1
|
Souza CC, Rigueto LG, Santiago HC, Seguro AC, Girardi AC, Luchi WM. Multiple electrolyte disorders triggered by proton pump inhibitor-induced hypomagnesemia: Case reports with a mini-review of the literature. Clin Nephrol Case Stud 2024; 12:6-11. [PMID: 38222324 PMCID: PMC10783169 DOI: 10.5414/cncs111284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/11/2023] [Indexed: 01/16/2024] Open
Abstract
Drug-induced hypomagnesemia is an adverse effect with the potential for serious and fatal outcomes. Although rare, chronic use of proton pump inhibitors (PPIs) can cause hypomagnesemia due to impaired intestinal absorption, mainly attributed to reduced transcellular transport of magnesium via transient receptor potential melastatin 6 (TRPM6) and 7 (TRPM7) channels. However, a reduction of magnesium paracellular absorption due to the downregulation of intestinal claudins has also been reported. PPI-induced hypomagnesemia can trigger other concomitant electrolyte derangements, including hypokalemia, hypocalcemia, hypophosphatemia, and hyponatremia. Here we report two cases of multiple electrolyte disorders associated with PPI-induced hypomagnesemia, the clinical manifestations of which were cardiac arrhythmia, cognitive changes, and seizure crisis. These cases illustrate the need to monitor serum magnesium levels in patients on long-term PPI use, especially in the elderly and those with malabsorptive bowel syndromes or taking loop diuretics and thiazides.
Collapse
Affiliation(s)
- Camila Costa Souza
- Hospital Universitário Cassiano Antonio Moraes, Universidade Federal do Espírito Santo (HUCAM-UFES), Vitória, ES
| | - Larissa G. Rigueto
- Hospital Universitário Cassiano Antonio Moraes, Universidade Federal do Espírito Santo (HUCAM-UFES), Vitória, ES
| | - Henrique Costa Santiago
- Hospital Universitário Cassiano Antonio Moraes, Universidade Federal do Espírito Santo (HUCAM-UFES), Vitória, ES
| | | | - Adriana Castello Girardi
- Laboratorio de Genetica e Cardiologia Molecular, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
| | - Weverton Machado Luchi
- Hospital Universitário Cassiano Antonio Moraes, Universidade Federal do Espírito Santo (HUCAM-UFES), Vitória, ES
| |
Collapse
|
2
|
Longobardi I, Gualano B, Seguro AC, Roschel H. Is It Time for a Requiem for Creatine Supplementation-Induced Kidney Failure? A Narrative Review. Nutrients 2023; 15:nu15061466. [PMID: 36986197 PMCID: PMC10054094 DOI: 10.3390/nu15061466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/22/2023] Open
Abstract
Creatine has become one of the most popular dietary supplements among a wide range of healthy and clinical populations. However, its potential adverse effects on kidney health are still a matter of concern. This is a narrative review of the effects of creatine supplementation on kidney function. Despite a few case reports and animal studies suggesting that creatine may impair kidney function, clinical trials with controlled designs do not support this claim. Creatine supplementation may increase serum creatinine (Crn) concentration for some individuals, but it does not necessarily indicate kidney dysfunction, as creatine is spontaneously converted into Crn. Based on studies assessing kidney function using reliable methods, creatine supplements have been shown to be safe for human consumption. Further studies with people who have pre-existing kidney disease remain necessary.
Collapse
Affiliation(s)
- Igor Longobardi
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, School of Medicine, University of Sao Paulo, Sao Paulo 01246-903, SP, Brazil; (I.L.); (B.G.)
| | - Bruno Gualano
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, School of Medicine, University of Sao Paulo, Sao Paulo 01246-903, SP, Brazil; (I.L.); (B.G.)
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 01246-903, SP, Brazil
| | - Antonio Carlos Seguro
- Nephrology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 01246-903, SP, Brazil;
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, School of Medicine, University of Sao Paulo, Sao Paulo 01246-903, SP, Brazil; (I.L.); (B.G.)
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 01246-903, SP, Brazil
- Correspondence: ; Tel.: +55-11-3061-8789
| |
Collapse
|
3
|
Bernardo DRD, Canale D, Nascimento MM, Shimizu MHM, Seguro AC, de Bragança AC, Volpini RA. The association between obesity and vitamin D deficiency modifies the progression of kidney disease after ischemia/reperfusion injury. Front Nutr 2022; 9:952028. [DOI: 10.3389/fnut.2022.952028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/13/2022] [Indexed: 11/18/2022] Open
Abstract
Acute kidney injury (AKI) alters renal hemodynamics, leading to tubular injury, activating pathways of inflammation, proliferation, and cell death. The initial damage caused to renal tissue after an ischemia/reperfusion (I/R) injury exerts an important role in the pathogenesis of the course of AKI, as well as in the predisposition to chronic kidney disease. Vitamin D deficiency has been considered a risk factor for kidney disease and it is associated with tubulointerstitial damage, contributing to the progression of kidney disease. Obesity is directly related to diabetes mellitus and hypertension, the main metabolic disorders responsible for the progression of kidney disease. Furthermore, the expansion of adipose tissue is described as an important factor for increased secretion of pro-inflammatory cytokines and their respective influence on the progression of kidney disease. We aimed to investigate the influence of vitamin D deficiency and obesity on the progression of renal disease in a murine model of renal I/R. Male Wistar rats underwent renal I/R surgery on day 45 and followed until day 90 of the protocol. We allocated the animals to four groups according to each diet received: standard (SD), vitamin D-depleted (VDD), high fat (HFD), or high fat vitamin D-depleted (HFDV). At the end of 90 days, we observed almost undetectable levels of vitamin D in the VDD and HFDV groups. In addition, HFD and HFDV groups presented alterations in the anthropometric and metabolic profile. The combination of vitamin D deficiency and obesity contributed to alterations of functional and hemodynamic parameters observed in the HFDV group. Moreover, this combination favored the exacerbation of the inflammatory process and the renal expression of extracellular matrix proteins and phenotypic alteration markers, resulting in an enlargement of the tubulointerstitial compartment. All these changes were associated with an increased renal expression of transforming growth factor β and reduced expression of the vitamin D receptor. Our results show that the synergistic effect of obesity and vitamin D deficiency exacerbated the hemodynamic and morphological changes present in the evolution of renal disease induced by I/R.
Collapse
|
4
|
Gonçalves LS, Natali J, Shimizu MHM, Sales LP, Saito T, Fernandes AL, Gualano B, Seguro AC, Artioli GG. Impaired Kidney Functional In Histidine Dipeptide Depleted Animals. An Exploratory Study With Carns1 Knockout Rats. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000882928.30841.9a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
5
|
Nascimento MM, Bernardo DRD, de Bragança AC, Massola Shimizu MH, Seguro AC, Volpini RA, Canale D. Treatment with β-blocker nebivolol ameliorates oxidative stress and endothelial dysfunction in tenofovir-induced nephrotoxicity in rats. Front Med (Lausanne) 2022; 9:953749. [PMID: 35991671 PMCID: PMC9386005 DOI: 10.3389/fmed.2022.953749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Tenofovir disoproxil fumarate (TDF), a widely prescribed component in antiretroviral regimens, has been associated with nephrotoxicity. Nebivolol is a third generation selective β-1 adrenergic receptor blocker and may protect renal structure and function through the suppression of oxidative stress and enhancement of nitric oxide (NO) synthesis. We aimed to investigate whether nebivolol could be an effective therapeutic strategy to mitigate tenofovir-induced nephrotoxicity. Methods We allocated Wistar rats to four groups: control (C), received a standard diet for 30 days; NBV, received a standard diet for 30 days added with nebivolol (100 mg/kg food) in the last 15 days; TDF, received a standard diet added with tenofovir (300 mg/kg food) for 30 days; and TDF+NBV, received a standard diet added with tenofovir for 30 days and nebivolol in the last 15 days. Results Long-term exposure to tenofovir led to impaired renal function, induced hypertension, endothelial dysfunction and oxidative stress. Nebivolol treatment partially recovered glomerular filtration rate, improved renal injury, normalized blood pressure and attenuated renal vasoconstriction. Administration of nebivolol contributed to reductions in asymmetric dimethylarginine (ADMA) levels as well as increases in endothelial nitric oxide sintase (eNOS) accompanied by renin-angiotensin-aldosterone system downregulation and decreases in macrophage and T-cells infiltrate. Furthermore, nebivolol was responsible for the maintenance of the adequate balance of thiobarbituric acid reactive substances (TBARS) and glutathione (GSH) levels and it was associated with reductions in NADPH oxidase (NOX) subunits. Conclusion Nebivolol holds multifaceted actions that promote an advantageous option to slow the progression of kidney injury in tenofovir-induced nephrotoxicity.
