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McLarnon SR, Johnson C, Sun J, Wei Q, Csanyi G, O'Herron P, Marshall B, Giddens P, Sullivan JC, Barrett A, O'Connor PM. Extravasation of Blood and Blood Toxicity Drives Tubular Injury from RBC Trapping in Ischemic AKI. FUNCTION 2023; 4:zqad050. [PMID: 37753180 PMCID: PMC10519276 DOI: 10.1093/function/zqad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/04/2023] [Accepted: 08/24/2023] [Indexed: 09/28/2023] Open
Abstract
Red blood cell (RBC) trapping is common in ischemic acute kidney injury (AKI) and presents as densely packed RBCs that accumulate within and engorge the kidney medullary circulation. In this study, we tested the hypothesis that "RBC trapping directly promotes tubular injury independent of extending ischemia time." Studies were performed on rats. Red blood cell congestion and tubular injury were compared between renal arterial clamping, venous clamping, and venous clamping of blood-free kidneys. Vessels were occluded for either 15 or 45 min with and without reperfusion. We found that RBC trapping in the medullary capillaries occurred rapidly following reperfusion from renal arterial clamping and that this was associated with extravasation of blood from congested vessels, uptake of blood proteins by the tubules, and marked tubular injury. To determine if this injury was due to blood toxicity or an extension of ischemia time, we compared renal venous and arterial clamping without reperfusion. Venous clamping resulted in RBC trapping and marked tubular injury within 45 min of ischemia. Conversely, despite the same ischemia time, RBC trapping and tubular injury were minimal following arterial clamping without reperfusion. Confirming the role of blood toward tubular injury, injury was markedly reduced in blood-free kidneys with venous clamping. Our data demonstrate that RBC trapping results in the rapid extravasation and uptake of blood components by tubular cells, causing toxic tubular injury. Tubular toxicity from extravasation of blood following RBC trapping appears to be a major component of tubular injury in ischemic AKI, which has not previously been recognized.
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Affiliation(s)
- Sarah R McLarnon
- Department of Physiology, Medical College of Georgia, Augusta University, 30912, Augusta, GA, USA
- Department of Cell Biology and Physiology, School of Medicine, University of North Carolina, 27599, Chapel Hill, NC, USA
| | - Chloe Johnson
- Department of Physiology, Medical College of Georgia, Augusta University, 30912, Augusta, GA, USA
| | - Jingping Sun
- Department of Physiology, Medical College of Georgia, Augusta University, 30912, Augusta, GA, USA
| | - Qingqing Wei
- Department of Anatomy and Cell Biology, Medical College of Georgia, Augusta University, 30912, Augusta, GA, USA
| | - Gabor Csanyi
- Department of Pharmacology and Toxicology, Augusta University, 30912, Augusta, GA, USA
| | - Phillip O'Herron
- Department of Physiology, Medical College of Georgia, Augusta University, 30912, Augusta, GA, USA
| | - Brendan Marshall
- Department of Anatomy and Cell Biology, Medical College of Georgia, Augusta University, 30912, Augusta, GA, USA
| | - Priya Giddens
- Department of Physiology, Medical College of Georgia, Augusta University, 30912, Augusta, GA, USA
| | - Jennifer C Sullivan
- Department of Physiology, Medical College of Georgia, Augusta University, 30912, Augusta, GA, USA
| | - Amanda Barrett
- Department of Pathology, Medical College of Georgia, Augusta University, 30912, Augusta, GA, USA
| | - Paul M O'Connor
- Department of Physiology, Medical College of Georgia, Augusta University, 30912, Augusta, GA, USA
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McLarnon SC, Johnson C, Giddens P, O'Connor PM. Hidden in Plain Sight: Does Medullary Red Blood Cell Congestion Provide the Explanation for Ischemic Acute Kidney Injury? Semin Nephrol 2022; 42:151280. [PMID: 36460572 DOI: 10.1016/j.semnephrol.2022.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acute kidney injury (AKI) represents a sudden reduction in renal function and is a major clinical problem with a high mortality rate. Despite decades of research, there are currently no direct therapies for AKI. The failure of therapeutic approaches identified in rodents to translate to human beings has led to questions regarding the appropriateness of these models. Our recent data indicate that there are two distinct processes driving tubular injury in the commonly used rat model of warm bilateral renal ischemia reperfusion injury, which often is used to mimic ischemic AKI. One results from the period of warm ischemia, manifesting as sublethal injury and coagulative necrosis of the proximal tubules in the renal cortex. This is the predominate type of injury observed 24 hours after reperfusion and the most well studied. The other results from red blood cell congestion of the outer medullary vasculature. This type of injury manifests as cell sloughing, along with the later formation of heme casts that fill distal nephron segments. Cell sloughing from congestion is most prominent in the early hours after reperfusion and often is masked by regeneration of the tubular epithelium by 24 hours postischemia. In this review, we argue that injury from outer medullary red blood cell congestion reflects the pathology observed in human kidneys and likely is representative of injury in most cases of ischemic AKI after shock. Greater focus on this congestive injury is likely to lead to improved translation in AKI.
