl-imidodiphosphate and forskolin, was not affected by the vitamin D status of the animal. PTH had little effect in activating protein kinase in cells from vitamin D-deficient chicks. In cells from vitamin D-sufficient birds, PTH caused a fourfold increase in adenosine 3',5'-cyclic monophosphate (cAMP)-dependent protein kinase. Dibutyryl cAMP inhibited Na+-dependent phosphate uptake by cells from 1,25-(OH)2D3-repleted animals, but the cyclic nucleotide had no effect on phosphate uptake in cells from vitamin D-depleted chicks. This finding suggests that the loss of PTH receptor sites known to be concomitant with the secondary hyperparathyroidism associated with vitamin D deficiency is only a partial explanation for the failure of PTH to inhibit phosphate uptake in cells from vitamin D-deficient animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Metabolic requirement for inorganic phosphate by the rabbit proximal tubule

These studies examine the effects of acute changes in the availability of inorganic phosphate on the function of isolated proximal renal tubules from rabbit kidney. We removed phosphate from the extracellular fluids and measured fluid absorption rates in isolated perfused tubules and oxygen consumption rates in suspensions of cortical tubules. In proximal convoluted tubules, the selective removal of phosphate from the luminal fluid reduced fluid absorption rates from 1.11+/-0.12 to -0.01+/-0.08 nl/mm . min. This effect on fluid absorption was dependent on the presence of glucose transport and metabolism. The addition of phlorizin to the phosphate-free luminal fluid preserved fluid absorption rates (1.12+/-0.12 nl/mm . min) as did the substitution of nonmetabolized alpha-methyl d-glucopyranoside for glucose (1.05+/-0.21 nl/mm . min) or the addition of 2-deoxyglucose, an inhibitor of glycolysis, to the bathing medium (1.01+/-0.15 nl/mm . min). There was no effect on fluid absorption if phosphate was removed from the bath only. Additionally, removal of phosphate from the luminal fluid of proximal straight rather than convoluted tubules had no effect on fluid absorption rates. Oxygen consumption rates in suspensions of cortical tubules were reduced from 18.9+/-0.6 to 10.6+/-0.6 nmol O(2)/mg tubular protein . min by the removal of phosphate from the medium. This inhibition was prevented by the substitution of alpha-methyl d-glucopyranoside for glucose in the phosphate-free medium. The data indicate that under certain conditions, proximal convoluted tubules require the presence of phosphate in the luminal fluid to preserve tubular function. In the absence of intraluminal phosphate, glucose metabolism causes a reduction in both oxidative metabolism and fluid absorption. This response is analogous to the Crabtree effect and suggests limitations on the intracellular availability of inorganic phosphate.

In vitro stimulation of phosphate uptake in isolated chick renal cells by 1,25-dihydroxycholecalciferol

Renal cells isolated from vitamin D-deficient chicks had an increased Na+-dependent phosphate uptake when preincubated with 1,25-dihydroxycholecalciferol [1,25-(OH)2D3]. Phosphate uptake in the absence of Na+ and methyl alpha-glucoside uptake dependent on Na+ were not affected. Phosphate uptake was stimulated 15% by 0.010 pM 1,25-(OH)2D3. Maximal enhancement of 30% was obtained with 100 pM. The uptake when fully stimulated by preincubation in vitro approximated the uptake of cells isolated from chicks that were previously repleted with 1,25-(OH)2D3 in vivo. Cells from repleted chicks were not stimulated additionally when preincubated with 1,25-(OH)2D3 in vitro. The increase in phosphate uptake could be measured after a 1-hr preincubation period; full response required at least 2 hr. Phosphate uptake induced by 1,25-(OH)2D3 was blocked by cycloheximide and actinomycin D. Enhancement of phosphate uptake was relatively specific for the 1,25-(OH)2D3 analog of vitamin D3. The potency order was 1,25-(OH)2D3 greater than 25-(OH)D3 = 1-(OH)D3 greater than 24,25-(OH)2D3 greater than D3. Kinetically, 1,25-(OH)2D3 increased the Vmax of the phosphate uptake system; the affinity for phosphate was unaffected. 3H-Labeled 1,25-(OH)2D3 was taken up by the isolated renal cells. It was estimated that the stimulation of phosphate uptake might be initiated by very few molecules of 1,25-(OH)2D3 per cell. It is proposed that 1,25-(OH)2D3 contributes importantly to the mechanisms by which phosphate transport is regulated in the kidney.