Collapse
Affiliation(s)
- Mariana Moura Nascimento
- Laboratorio de Investigacao Medica 12 (LIM12), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Ana Carolina de Bragança
- Laboratorio de Investigacao Medica 12 (LIM12), Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | | | - Antonio Carlos Seguro
- Laboratorio de Investigacao Medica 12 (LIM12), Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Rildo Aparecido Volpini
- Laboratorio de Investigacao Medica 12 (LIM12), Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Daniele Canale
- Laboratorio de Investigacao Medica 12 (LIM12), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- *Correspondence: Daniele Canale
| |
Collapse
|
6
|
Bernardo D, Carolina de Braganca A, Heloisa Massola Shimizu M, Carlos Seguro A, Moura Nascimento M, Canale D, Aparecido Volpini R. MO417: Obesity Associated With Vitamin D Deficiency Impairs Renal Function, Haemodynamics, Metabolic Parameters And Aggravates the Renal Morphological Damage in Rats Submitted To Ischaemia-Reperfusion Injury. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac070.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Acute kidney injury (AKI) alters renal haemodynamics, leads to tubular injury, activates pathways of inflammation, proliferation and cell death. The initial damage caused by ischaemia/reperfusion injury (IRI) plays an important role in the pathogenesis of the AKI and predisposition to chronic kidney disease (CKD). Vitamin D deficiency has been considered a risk factor for kidney disease and is associated with haemodynamic changes and tubulointerstitial damage. Obesity is directly related to diabetes mellitus (DM) and hypertension, the main metabolic disorders responsible for the progression to end-stage kidney disease. In addition, studies have been showing that adipose tissue expansion can increase the secretion of pro-inflammatory cytokines and its possible influence on the course of CKD. Thus, we evaluated the influence of both obesity and vitamin D deficiency risk factors on renal disease progression in a murine model of renal IRI.
METHOD
We followed Male wistar rats during a 90-day protocol. On day 45, we submitted all rats to bilateral 45 min IRI surgery. We shared the animals into four groups: i) Standard (S)—fed a standard diet for 90 days; ii) Vitamin D Deficient (VDD)—fed a vitamin D-free diet for 90 days; iii) High-fat (H)—fed a high-fat diet for 90 days; and iv) High-fat vitamin D deficient (H + VDD)—fed a high-fat vitamin D-free diet for 90 days. We evaluated insulin clearance (Cin); mean arterial pressure (MAP); anthropometrical parameters such as body mass index (BMI) and abdominal circumference (AC); plasma levels of 25(OH)D, aldosterone, leptin, glucose, triglycerides and cholesterol as well as renal tissue levels of collagen type 3 (COL-3) and MCP-1 by ELISA. Moreover, we performed qPCR and immunoblotting for vitamin D receptor (VDR) in adipose and renal tissues, respectively. We also analysed α-actin expression by immunohistochemistry and evaluated the fractional interstitial area (FIA). All the results are described in Table 1.
RESULTS
H + VDD animals presented a lower glomerular filtration rate, higher MAP and increased anthropometrical and metabolic parameters compared to the other groups. In addition, we observed severe morphological damage, characterized by an increase in the fractional interstitial area and renal expression of α-actin, MCP-1 and COL-3.
CONCLUSION
Our study suggests that the association between vitamin D deficiency and obesity impairs the haemodynamics, renal function and metabolic parameters in the H + VDD rats. In addition, obesity-associated to vitamin D deficiency aggravated the renal inflammation and morphological alterations associated to renal disease progression.
FUNDING: CAPES and FAPESP (2019/20840–0, 2018/12297–1, 2018/04930–6).
Collapse
Affiliation(s)
- Desiree Bernardo
- Laboratorio de Investigacao Medica 12 (LIM12), Faculdade de Medicina, Universidade de São Paulo, Nephrology, São Paulo, Brazil
| | - Ana Carolina de Braganca
- Laboratorio de Investigacao Medica 12 (LIM12), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Nephrology, São Paulo, Brazil
| | - Maria Heloisa Massola Shimizu
- Laboratorio de Investigacao Medica 12 (LIM12), Faculdade de Medicina, Universidade de São Paulo, Nephrology, São Paulo, Brazil
| | - Antonio Carlos Seguro
- Laboratorio de Investigacao Medica 12 (LIM12), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Nephrology, São Paulo, Brazil
| | - Mariana Moura Nascimento
- Laboratorio de Investigacao Medica 12 (LIM12), Faculdade de Medicina, Universidade de São Paulo, Nephrology, São Paulo, Brazil
| | - Daniele Canale
- Laboratorio de Investigacao Medica 12 (LIM12), Faculdade de Medicina, Universidade de São Paulo, Nephrology, São Paulo, Brazil
| | - Rildo Aparecido Volpini
- Laboratorio de Investigacao Medica 12 (LIM12), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Nephrology, São Paulo, Brazil
| |
Collapse
|
7
|
Heloisa Massola Shimizu M, Aparecido Volpini R, Carolina de Braganca A, Moura Nascimento M, Bernardo D, Canale D, Carlos Seguro A. MO271: A Single Dose of Lithium Protects Against Renal Injury Following Bilateral Ureteral Obstruction. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac067.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Obstructive nephropathy decreases renal blood flow (RBF) and glomerular filtration rate (GFR). Glycogen synthase kinase 3β (GSK3 β), an apoptotic enzyme, is increased in a model of unilateral obstruction. Treatment with a single dose of lithium, a selective inhibitor of GSK3β, accelerated recovery of renal function in models of cisplatin and ischemia-reperfusion induced acute kidney injury (AKI). The aim of this study was to evaluate the efficacy of a single dose of lithium in the treatment of AKI induced by bilateral ureteral obstruction (BUO)
METHOD
Adult male Wistar rats were divided in four groups: (i) sham (sham operated); (ii) lithium: rats treated with lithium chloride 80 mg/Kg BW Intraperitonially (IP); (iii) BUO during 24 h; (iv) BUO during 24 h and treated with the same dose immediately after ureteral desobstruction. The rats were anesthetized 48 h after desobstruction to measure inulin clearance and renal blood flow. At the end of the clearance experiments, the rats were euthanized and the kidneys were removed to measure GSK3 β renal expression.
RESULTS
As described in the Table 1, BUO showed markedly reduction of GFR and RBF associated with an increase of GSK3β. A single dose of lithium administration ameliorated all these alterations.
CONCLUSION
Lithium treatment attenuated renal dysfunction in this model of BUO-associated AKI by improving inulin clearance. These therapeutic effects were due to an inhibition of renal expression of GSK3β. This may be a new therapeutic approach for BUO-induced AKI.
Collapse
Affiliation(s)
- Maria Heloisa Massola Shimizu
- Nephrology, Laboratorio de Investigacao Medica 12 (LIM12), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rildo Aparecido Volpini
- Nephrology, Laboratorio de Investigacao Medica 12 (LIM12), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ana Carolina de Braganca
- Nephrology, Laboratorio de Investigacao Medica 12 (LIM12), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Mariana Moura Nascimento
- Nephrology, Laboratorio de Investigacao Medica 12 (LIM12), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Desiree Bernardo
- Nephrology, Laboratorio de Investigacao Medica 12 (LIM12), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Daniele Canale
- Nephrology, Laboratorio de Investigacao Medica 12 (LIM12), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Antonio Carlos Seguro
- Nephrology, Laboratorio de Investigacao Medica 12 (LIM12), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
8
|
Moura Nascimento M, Bernardo D, Carolina de Braganca A, Heloisa Massola Shimizu M, Carlos Seguro A, Aparecido Volpini R, Canale D. MO079: Treatment with Nebivolol Ameliorates Renovascular Alterations and Oxidative Stress in Tenofovir-Induced Nephrotoxicity in Rats. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac064.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Human immunodeficiency virus (HIV) continues to be a major global public health issue, having claimed millions of lives so far. Tenofovir disoproxil fumarate (TDF), a widely prescribed component in antiretroviral regimens for HIV treatment, has been associated with nephrotoxicity. Nebivolol (NBV) is a third generation selective β-1 adrenergic receptor blocker currently used in the treatment of hypertension and cardiovascular diseases. The potential mechanisms by which NBV may protect renal structure and function include suppression of oxidative stress and enhancement of nitric oxide synthesis. The aim of this study was to investigate whether NBV could be an effective therapeutic option to mitigate TDF-induced nephrotoxicity.