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Affiliation(s)
- Sarah C McLarnon
- Department of Cell Biology and Physiology, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Chloe Johnson
- Department of Physiology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Priya Giddens
- Department of Physiology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Paul M O'Connor
- Department of Physiology, Medical College of Georgia, Augusta University, Augusta, Georgia.
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McLarnon SR, Wilson K, Patel B, Sun J, Sartain CL, Mejias CD, Musall JB, Sullivan JC, Wei Q, Chen JK, Hyndman KA, Marshall B, Yang H, Fogo AB, O’Connor PM. Lipopolysaccharide Pretreatment Prevents Medullary Vascular Congestion following Renal Ischemia by Limiting Early Reperfusion of the Medullary Circulation. J Am Soc Nephrol 2022; 33:769-785. [PMID: 35115326 PMCID: PMC8970460 DOI: 10.1681/asn.2021081089] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/16/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Vascular congestion of the renal medulla-trapped red blood cells in the medullary microvasculature-is a hallmark finding at autopsy in patients with ischemic acute tubular necrosis. Despite this, the pathogenesis of vascular congestion is not well defined. METHODS In this study, to investigate the pathogenesis of vascular congestion and its role in promoting renal injury, we assessed renal vascular congestion and tubular injury after ischemia reperfusion in rats pretreated with low-dose LPS or saline (control). We used laser Doppler flowmetry to determine whether pretreatment with low-dose LPS prevented vascular congestion by altering renal hemodynamics during reperfusion. RESULTS We found that vascular congestion originated during the ischemic period in the renal venous circulation. In control animals, the return of blood flow was followed by the development of congestion in the capillary plexus of the outer medulla and severe tubular injury early in reperfusion. Laser Doppler flowmetry indicated that blood flow returned rapidly to the medulla, several minutes before recovery of full cortical perfusion. In contrast, LPS pretreatment prevented both the formation of medullary congestion and its associated tubular injury. Laser Doppler flowmetry in LPS-pretreated rats suggested that limiting early reperfusion of the medulla facilitated this protective effect, because it allowed cortical perfusion to recover and clear congestion from the large cortical veins, which also drain the medulla. CONCLUSIONS Blockage of the renal venous vessels and a mismatch in the timing of cortical and medullary reperfusion results in congestion of the outer medulla's capillary plexus and promotes early tubular injury after renal ischemia. These findings indicate that hemodynamics during reperfusion contribute to the renal medulla's susceptibility to ischemic injury.
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Affiliation(s)
- Sarah R. McLarnon
- Department of Physiology, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Katie Wilson
- Department of Physiology, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Bansari Patel
- Department of Physiology, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Jingping Sun
- Department of Physiology, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Christina L. Sartain
- Department of Physiology, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Christopher D. Mejias
- Department of Physiology, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Jacqueline B. Musall
- Department of Physiology, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Jennifer C. Sullivan
- Department of Physiology, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Qingqing Wei
- Department of Cell Biology and Anatomy, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Jian-Kang Chen
- Department of Cell Biology and Anatomy, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Kelly A. Hyndman
- Cardio-Renal Physiology and Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brendan Marshall
- Department of Cell Biology and Anatomy, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Haichun Yang
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Agnes B. Fogo
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Paul M. O’Connor
- Department of Physiology, Medical College of Georgia at Augusta University, Augusta, Georgia
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Bo CRD, de Paula VP, Strazzi APWB, Wolosker N, Aloia TPA, Mazzeo A, Kaufmann OG. Effect of unilateral renal ischemia on the contralateral kidney assessed by Caspase 3 expression. J Vasc Bras 2021; 20:e20210040. [PMID: 34349794 PMCID: PMC8294808 DOI: 10.1590/1677-5449.210040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/14/2021] [Indexed: 11/22/2022] Open
Abstract
Background Studies have demonstrated with histological analysis and Doppler flow measurement analysis that unilateral renal ischemia, which is performed in some surgeries, interfered with the contralateral kidney, identifying the phenomenon of kidney-kidney crosstalk. Objectives To identify the effects on the ischemic and contralateral kidney of renal ischemia induced by two types of clamping technique by analyzing the volume of kidney cells positive for Caspase 3. Methods Sixteen pigs were divided into 2 groups, as follows: A (n = 8) – clamping of left renal artery only and AV (n = 8) – clamping of left renal artery and vein. Immunohistochemical analyses (anti Caspase 3) were conducted with biopsy specimens collected from the ischemic and contralateral kidney at 0, 30, 60, and 90 minutes of ischemia and morphometric analysis was performed, taking the mean to represent the volume of the Caspase 3 positive area (%). Results Morphometric analysis of specimens collected at 30, 60, and 90 minutes of ischemia showed that the mean area marked for Caspase 3 was statistically larger in the contralateral kidney than the ischemic kidney in both groups: clamped renal artery (A) and clamped renal artery and vein (AV). Comparing the ischemic and contralateral kidney, there was no statistically significant difference in the area marked for Caspase 3 between the two types of clamping. Conclusions In the experimental model of unilateral renal ischemia, the non-ischemic kidney exhibited cell damage, demonstrated by Caspase 3 expression. The type of hilum clamping does not appear to influence the area marked for Caspase 3.