Effects of 1,25-(OH)2D3 administered in vivo on phosphate uptake by isolated chick renal cells

Renal cells from Vitamin D-deficient and 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3]-repleted chicks were isolated by a collagenase-hyaluronidase procedure. Exclusion of trypan blue and respiratory measurements indicate that the cells were functionally intact and metabolically active. The uptakes of phosphate and alpha-methylglucoside were stimulated markedly by Na+ in the extracellular medium. Phosphate uptake in the presence of Na+ was saturable with respect to phosphate concentration; half-maximal activity was obtained with approximately 0.2 mM. Three hours after 1,25-(OH)2D3 was injected into vitamin D-deficient chicks the Na+-dependent phosphate uptake by the isolated cells had increased about 40%, i.e., 2.00 compared with 1.44 nmol.min-1.mg protein-1. Phosphate uptake in the presence of K+ in the extracellular medium and alpha-methylglucoside uptake in the presence or absence of Na+ were unchanged. In a secondary response found 17 h after 1,25-(OH)2D3 injection, Na+-dependent phosphate uptake decreased. Serum concentrations of phosphorus and calcium were not measurably changed in the 3-h repleted bird, but both levels were increased 17 h after treatment. Administration of phosphate into vitamin D-deficient chicks, so that the serum concentration of phosphorus was raised to that of the 17-h 1,25-(OH)2D3 repleted animal, effected a comparable decrease in phosphate uptake. Serum calcium levels were not altered by this treatment. The actions of parathyroid hormone in stimulating adenylate cyclase and in inhibiting phosphate uptake were notably blunted in the vitamin D-deficient chick. Sensitivity to parathyroid hormone was not restored until several days after 1,25-(OH)2D3 repletion. These findings suggest that the initial response to 1,25-(OH)2D3, to increase renal phosphate uptake, and the secondary response, to decrease phosphate uptake, were by parathyroid hormone-independent processes. The results also indicate that the isolated renal cell represents an excellent model for studying the mechanism by which 1,25-(OH)2D3 regulates phosphate transport in the kidney.

Acid-base maneuvers and phosphate transport in the isolated rat kidney

The influence of bicarbonate (HCO3-), the carbon dioxide tension (PCO2), and pH on phosphate (Pi) excretion were assessed in isolated rat kidneys, perfused in vitro with recirculating synthetic solutions. After establishing control values, the perfusate HCO3- or PCO2 was altered separately. When the perfusate pH was decreased, either by increasing PCO2 or decreasing HCO3-, the absolute and fractional Pi excretions increased. Perfusate alkalinization by slightly decreasing the PCO2 did not affect Pi excretion, but increasing the perfusate pH with addition of HCO3- elicited phosphaturia. Other kidneys were perfused with a solution from which the CO2/HCO3- buffer system was nominally absent. Alkalinization of HCO3--free perfusate had no effect upon Pi excretion, but acidification resulted in marked phosphaturia. Perfusate acidification, whether achieved by decreasing HCO3-, increasing PCO2, or by adding hydrogen ions, uniformly elicited phosphaturia. The data indicate that either decreasing the extracellular pH or increasing the extracellular HCO3- inhibits renal Pi reabsorption.

Influence of peritubular protein on solute absorption in the rabbit proximal tubule. A specific effect on NaCl transport

The effect of removal of peritubular protein on the reabsorption of various solutes and water was examined in isolated rabbit proximal convoluted tubules (PCT) perfused in vitro. In 22 PCT perfused with ultrafiltrate (UF) and bathed in serum, volume absorption (Jv) was 1.44 nl/mm per min and potential difference (PD) was -3.6 mV. When these same PCT were bathed in a protein-free UF, Jv was reduced 38% without a change in PD. Simultaneous measurements of total CO2 net flux (JTCO2) and glucose efflux (JG) showed that less than 2% of the decrease in JV could be accounted for by a reduction in JTCO2 and JG, suggesting that removal of peritubular protein inhibited sodium chloride transport (JNaCl). Therefore, in eight additional PCT, JNaCl was measured, in addition to PD, Jv, JG, and JTCO2. In these PCT, the decrease in total solute transport induced by removal of bath protein was 201.7 +/- 37.5 posmol/mm per min. JG decreased slightly (9.1 +/- 3.9 posmol/mm per min); NaHCO3 transport did not change (9.2 +/- 6.6 posmol/mm per min); but JNaCl decreased markedly (160.6 +/- 35.7 posmol/mm per min). 80% of the decrease in Jv could be accounted for by a decrease in JNaCl. In 13 additional PCT perfused with simple NaCl solutions, a comparable decrease in Jv and JNaCl was observed when peritubular protein was removed without an increase in TCO2 backleak. In summary, removal of peritubular protein reduced Jv and JNacl, but did not significantly alter PD, JG, JTCO2, or TCO2 backleak. The failure to inhibit JG and JTCO2, known sodium-coupled transport processes, indicates that protein removal does not primarily affect the Na-K ATPase pump system. Furthermore, since PD and TCO2 backleak were not influenced, it is unlikely that protein removal increased the permeability of the paracellular pathway. We conclude that protein removal specifically inhibits active transcellular or passive paracellular NaCl transport.