METHOD
We divided Wistar rats into four groups: control (C, n = 8), received a standard diet for 30 days; TDF (n = 9), received a standard diet with the addition of TDF (300 mg/kg food) for 30 days; NBV (n = 8), received a standard diet for 30 days with the addition of NBV (100 mg/kg food) in the last 15 days; and TDF + NBV (n = 9), received a standard diet with the addition of TDF for 30 days and NBV in the last 15 days. We evaluated inulin clearance (GFR); tubular injury; mean arterial pressure (MAP); renal blood flow (RBF) and calculated renal vascular resistance (RVR); plasma and tissue angiotensin II (AIIp and AIIt, respectively); plasma aldosterone; plasma asymmetric dimethylarginine (ADMA); plasma and urinary thiobarbituric acid reactive substances (TBARSp and TBARSu, respectively); and whole blood glutathione (GSH). In renal tissue, we immunoblotted for endothelial nitric oxide synthase (eNOS), p47phox and p67phox. Data are expressed as mean ± SEM.
RESULTS
TDF + NBV rats showed an improvement in renal function, a normalization of MAP and attenuation in renal vasoconstriction, evidenced by increased RBF and diminished RVR. Administration of NBV also reduced AII and aldosterone levels in TDF-treated animals. Furthermore, the TDF + NBV group showed a lower plasma ADMA concentration and a higher protein expression of eNOS. Treatment with NBV was responsible for the maintenance of an adequate balance of TBARS and GSH levels, and it was associated with reductions in renal p47phox and p67phox. All results are described in Table 1.
CONCLUSION
Our data demonstrated the protective role of NBV in TDF-induced nephrotoxicity. The beneficial effects of NBV include a reduction in oxidative stress and RAAS activation, as well as a decrease in endothelial dysfunction, observed by an upregulation on the NO cascade. Therefore, NBV may be an effective therapeutic strategy in the treatment of patients with TDF-induced nephrotoxicity. Financial support: CAPES and FAPESP (2019/20840–0, 2018/12297–1, 2018/04930–6).
Collapse
Affiliation(s)
- Mariana Moura Nascimento
- Laboratorio de Investigacao Medica 12 (LIM12), Faculdade de Medicina, Universidade de São Paulo, Nephrology, São Paulo, Brazil
| | - Desiree Bernardo
- Laboratorio de Investigacao Medica 12 (LIM12), Faculdade de Medicina, Universidade de São Paulo, Nephrology, São Paulo, Brazil
| | - Ana Carolina de Braganca
- Laboratorio de Investigacao Medica 12 (LIM12), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Nephrology, São Paulo, Brazil
| | - Maria Heloisa Massola Shimizu
- Laboratorio de Investigacao Medica 12 (LIM12), Faculdade de Medicina, Universidade de São Paulo, Nephrology, São Paulo, Brazil
| | - Antonio Carlos Seguro
- Laboratorio de Investigacao Medica 12 (LIM12), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Nephrology, São Paulo, Brazil
| | - Rildo Aparecido Volpini
- Laboratorio de Investigacao Medica 12 (LIM12), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Nephrology, São Paulo, Brazil
| | - Daniele Canale
- Laboratorio de Investigacao Medica 12 (LIM12), Faculdade de Medicina, Universidade de São Paulo, Nephrology, São Paulo, Brazil
| |
Collapse
|
9
|
Polidoro JZ, Luchi WM, Seguro AC, Malnic G, Girardi ACC. Paracrine and endocrine regulation of renal potassium secretion. Am J Physiol Renal Physiol 2022; 322:F360-F377. [DOI: 10.1152/ajprenal.00251.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The seminal studies conducted by Giebisch and colleagues in the 1960s paved the way for understanding the renal mechanisms involved in K+ homeostasis. It was demonstrated that differential handling of K+ in the distal segments of the nephron is crucial for proper K+ balance. Although aldosterone had been classically ascribed as the major ion transport regulator in the distal nephron, thereby contributing to K+ homeostasis, it became clear that aldosterone per se could not explain the kidney's ability to modulate kaliuresis in both acute and chronic settings. The existence of alternative kaliuretic and antikaliuretic mechanisms was suggested by physiological studies in the 1980s but only gained form and shape with the advent of molecular biology. It is now established that the kidneys recruit several endocrine and paracrine mechanisms for adequate kaliuretic response. These mechanisms include the direct effects of peritubular K+, a gut-kidney regulatory axis sensing dietary K+ levels, the kidney secretion of kallikrein during postprandial periods, the upregulation of angiotensin II receptors in the distal nephron during chronic changes in the K+ diet, and the local increase of prostaglandins by low K+ diet. This review discusses recent advances in the understanding of endocrine and paracrine mechanisms underlying the modulation of K+ secretion and how these mechanisms impact kaliuresis and K+ balance. We also highlight important unknowns about the regulation of renal K+ excretion under physiological circumstances.
Collapse
Affiliation(s)
- Juliano Z. Polidoro
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Weverton Machado Luchi
- Department of Internal Medicine, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Antonio Carlos Seguro
- Department of Nephrology (LIM 12), University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Gerhard Malnic
- Department of Physiology and Biophysics, University of São Paulo Medical School, São Paulo, Brazil
| | | |
Collapse
|
10
|
Fioroti CEA, Distenhreft JIQ, Paulino BB, Lacchine K, Ramos DR, Seguro AC, Luchi WM. Tenofovir-induced renal and bone toxicity: report of two cases and literature review. Rev Inst Med Trop Sao Paulo 2022; 64:e10. [PMID: 35170711 PMCID: PMC8845457 DOI: 10.1590/s1678-9946202264010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/03/2022] [Indexed: 11/22/2022] Open
Abstract
Tenofovir Disoproxil Fumarate (TDF) is one of the drugs in the initial first-line antiretroviral regimen for the treatment of hepatitis B and HIV infections. Despite its effectiveness and few adverse effects, it is related to renal and bone toxicity. We described two cases of HIV-positive middle-aged women who had been using TDF for two and four years (cases 1 and 2, respectively) and were admitted to the emergency room. Case 1 presented with metabolic ileum and diffuse bone pain while case 2 presented with bilateral coxo-femoral pain after a fall from standing height. Both cases had similar laboratory tests: hyperchloremic metabolic acidosis, hypophosphatemia, hypokalemia, hypouricemia and elevated plasma creatinine. In urinary exams, there was evidence of renal loss of electrolytes, justifying the serum alterations, in addition to glucosuria and proteinuria. The bone pain investigation identified bone fractures and reduced bone mineral density, together with increased levels of parathyroid hormone, alkaline phosphatase and vitamin D deficiency. These two cases illustrate the spectrum of adverse renal and bone effects associated with TDF use. TDF was discontinued and treatment was focused on correcting the electrolyte disturbances and acidosis, in addition to controlling the bone disease through vitamin D and calcium supplementation. The renal changes found in both cases characterized the Fanconi’s syndrome, and occurred due to TDF toxicity to proximal tubule cells mitochondria. Bone toxicity occurred due to direct interference of TDF in bone homeostasis, in addition to vitamin D deficiency and phosphaturia resulting from tubulopathy. During the follow-up, both cases evolved with chronic kidney disease and in one of them, the Fanconi’s syndrome did not revert. We emphasize the need to monitor markers of bone metabolism and glomerular and tubular functions in patients using TDF.