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Affiliation(s)
- Carolina Rodrigues Dal Bo
- Faculdade Israelita de Ciências da Saúde Albert Einstein - FICSAE, São Paulo, SP, Brasil.,Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, Brasil
| | - Vitória Penido de Paula
- Faculdade Israelita de Ciências da Saúde Albert Einstein - FICSAE, São Paulo, SP, Brasil.,Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, Brasil
| | | | - Nelson Wolosker
- Faculdade Israelita de Ciências da Saúde Albert Einstein - FICSAE, São Paulo, SP, Brasil.,Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, Brasil.,Faculdade de Medicina da Universidade de São Paulo - USP, São Paulo, SP, Brasil
| | - Thiago Pinheiro Arrais Aloia
- Instituto de Ensino e Pesquisa - IIEP, Hospital Albert Einstein, São Paulo, SP, Brasil.,Faculdade de Medicina da Universidade de São Paulo - USP, São Paulo, SP, Brasil
| | - Angela Mazzeo
- Instituto de Ensino e Pesquisa - IIEP, Hospital Albert Einstein, São Paulo, SP, Brasil
| | - Oskar Grau Kaufmann
- Instituto de Ensino e Pesquisa - IIEP, Hospital Albert Einstein, São Paulo, SP, Brasil.,Faculdade de Medicina da Universidade de São Paulo - USP, São Paulo, SP, Brasil
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Rezk AM, Ibrahim IAAEH, Mahmoud MF, Mahmoud AAA. Quercetin and lithium chloride potentiate the protective effects of carvedilol against renal ischemia-reperfusion injury in high-fructose, high-fat diet-fed Swiss albino mice independent of renal lipid signaling. Chem Biol Interact 2020; 333:109307. [PMID: 33159969 DOI: 10.1016/j.cbi.2020.109307] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/12/2020] [Accepted: 10/28/2020] [Indexed: 12/19/2022]
Abstract
Renal ischemia-reperfusion injury (R-IRI) is the main cause of acute renal failure. Carvedilol has been shown to protect against R-IRI. However, the underlying mechanisms are still not completely clarified. This study aimed to investigate the role of lipid signaling in mediating carvedilol protective effects against R-IRI in insulin-resistant mice by using two different lipid signaling modulators, quercetin and lithium chloride (LiCl). Mice were fed high-fructose, high-fat diet (HFrHFD) for 16 weeks to induce insulin resistance. At the end of feeding period, mice were randomly distributed into five groups; Sham, R-IRI, Carvedilol (20 mg/kg, i.p.), Carvedilol + Quercetin (10 mg/kg, i.p.), Carvedilol + LiCl (200 mg/kg, i.p.). R-IRI was performed by applying 30 min of unilateral renal ischemia followed by one hour of reperfusion. Quercetin and LiCl were administered 30 min before carvedilol administration and carvedilol was administered 30 min before ischemia. Changes in kidney function tests, histopathology, fibrosis area, lipid signaling, inflammatory, apoptosis and oxidative stress markers in the kidney were measured. Results showed that R-IRI decreased kidney function, impaired renal tissue integrity, modulated lipid signaling and increased renal inflammation, apoptosis and oxidative stress. Carvedilol treatment decreased the detrimental effects induced by R-IRI. In addition, pre-injection of both quercetin and LiCl potentiated the reno-protective effects of carvedilol against R-IRI independent of changes in lipid mediators like phosphatidyl inositol 4,5 bisphosphate (PIP2) and diacylglycerol (DAG). In conclusion, quercetin and LiCl potentiate the protective effects of carvedilol against R-IRI in HFrHFD-fed mice by reducing inflammation and oxidative stress independent of lipid signaling.
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Affiliation(s)
- Asmaa M Rezk
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zagazig University, Zagazig, 44519, Egypt; Department of Pharmacies, Benha University Hospitals, Benha, Egypt
| | - Islam A A E-H Ibrahim
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zagazig University, Zagazig, 44519, Egypt.
| | - Mona F Mahmoud
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zagazig University, Zagazig, 44519, Egypt
| | - Amr A A Mahmoud
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zagazig University, Zagazig, 44519, Egypt
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Favorito LA. Editorial Comment: Study of kidney morphologic and structural changes related to different ischemia times and types of clamping of the renal vascular pedicle. Int Braz J Urol 2019; 45:763-764. [PMID: 31397989 PMCID: PMC6837593 DOI: 10.1590/s1677-5538.ibju.2018.0559.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Luciano A. Favorito
- Univ. Est. do Rio de Janeiro, Brasil; Hospital da Lagoa Federal, Brasil; International Braz J Urol, Brasil
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