Inhibition of Renal Metabolism. Relative effects of arsenate on sodium, phosphate, and glucose transport by the rabbit proximal tubule

These studies examine the inhibitory effects of arsenate on the transport of sodium, phosphate, glucose, and para-aminohippurate (PAH) as well as oxidative metabolism by proximal convoluted tubules from the rabbit kidney. Transport rates were measured with radioisotopes in isolated and perfused segments. Metabolic activity was monitored through oxygen-consumption rates and HADH fluorescence in parallel studies in suspensions of cortical tubules. The addition of 1mM arsenate to the perfusate reduced fluid absorption rates from 1.24 +/- 0.17 to 0.66 +/- 0.19 nl/nm.min (P < 0.01) and lumen-to-bath phosphate transport from 9.93 +/- 3.47 to 4.25 +/- 1.08 pmol/mm.min (P < 0.01). Similar concentrations of arsenate reduced glucose transport only slightly from 66.1 +/- 6.0 to 56.8 +/-4 4.6 pmol/mm.min (P < 0.05) and had no effect of PAH secretion. Removing phosphate from the perfusate did not affect the net transport of sodium or glucose. In suspensions of tubules, arsenate increased oxygen consumption rates by 20.5 +/- 2.9% and decreased NADH fluorescence by 10.8 +/- 1.5%. These effects on metabolism were concentration dependent and magnified in the presence of ouabain. The data indicate that arsenate's main effect is to uncouple oxidative phosphorylation, and that graded uncoupling of oxidative metabolism causes graded reductions in the net transport of both sodium and phosphate. Glucose transport is inhibited only slightly and PAH secretion is not affected. Thus, partial as opposed to complete inhibition of metabolism reveals that different relationships exist between net sodium transport and the transport of phosphate, glucose, and PAH by the proximal renal tubule.

A new hypothesis for alloxan diabetes

A new hypothesis ("Pi-pH hypothesis") for alloxan diabetes is presented. It is based upon data from our own studies and from the literature. The following data and interpreatations are assumed to be of special importance for the B-cytotoxicity of alloxan: Inhibition of a mitochondrial sulfhydryl dependent transport system for inorganic phosphate (Pi) leading to increased concentration of Pi and decreased pH in the cytosol, and to inhibition of NAD-dependent oxidations and oxidative phosphorylation; mitochondrial lesion because of altered localization and concentration of Pi; inhibited synthesis and glucose induced release of insulin, at least partly due to a fall in intracellular pH; and finally necrosis because of absent mitochondrial function. An inverse relationship between Pi and pH may exist in the B-cells; alloxan sensitivity being associated with high Pi and low pH. Alloxan antagonism may be due to induction of low Pi and high pH in the cytosol. The selectivity of the B-cell for alloxan is believed to be associated with its free permeability for glucose.

Phosphate transport in isolated and perfused renal tubules

In summary, studies of phosphate transport by isolated renal tubules perfused in vitro confirm many of the data obtained by other techniques with regard to localization. The major contributions of the technique revolve around studies of segments not accessible to micropuncture techniques and around studies of epithelial transport processes that are difficult to examine in vivo.

The control of phosphate uptake by the isolated renal tubule

An in vitro isolated tubular model is presented which appears to have many characteristics of an active transport system in that Pi accumulation by the preparation is sodium- and temperature-dependent, stimulated by PTH and cAMP and is also conditioned by the metabolic integrity of the tissue. The relationship between the observations made in the dispersed convolutal tubule preparation in the present study and the mechanisms by which PTH affects phosphate transport in isolated perfused tubules and in vivo has not yet been ascertained.

The influence of D-glucose of phosphate absorption in the rat proximal tubule

The present studies demonstrate that a tubular maximum for phosphate absorption is present in the proximal tubule in the rat. In addition, the presence of D-glucose in the solution on the luminal side of the renal tubular cells inhibits phosphate absorption. The effect of D-glucose on phosphate absorption requires the tubular absorption of D-glucose and does not appear to be due to an interaction between glucose and phosphate at the luminal surface of the renal tubular cells.

Phosphate transport by rat renal brush border membrane vesicles: influence of dietary phosphate, thyroparathyroidectomy, and 1,25-dihydroxyvitamin D3

In the present work we have investigated whether the changes in the renal handling of inorganic phosphate (Pi) induced by 1) dietary Pi, 2) removal of parathyroid glands and 3, 1,25-dihydroxyvitamin D3 [1,25(OH)2D3], are associated with alterations in the Na-dependent Pi uptake by brush border membrane vesicles (BBMV) isolated from renal cortex. Sham-operated (SHAM) or thyroparathyroidectomized (TPTX) rats treated or not with 26 pmol/day of 1,25(OH)2D3 i.p. were fed low (0.2%) or high (1.2%) P diet for 7 days. The results showed that in SHAM, TPTX and TPTX+1,25(OH)2D3 the Pi uptake by BBMV was greater after low than high Pi diet. It was greater in TPTX than in SHAM counterparts fed either diets. In TPTX fed low or high Pi diet 1,25(OH)2D3 decreased the Pi uptake to the level observed in SHAM. A striking parallelism was found between variations in Pi uptake by BBMV and in the tubular Pi reabsorption of the whole kidney. The Na-dependent glucose, the mannitol uptake by BBMV, and the alkaline phosphatase activity in cortical homogenates and BBMV were not affected by the various treatments. Thus, dietary Pi, chronic TPTX and 1,25(OH)2D3 appear to specifically affect the Na-dependent Pi transport system bound to the brush border membranes of renal cortical tubules. The alterations observed at this membrane level could account, at least in part, for the changes induced by these factors on the overall tubular reabsorption of Pi.