Collapse
|
11
|
Albino AH, Zambom FFF, Foresto-Neto O, Oliveira KC, Ávila VF, Arias SCA, Seguro AC, Malheiros DMAC, Camara NOS, Fujihara CK, Zatz R. Renal Inflammation and Innate Immune Activation Underlie the Transition From Gentamicin-Induced Acute Kidney Injury to Renal Fibrosis. Front Physiol 2021; 12:606392. [PMID: 34305624 PMCID: PMC8293269 DOI: 10.3389/fphys.2021.606392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 06/11/2021] [Indexed: 01/15/2023] Open
Abstract
Subjects recovering from acute kidney injury (AKI) are at risk of developing chronic kidney disease (CKD). The mechanisms underlying this transition are unclear and may involve sustained activation of renal innate immunity, with resulting renal inflammation and fibrosis. We investigated whether the NF-κB system and/or the NLRP3 inflammasome pathway remain activated after the resolution of AKI induced by gentamicin (GT) treatment, thus favoring the development of CKD. Male Munich-Wistar rats received daily subcutaneous injections of GT, 80 mg/kg, for 9 days. Control rats received vehicle only (NC). Rats were studied at 1, 30, and 180 days after GT treatment was ceased. On Day 1, glomerular ischemia (ISCH), tubular necrosis, albuminuria, creatinine retention, and tubular dysfunction were noted, in association with prominent renal infiltration by macrophages and myofibroblasts, along with increased renal abundance of TLR4, IL-6, and IL1β. Regression of functional and structural changes occurred on Day 30. However, the renal content of IL-1β was still elevated at this time, while the local renin-angiotensin system remained activated, and interstitial fibrosis became evident. On Day 180, recurring albuminuria and mild glomerulosclerosis were seen, along with ISCH and unabated interstitial fibrosis, whereas macrophage infiltration was still evident. GT-induced AKI activates innate immunity and promotes renal inflammation. Persistence of these abnormalities provides a plausible explanation for the transition of AKI to CKD observed in a growing number of patients.
Collapse
Affiliation(s)
- Amanda Helen Albino
- Renal Division, Department of Clinical Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Orestes Foresto-Neto
- Renal Division, Department of Clinical Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Karin Carneiro Oliveira
- Renal Division, Department of Clinical Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Victor Ferreira Ávila
- Renal Division, Department of Clinical Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Simone Costa Alarcon Arias
- Renal Division, Department of Clinical Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Antonio Carlos Seguro
- Renal Division, Department of Clinical Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Niels Olsen Saraiva Camara
- Renal Division, Department of Clinical Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Laboratory of Transplantation Immunobiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Clarice Kazue Fujihara
- Renal Division, Department of Clinical Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Roberto Zatz
- Renal Division, Department of Clinical Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
12
|
Dos Santos MS, Canale D, Bernardo DRD, Shimizu MHM, Seguro AC, Volpini RA, de Bragança AC. The Restoration of Vitamin D Levels Slows the Progression of Renal Ischemic Injury in Rats Previously Deficient in Vitamin D. Front Med (Lausanne) 2021; 8:625647. [PMID: 33869246 PMCID: PMC8049292 DOI: 10.3389/fmed.2021.625647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/04/2021] [Indexed: 11/13/2022] Open
Abstract
Chronic kidney disease (CKD) remains a global public health problem. The initial damage after ischemia/reperfusion (I/R) injury plays an important role in the pathogenesis of acute kidney injury (AKI) and predisposition to CKD. Several studies have been showing that nontraditional risk factors such as AKI and hypovitaminosis D could also be involved in CKD progression. Vitamin D deficiency (VDD) is associated with hemodynamic changes, activation of inflammatory pathways and renal disease progression (RDP) following I/R-AKI. Strategies for prevention and/or slowing RDP have been determined and the sufficiency of vitamin D has been emerging as a renoprotective factor in many diseases. Therefore, we investigated the effect of the restoration of vitamin D levels in the progression of I/R injury (IRI) in rats previously deficient in vitamin D. On day 30, male Wistar rats were submitted to bilateral 45 min IRI and divided into three groups: IRI, standard diet for 120 days; VDD+IRI, vitamin D-free diet for 120 days; and VDD+IRI+R, vitamin D-free diet in the first 30 days and just after I/R, we reintroduced the standard diet in the last 90 days. After the 120-day protocol, VDD+IRI+R rats presented an improvement in the renal function and renal protein handling followed by a smaller fractional interstitial area. Furthermore, those animals exhibited a reestablishment regarding the hemodynamic parameters and plasma levels of aldosterone, urea and PTH. In addition, the restoration of vitamin D levels reestablished the amount of MCP1 and the renal expressions of CD68+ and CD3+ cells in the VDD+IRI+R rats. Also, VDD+IRI+R rats showed a restoration regarding the amount of collagen type III and renal expressions of fibronectin, vimentin and α-SMA. Such changes were also accompanied by a reestablishment on the renal expression of VDR, Klotho, JG12, and TGF-β1. Our findings indicate that the restoration of vitamin D levels not only improved the renal function and hemodynamics but also reduced the inflammation and fibrosis lesions observed in I/R-AKI associated with VDD. Thus, monitoring of vitamin D status as well as its replacement in the early stages of kidney injury may be a therapeutic alternative in the mitigation of renal disease progression.
Collapse
Affiliation(s)
- Michele Santiago Dos Santos
- Laboratorio de Investigacao Medica 12 (LIM12), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Daniele Canale
- Laboratorio de Investigacao Medica 12 (LIM12), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Antonio Carlos Seguro
- Laboratorio de Investigacao Medica 12 (LIM12), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rildo Aparecido Volpini
- Laboratorio de Investigacao Medica 12 (LIM12), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ana Carolina de Bragança
- Laboratorio de Investigacao Medica 12 (LIM12), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
13
|
Vieira JVDA, Marques VB, Vieira LV, Crajoinas RDO, Shimizu MHM, Seguro AC, Carneiro MTWD, Girardi ACC, Vassallo DV, Dos Santos L. Changes in the renal function after acute mercuric chloride exposure in the rat are associated with renal vascular endothelial dysfunction and proximal tubule NHE3 inhibition. Toxicol Lett 2021; 341:23-32. [PMID: 33476711 DOI: 10.1016/j.toxlet.2021.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
Mercury is an environmental pollutant and a threat to human health. Mercuric chloride (HgCl2)-induced acute renal failure has been described by several reports, but the mechanisms of renal dysfunction remain elusive. This study tested the hypothesis that HgCl2 directly impairs renal vascular reactivity. Additionally, due to the mercury toxicity on the proximal tubule, we investigated whether the HgCl2-induced natriuresis is accompanied by inhibition of Na+/H+ exchanger isoform-3 (NHE3). We found that 90-min HgCl2 infusion (6.5 μg/kg i.v.) remarkably increased urinary output, reduced GFR and renal blood flow, and increased vascular resistance in rats. "In vitro" experiments of HgCl2 infusion in isolated renal vascular bed demonstrated an elevation of perfusion pressure in a concentration- and time-dependent manner, associated with changes on the endothelium-dependent vasodilatation and the flow-pressure relationship. Moreover, by employing "in vivo" stationary microperfusion of the proximal tubule, we found that HgCl2 inhibits NHE3 activity and increases the phosphorylation of NHE3 at serine 552 in the renal cortex, in line with the HgCl2-induced diuresis. Changes in renal proximal tubular function induced by HgCl2 were parallel to increased urinary markers of proximal tubular injury. Besides, atomic spectrometry showed that mercury accumulated in the renal cortex. We conclude that acute HgCl2 exposure causes renal vasoconstriction that is associated with reduced endothelial vasodilator agonist- and flow-mediated responses and inhibition of NHE3-mediated sodium reabsorption. Thus, our data suggest that HgCl2-induced acute renal failure may be attributable at least in part by its direct effects on renal hemodynamics and NHE3 activity.
Collapse
Affiliation(s)
| | | | - Luiza Valli Vieira
- Department of Chemistry, Federal University of Espirito Santo, Vitoria, ES, Brazil
| | | | | | - Antonio Carlos Seguro
- Department of Nephrology (LIM-12), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | | | | | | | - Leonardo Dos Santos
- Department of Physiological Sciences, Federal University of Espirito Santo, Vitoria, ES, Brazil.
| |
Collapse
|
14
|
Gonçalves JG, Canale D, de Bragança AC, Seguro AC, Shimizu MHM, Volpini RA. The Blockade of TACE-Dependent EGF Receptor Activation by Losartan-Erlotinib Combination Attenuates Renal Fibrosis Formation in 5/6-Nephrectomized Rats Under Vitamin D Deficiency. Front Med (Lausanne) 2021; 7:609158. [PMID: 33469545 PMCID: PMC7813781 DOI: 10.3389/fmed.2020.609158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/03/2020] [Indexed: 11/23/2022] Open
Abstract
Chronic kidney disease (CKD) has been considered a major public health issue. In addition to cardiovascular diseases and infections, hypovitaminosis D has been considered a non-traditional aggravating factor for CKD progression. Interstitial fibrosis is a hallmark of CKD strongly correlated with deterioration of renal function. Transforming growth factor β (TGF-β) is the major regulatory profibrotic cytokine in CKD. Many injurious stimuli converge on the TGF-β pathway, which has context-dependent pleiotropic effects and interacts with several related renal fibrosis formation (RFF) pathways. Epidermal growth factor receptor (EGFR) is critically involved in CKD progression, exerting a pathogenic role in RFF associated with TGF-β-related fibrogenesis. Among others, EGFR pathway can be activated by a disintegrin and a metalloproteinase known as tumor necrosis factor α-converting enzyme (TACE). Currently no effective therapy is available to completely arrest RFF and slow the progression of CKD. Therefore, we investigated the effects of a double treatment with losartan potassium (L), an AT1R antagonist, and the tyrosine kinase inhibitor erlotinib (E) on the alternative pathway of RFF related to TACE-dependent EGFR activation in 5/6-nephrectomized rats under vitamin D deficiency (D). During the 90-day protocol, male Wistar rats under D, were submitted to 5/6 nephrectomy (N) on day 30 and randomized into four groups: N+D, no treatment; N+D+L, received losartan (50 mg/kg/day); N+D+E, received erlotinib (6 mg/kg/day); N+D+L+E received losartan+erlotinib treatment. N+D+L+E data demonstrated that the double treatment with losartan+erlotinib not only blocked the TACE-dependent EGF receptor activation but also prevented the expression of TGF-β, protecting against RFF. This renoprotection by losartan+erlotinib was corroborated by a lower expression of ECM proteins and markers of phenotypic alteration as well as a lesser inflammatory cell infiltrate. Although erlotinib alone has been emerging as a renoprotective drug, its association with losartan should be considered as a potential therapeutic strategy on the modulation of RFF.
Collapse
Affiliation(s)
- Janaína Garcia Gonçalves
- Laboratorio de Investigacao Medica 12, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Daniele Canale
- Laboratorio de Investigacao Medica 12, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ana Carolina de Bragança
- Laboratorio de Investigacao Medica 12, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Antonio Carlos Seguro
- Laboratorio de Investigacao Medica 12, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Rildo Aparecido Volpini
- Laboratorio de Investigacao Medica 12, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
15
|
de Souza SI, Rocha EC, Ferraz HR, Dias JA, Seguro AC, Volpini RA, Canale D, de Bragança AC, Shimizu MHM, Marques LM, de Magalhães ACM, Coimbra TM, de Jesus Soares T. Acute kidney injury induced by glycerol is worsened by orchiectomy and attenuated by testosterone replacement. Steroids 2021; 165:108755. [PMID: 33171132 DOI: 10.1016/j.steroids.2020.108755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/15/2020] [Accepted: 10/24/2020] [Indexed: 12/24/2022]
Abstract
Although several studies have demonstrated that the male gender represents an independent risk factor for renal disease, evidence shows that androgens exert renal protective actions. The findings are controversial and no studies have evaluated the effects of orchiectomy and testosterone replacement on glycerol-induced renal injury. Male Wistar rats were submitted to orchiectomy or sham surgery and divided into four groups: SC, sham control rats injected with NaCl; SG, sham rats injected with glycerol; OG, orchiectomized rats injected with glycerol; OGT, orchiectomized rats injected with glycerol and testosterone. Testosterone was administered daily for 14 days in the OGT group. After 11 days of testosterone replacement in the OGT group, SC rats were submitted to a saline injection, while SG, OG and OGT rats received glycerol. All rats were euthanized three days after injections. OG rats presented higher serum creatinine and urea, and sodium excretion, compared to SC and SG, while testosterone attenuated these changes. Acute tubular necrosis was also mitigated by testosterone. Renal immunostaining for macrophages, lymphocytes and NF-κB was higher in OG compared to SC and SG. In addition, renal interleukin-1β, Caspase 3 and AT1 gene expression was higher in OG rats compared to SG. Testosterone attenuated these alterations, except the NF-κB immunostaining. The renal NO was lower in OG rats compared to SG. Only the OG rats presented decreases in serum NO and renal HO-1, and increased TNF-α, angiotensinogen and AT1 expression compared to SC. We conclude that orchiectomy worsened glycerol-induced kidney injury, while testosterone attenuated this renal damage.
Collapse
Affiliation(s)
- Samira Itana de Souza
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Bahia 45029-094, Brazil
| | - Edilene Cândido Rocha
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Bahia 45029-094, Brazil
| | - Halanna Rocha Ferraz
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Bahia 45029-094, Brazil
| | - Jéssica Afonso Dias
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Bahia 45029-094, Brazil
| | - Antonio Carlos Seguro
- Laboratório de Investigação Médica 12 (LIM12), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rildo Aparecido Volpini
- Laboratório de Investigação Médica 12 (LIM12), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Daniele Canale
- Laboratório de Investigação Médica 12 (LIM12), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ana Carolina de Bragança
- Laboratório de Investigação Médica 12 (LIM12), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Maria Heloisa Massola Shimizu
- Laboratório de Investigação Médica 12 (LIM12), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Lucas Miranda Marques
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Bahia 45029-094, Brazil
| | | | - Terezila Machado Coimbra
- Departamento de Fisiologia, Universidade de São Paulo, Ribeirão Preto, São Paulo 14049-900, Brazil
| | - Telma de Jesus Soares
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Bahia 45029-094, Brazil.
| |
Collapse
|
16
|
da Silva BHCS, Ariga SK, Barbeiro HV, Volpini RA, Barbeiro DF, Seguro AC, Pinheiro da Silva F. Cathelicidin protects mice from Rhabdomyolysis-induced Acute Kidney Injury. Int J Med Sci 2021; 18:883-890. [PMID: 33456345 PMCID: PMC7807180 DOI: 10.7150/ijms.52397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/08/2020] [Indexed: 12/01/2022] Open
Abstract
Background: Cathelicidins are ancient and well-conserved antimicrobial peptides (AMPs) with intriguing immunomodulatory properties in both infectious and non-infectious inflammatory diseases. In addition to direct antimicrobial activity, cathelicidins also participate in several signaling pathways inducing both pro-inflammatory and anti-inflammatory effects. Acute kidney injury (AKI) is common in critically ill patients and is associated with high mortality and morbidity. Rhabdomyolysis is a major trigger of AKI. Objectives: Here, we investigated the role of cathelicidins in non-infectious Acute kidney Injury (AKI). Method: Using an experimental model of rhabdomyolysis, we induced AKI in wild-type and cathelicidin-related AMP knockout (CRAMP-/-) mice. Results: We previously demonstrated that CRAMP-/- mice, as opposed wild-type mice, are protected from AKI during sepsis induced by cecal ligation and puncture. Conversely, in the current study, we show that CRAMP-/- mice are more susceptible to the rhabdomyolysis model of AKI. A more in-depth investigation of wild-type and CRAMP-/- mice revealed important differences in the levels of several inflammatory mediators. Conclusion: Cathelicidins can induce a varied and even opposing repertoire of immune-inflammatory responses depending on the subjacent disease and the cellular context.
Collapse
Affiliation(s)
| | - Suely Kubo Ariga
- Departamento de Emergências Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | | | - Rildo Aparecido Volpini
- Laboratório de Investigação Médica 12 (LIM12), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Antonio Carlos Seguro
- Laboratório de Investigação Médica 12 (LIM12), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | |
Collapse
|
17
|
Iglezias SD, Abreu PAE, Kanamura C, Magaldi AJ, Seguro AC, Brito TD. Immunohistochemical detection of Lp25 and LipL32 proteins in skeletal and cardiac muscles of fatal human leptospirosis. Rev Inst Med Trop Sao Paulo 2020; 62:e85. [PMID: 33174979 PMCID: PMC7653813 DOI: 10.1590/s1678-9946202062085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/13/2020] [Indexed: 11/22/2022] Open
Abstract
Leptospirosis is an acute infection caused by pathogenic species of the genus Leptospira, which affects humans and animals in all world. In severe forms of the disease, kidneys, liver and lungs are the main affected organs, resulting in acute kidney injury, jaundice and pulmonary hemorrhage. Previous post-mortem studies have shown that lesions are not limited to these organs. Cardiac and striated muscle injuries have already been reported, but the pathophysiology of cardiac and skeletal lesions in leptospirosis is not fully understood. It has been suggested that the tissue damage observed in leptospirosis could be directly mediated by leptospires or by their toxic cellular components. LipL32 and Lp25 are leptospira membrane proteins with unknown functions, that are present only in pathogenic strains of Leptospira spp. Both proteins induce skeletal muscle lesions similar to those observed when normal guinea pigs are inoculated with leptospires. Through immunohistochemistry, this study showed the presence of LipL32 and Lp25 proteins on muscle cell membranes and in the underlying cytoplasm of skeletal muscles, as well as focal lesions in cardiac tissues of fatal cases of leptospirosis. Altogether, these results reinforce that both proteins can be important factors in the pathogenesis of leptospirosis.
Collapse
Affiliation(s)
| | | | - Cristina Kanamura
- Instituto Adolfo Lutz, Laboratório de Patologia, São Paulo, São Paulo, Brazil
| | - Antonio José Magaldi
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Nefrologia, Laboratório de Investigação Médica (LIM-12), São Paulo, São Paulo, Brazil
| | - Antonio Carlos Seguro
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Nefrologia, Laboratório de Investigação Médica (LIM-12), São Paulo, São Paulo, Brazil
| | - Thales De Brito
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil.,in memoriam
| |
Collapse
|
18
|
Seguro AC, Santos MS, Denelle Bernardo DR, Canale D, Shimizu MHM, Volpini RA, De Braganca AC. P0722VITAMIN D-DEFICIENT RATS RECOVER RENAL ALTERATIONS AFTER VITAMIN D REPLACEMENT FOLLOWING ISCHEMIA-REPERFUSION INJURY. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Several studies have been linking vitamin D deficiency (VDD) as a non-traditional risk factor to acute kidney injury (AKI). It has been shown that VDD associated with AKI potentiates the injury and may accelerate the progression of kidney disease. Conversely, some lines of evidence have been describing that vitamin D sufficiency can be considered as a renal protective factor. Thus, we aimed to verify the effect of vitamin D replacement (R) on the renal disease progression post ischemia-reperfusion injury (IRI) in vitamin D deficient rats.
Method
We performed bilateral 45 min IRI on day 30 in all animal groups. Male Wistar rats were randomized into three groups: 1- IRI (fed a standard diet for 120 days); 2- VDD+IRI (fed a vitamin D-free diet for 120 days); and 3- VDD+IRI+R (fed a vitamin D-free diet for 30 days and just after IRI, on day 31, we reintroduced the standard diet for more 90 days). We evaluated inulin clearance (Cin); mean arterial pressure (MAP); renal blood flow (RBF); plasma levels of Vitamin D2+D3 [25(OH)D] and Parathormone (PTH) by ELISA. In addition, we performed histomorphometrical studies for CD3+ cells, fibronectin and vimentin as well as the fractional interstitial area (FIA). Moreover, we run qPCR studies and immunoblotted for vitamin D receptor (VDR) and Klotho. All the results are described in table 1.
Results
Vitamin D replacement restored the plasma levels of 25(OH)D and PTH in VDD+IRI+R group. Also, VDD+IRI+R presented an improvement of renal function and hemodynamic parameters. In addition, we observed more evident alterations in tubulointerstitial compartment, featuring interstitial expansion (renal fibrosis and inflammatory cell infiltrates) and fibronectin and vimentin expression in VDD+IRI rats. These alterations were recovered by vitamin D replacement. Concerning VDR and Klotho data, our results revealed a decreased expression of these targets in VDD+IRI group. On the other hand, vitamin D replacement retrieved the expression of VDR and Klotho.
Conclusion
Our study suggests that vitamin D replacement improved the recovery of renal function, hemodynamics, inflammatory and morphological alterations. In addition, vitamin D replacement was able to reestablish the expression of VDR and Klotho in IRI-AKI associated with vitamin D deficiency. Thus, it is recommendable that vitamin D levels should be observed as well as its reposition should be taken into account in renal patients.
Collapse
Affiliation(s)
| | - Michele S Santos
- Faculty of Medicine - University of Sao Paulo, Nephrology, São Paulo, Brazil
| | | | - Daniele Canale
- Faculty of Medicine - University of Sao Paulo, Nephrology, São Paulo, Brazil
| | | | | | | |
Collapse
|
19
|
Ferreira D, de Bragança AC, Volpini RA, Shimizu MHM, Gois PHF, Girardi ACC, Seguro AC, Canale D. Vitamin D deficiency is a potential risk factor for lipid Amphotericin B nephrotoxicity. PLoS Negl Trop Dis 2019; 13:e0007567. [PMID: 31295336 PMCID: PMC6622473 DOI: 10.1371/journal.pntd.0007567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/20/2019] [Indexed: 12/21/2022] Open
Abstract
Invasive fungal infections (IFI) is a worldwide serious health problem and Amphotericin B (AmB) has been considered the drug of choice for IFI treatment. Despite its efficacy, clinical use of AmB has been associated with renal toxicity. Some lines of evidence have shown that an extemporaneous lipid emulsion preparation of AmB (AmB/LE) was able to attenuate nephrotoxicity, presenting similar benefits at a lower cost. Studies have been demonstrating that hypovitaminosis D may hasten the progression of kidney disease and reflect on a worse prognosis in cases of drug-induced nephrotoxicity. In view of the high worldwide incidence of hypovitaminosis D, the aim of this study was to investigate whether vitamin D deficiency may induce AmB/LE-related nephrotoxicity. Wistar rats were divided into four groups: control, received a standard diet for 34 days; AmB/LE, received a standard diet for 34 days and AmB/LE (5 mg/kg/day) intraperitoneally in the last 4 days; VDD, received a vitamin D-free diet for 34 days; and VDD+AmB/LE, received a vitamin D-free diet for 34 days and AmB/LE as described. At the end of the protocol, animals were euthanized and blood, urine and renal tissue samples were collected in order to evaluate AmB/LE effects on renal function and morphology. Association of AmB/LE and vitamin D deficiency led to diminished glomerular filtration rate and increased tubular injury, evidenced by reduced renal protein expression of NaPi-IIa and TRPM6 leading to hyperphosphaturia / hypermagnesuria. VDD+AmB/LE rats also presented alterations in the PTH-Klotho-FGF-23 signaling axis, urinary concentrating defect and hypertension, probably due to an inappropriate activation of the renin-angiotensin-aldosterone system. Hence, it is important to monitor vitamin D levels in AmB/LE treated patients, since vitamin D deficiency induces AmB/LE nephrotoxicity. Amphotericin B (AmB) is the treatment of choice for systemic fungal infections. Despite its efficacy, clinical use of AmB has been associated with renal toxicity. In an attempt to improve the therapeutic effect and to reduce adverse reactions, lipid formulations of AmB were developed. Among these formulations, an in-house lipid emulsion preparation of AmB (AmB/LE) is a lower cost alternative with similar benefits. Furthermore, vitamin D is an essential nutrient for the regulation of several physiological activities. Hence, vitamin D deficiency or insufficiency can contribute to the progression of diseases and increase the risk of chronic illnesses as well. Nowadays, VDD is a health problem worldwide and its prevalence in general population is high, including the sunny and industrialized countries, where vitamin D supplementation has been successfully implemented. Thus, it is essential to monitor vitamin D levels in both patients treated with conventional or lipid formulations of AmB in order to ensure a better prognosis in the development of renal diseases.
Collapse
Affiliation(s)
- Daniela Ferreira
- Laboratorio de Investigacao Medica 12 (LIM12), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ana Carolina de Bragança
- Laboratorio de Investigacao Medica 12 (LIM12), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rildo Aparecido Volpini
- Laboratorio de Investigacao Medica 12 (LIM12), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Pedro Henrique França Gois
- Laboratorio de Investigacao Medica 12 (LIM12), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Antonio Carlos Seguro
- Laboratorio de Investigacao Medica 12 (LIM12), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Daniele Canale
- Laboratorio de Investigacao Medica 12 (LIM12), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- * E-mail:
| |
Collapse
|
20
|
Distenhreft JIQ, Vianna JGP, Scopel GS, Ramos JM, Seguro AC, Luchi WM. The role of urea-induced osmotic diuresis and hypernatremia in a critically ill patient: case report and literature review. ACTA ACUST UNITED AC 2019; 42:106-112. [PMID: 31063175 PMCID: PMC7213928 DOI: 10.1590/2175-8239-jbn-2018-0226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/04/2019] [Indexed: 01/28/2023]
Abstract
Hypernatremia is a common electrolyte problem at the intensive care setting, with a prevalence that can reach up to 25%. It is associated with a longer hospital stay and is an independent risk factor for mortality. We report a case of hypernatremia of multifactorial origin in the intensive care setting, emphasizing the role of osmotic diuresis due to excessive urea generation, an underdiagnosed and a not well-known cause of hypernatremia. This scenario may occur in patients using high doses of corticosteroids, with gastrointestinal bleeding, under diets and hyperprotein supplements, and with hypercatabolism, especially during the recovery phase of renal injury. Through the present teaching case, we discuss a clinical approach to the diagnosis of urea-induced osmotic diuresis and hypernatremia, highlighting the utility of the electrolyte-free water clearance concept in understanding the development of hypernatremia.
Collapse
Affiliation(s)
| | - Júlia Guasti Pinto Vianna
- Serviço de Nefrologia, Hospital Universitário Cassiano Antonio Moraes, Universidade Federal do Espírito Santo, Vitória, ES, Brasil
| | - Gabriela S Scopel
- Serviço de Nefrologia, Hospital Universitário Cassiano Antonio Moraes, Universidade Federal do Espírito Santo, Vitória, ES, Brasil
| | - Jayme Mendonça Ramos
- Serviço de Nefrologia, Hospital Universitário Cassiano Antonio Moraes, Universidade Federal do Espírito Santo, Vitória, ES, Brasil
| | - Antonio Carlos Seguro
- Laboratório de Investigação Médica, Hospital das Clínicas da Faculdade de Medicina da São Paulo, Universidade de São Paulo, São Paulo, Brasil
| | - Weverton Machado Luchi
- Serviço de Nefrologia, Hospital Universitário Cassiano Antonio Moraes, Universidade Federal do Espírito Santo, Vitória, ES, Brasil
| |
Collapse
|
21
|
Silveira MAD, Teles F, Berretta AA, Sanches TR, Rodrigues CE, Seguro AC, Andrade L. Effects of Brazilian green propolis on proteinuria and renal function in patients with chronic kidney disease: a randomized, double-blind, placebo-controlled trial. BMC Nephrol 2019; 20:140. [PMID: 31023272 PMCID: PMC6485062 DOI: 10.1186/s12882-019-1337-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 04/15/2019] [Indexed: 01/13/2023] Open
Abstract
Background Chronic kidney disease (CKD) is a public health problem worldwide, and proteinuria is a well-established marker of disease progression in CKD patients. Propolis, a natural resin produced by bees from plant materials, has anti-inflammatory, immunomodulatory, and anti-oxidant properties, as well as having been shown to have an antiproteinuric effect in experimental CKD. The aim of this study was to evaluate the impact of Brazilian green propolis extract on proteinuria reduction and the changes in the estimated glomerular filtration rate (eGFR). Methods This was a randomized, double-blind, placebo-controlled study including patients with CKD caused by diabetes or of another etiology, 18–90 years of age, with an eGFR of 25–70 ml/min per 1.73 m2 and proteinuria (urinary protein excretion > 300 mg/day) or micro- or macro-albuminuria (urinary albumin-to-creatinine ratio > 30 mg/g or > 300 mg/g, respectively). We screened 148 patients and selected 32, randomly assigning them to receive 12 months of Brazilian green propolis extract at a dose of 500 mg/day (n = 18) or 12 months of a placebo (n = 14). Results At the end of treatment, proteinuria was significantly lower in the propolis group than in the placebo group—695 mg/24 h (95% CI, 483 to 999) vs. 1403 mg/24 h (95% CI, 1031 to 1909); P = 0.004—independent of variations in eGFR and blood pressure, which did not differ between the groups during follow-up. Urinary monocyte chemoattractant protein-1 was also significantly lower in the propolis group than in the placebo group—58 pg/mg creatinine (95% CI, 36 to 95) vs. 98 pg/mg creatinine (95% CI, 62 to 155); P = 0.038. Conclusions Brazilian green propolis extract was found to be safe and well tolerated, as well as to reduce proteinuria significantly in patients with diabetic and non-diabetic CKD. Trial Registration. (ClinicalTrials.gov number NCT02766036. Registered: May 9, 2016). Electronic supplementary material The online version of this article (10.1186/s12882-019-1337-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Marcelo Augusto Duarte Silveira
- Division of Nephrology, University of São Paulo School of Medicine, São Paulo, SP, Av. Dr. Arnaldo, 455, 3° andar, sala 3310, CEP 01246-903, Brazil.
| | - Flávio Teles
- School of Medicine, Federal University of Alagoas, Maceió, Brazil
| | - Andressa A Berretta
- Laboratory of Research, Development & Innovation, Apis Flora Industrial e Comercial Ltda, Ribeirão Preto, Brazil
| | - Talita R Sanches
- Division of Nephrology, University of São Paulo School of Medicine, São Paulo, SP, Av. Dr. Arnaldo, 455, 3° andar, sala 3310, CEP 01246-903, Brazil
| | - Camila Eleutério Rodrigues
- Division of Nephrology, University of São Paulo School of Medicine, São Paulo, SP, Av. Dr. Arnaldo, 455, 3° andar, sala 3310, CEP 01246-903, Brazil
| | - Antonio Carlos Seguro
- Division of Nephrology, University of São Paulo School of Medicine, São Paulo, SP, Av. Dr. Arnaldo, 455, 3° andar, sala 3310, CEP 01246-903, Brazil
| | - Lúcia Andrade
- Division of Nephrology, University of São Paulo School of Medicine, São Paulo, SP, Av. Dr. Arnaldo, 455, 3° andar, sala 3310, CEP 01246-903, Brazil
| |
Collapse
|
22
|
de Bragança AC, Canale D, Gonçalves JG, Shimizu MHM, Seguro AC, Volpini RA. Vitamin D Deficiency Aggravates the Renal Features of Moderate Chronic Kidney Disease in 5/6 Nephrectomized Rats. Front Med (Lausanne) 2018; 5:282. [PMID: 30370270 PMCID: PMC6194324 DOI: 10.3389/fmed.2018.00282] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/14/2018] [Indexed: 01/22/2023] Open
Abstract
The pathogenesis of chronic kidney disease (CKD) involves a very complex interaction between hemodynamic and inflammatory processes, leading to glomerular/vascular sclerosis, and fibrosis formation with subsequent evolution to end-stage of renal disease. Despite efforts to minimize the progression of CKD, its incidence and prevalence continue to increase. Besides cardiovascular diseases and infections, several studies demonstrate that vitamin D status could be considered as a non-traditional risk factor for the progression of CKD. Therefore, we investigated the effects of vitamin D deficiency (VDD) in the course of moderate CKD in 5/6 nephrectomized rats (Nx). Adult male Wistar rats underwent Sham surgery or Nx and were subdivided into the following four groups: Sham, receiving standard diet (Sham); Sham VDD, receiving vitamin D-free diet (VDD); Nx, receiving standard diet (Nx); and VDD+Nx, receiving vitamin D-free diet (VDD+Nx). Sham or Nx surgeries were performed 30 days after standard or vitamin D-free diets administration. After validation of vitamin D depletion, we considered only Nx and VDD+Nx groups for the following studies. Sixty days after surgeries, VDD+Nx rats exhibited hypertension, a greater decline in renal function and plasma FGF-23 levels, renal hypertrophy, as well as higher plasma levels of PTH and aldosterone. In addition, those animals presented more significant chronic tubulointerstitial changes (cortical interstitial expansion/inflammation/fibrosis), higher expression of collagen IV, fibronectin and α-smooth muscle actin, and lower expressions of JG12 and M2 macrophages. Also, VDD+Nx rats had greater infiltration of inflammatory cells (M1 macrophages and T-cells). Such changes were accompanied by higher expression of TGF-β1 and angiotensinogen and decreased expression of VDR and Klotho protein. Our observations indicate that vitamin D deficiency impairs the renal function and worsens the renovascular and morphological changes, aggravating the features of moderate CKD in 5/6 nephrectomized rats.
Collapse
Affiliation(s)
- Ana Carolina de Bragança
- Laboratorio de Investigacao Medica 12 (LIM12), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Daniele Canale
- Laboratorio de Investigacao Medica 12 (LIM12), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Janaína Garcia Gonçalves
- Laboratorio de Investigacao Medica 12 (LIM12), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Antonio Carlos Seguro
- Laboratorio de Investigacao Medica 12 (LIM12), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rildo Aparecido Volpini
- Laboratorio de Investigacao Medica 12 (LIM12), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
23
|
Franca Gois PH, Wolley M, Ranganathan D, Seguro AC. Vitamin D Deficiency in Chronic Kidney Disease: Recent Evidence and Controversies. Int J Environ Res Public Health 2018; 15:E1773. [PMID: 30126163 PMCID: PMC6121405 DOI: 10.3390/ijerph15081773] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 12/16/2022]
Abstract
Vitamin D (VD) is a pro-hormone essential for life in higher animals. It is present in few types of foods and is produced endogenously in the skin by a photochemical reaction. The final step of VD activation occurs in the kidneys involving a second hydroxylation reaction to generate the biologically active metabolite 1,25(OH)₂-VD. Extrarenal 1α-hydroxylation has also been described to have an important role in autocrine and paracrine signaling. Vitamin D deficiency (VDD) has been in the spotlight as a major public healthcare issue with an estimated prevalence of more than a billion people worldwide. Among individuals with chronic kidney disease (CKD), VDD prevalence has been reported to be as high as 80%. Classically, VD plays a pivotal role in calcium and phosphorus homeostasis. Nevertheless, there is a growing body of evidence supporting the importance of VD in many vital non-skeletal biological processes such as endothelial function, renin-angiotensin-aldosterone system modulation, redox balance and innate and adaptive immunity. In individuals with CKD, VDD has been associated with albuminuria, faster progression of kidney disease and increased all-cause mortality. Recent guidelines support VD supplementation in CKD based on extrapolation from cohorts conducted in the general population. In this review, we discuss new insights on the multifactorial pathophysiology of VDD in CKD as well as how it may negatively modulate different organs and systems. We also critically review the latest evidence and controversies of VD monitoring and supplementation in CKD patients.
Collapse
Affiliation(s)
- Pedro Henrique Franca Gois
- Kidney Health Service, Royal Brisbane and Women's Hospital, Herston QLD 4029, Australia.
- Medical School, University of Queensland, Herston QLD 4029, Australia.
| | - Martin Wolley
- Kidney Health Service, Royal Brisbane and Women's Hospital, Herston QLD 4029, Australia.
- Medical School, University of Queensland, Herston QLD 4029, Australia.
| | - Dwarakanathan Ranganathan
- Kidney Health Service, Royal Brisbane and Women's Hospital, Herston QLD 4029, Australia.
- Medical School, University of Queensland, Herston QLD 4029, Australia.
| | - Antonio Carlos Seguro
- Laboratory of Medical Research-LIM12, Nephrology Department, University of São Paulo School of Medicine, São Paulo, CEP 01246-903, Brazil.
| |
Collapse
|
24
|
Menegussi J, Tatagiba LS, Vianna JGP, Seguro AC, Luchi WM. A physiology-based approach to a patient with hyperkalemic renal tubular acidosis. ACTA ACUST UNITED AC 2018; 40:410-417. [PMID: 30048563 PMCID: PMC6534002 DOI: 10.1590/2175-8239-jbn-3821] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/04/2017] [Indexed: 11/21/2022]
Abstract
Hyperkalemic renal tubular acidosis is a non-anion gap metabolic acidosis that
invariably indicates an abnormality in potassium, ammonium, and hydrogen ion
secretion. In clinical practice, it is usually attributed to real or apparent
hypoaldosteronism caused by diseases or drug toxicity. We describe a 54-year-old
liver transplant patient that was admitted with flaccid muscle weakness
associated with plasma potassium level of 9.25 mEq/L. Additional investigation
revealed type 4 renal tubular acidosis and marked hypomagnesemia with high
fractional excretion of magnesium. Relevant past medical history included a
recent diagnosis of Paracoccidioidomycosis, a systemic fungal infection that is
endemic in some parts of South America, and his outpatient medications contained
trimethoprim-sulfamethoxazole, tacrolimus, and propranolol. In the present
acid-base and electrolyte case study, we discuss a clinical approach for the
diagnosis of hyperkalemic renal tubular acidosis and review the pathophysiology
of this disorder.
Collapse
Affiliation(s)
| | | | | | - Antonio Carlos Seguro
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Nefrologia, Laboratório de Pesquisa Médica - LIM12, São Paulo, SP, Brasil
| | - Weverton Machado Luchi
- Universidade Federal do Espírito Santo, Departamento de Clínica Médica, Divisão de Nefrologia, Vitória, ES, Brasil
| |
Collapse
|
25
|
Fragoso MCBV, Albuquerque EVDA, Cardoso ALDA, da Rosa PWL, de Paulo RB, Schimizu MHM, Seguro AC, Passarelli M, Koehler K, Huebner A, Almeida MQ, Latronico AC, Arnhold IJP, Mendonca BB. Triple A Syndrome: Preliminary Response to the Antioxidant N-Acetylcysteine Treatment in a Child. Horm Res Paediatr 2018; 88:167-171. [PMID: 28395280 DOI: 10.1159/000465520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 02/21/2017] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Triple A syndrome (AAAS) is a rare autosomal recessive disorder characterized by alacrima, achalasia, ACTH-resistant adrenal insufficiency, autonomic dysfunction, and progressive neurodegeneration. Increased oxidative stress, demonstrated in patients' fibroblasts in vitro, may be a central disease mechanism. N-acetylcysteine protects renal function in patients with kidney injuries associated with increased oxidative stress and improves viability of AAAS-knockdown adrenal cells in vitro. PATIENT AND RESULTS A boy diagnosed with AAAS presented with short stature and increased oxidative stress in vivo assessed by increased thiobarbituric acid reactive substances (TBARS), which are markers of lipid peroxidation, and by the susceptibility of LDL to oxidation and the capacity of HDL to prevent it. A homozygous missense germline mutation (c.523G>T, p.Val175Phe) in AAAS was identified. N-acetylcysteine (600 mg orally, twice daily) decreased oxidative stress but did not change the patient's growth pattern. CONCLUSIONS An increase in oxidative stress is reported for the first time in vivo in an AAAS patient. N-acetylcysteine was capable of decreasing TBARS levels, reducing the susceptibility of LDL to oxidation and improving the antioxidant role of HDL. The long-term effect of antioxidant treatment should be evaluated to determine the real benefit for the prevention of the degenerative process in AAAS.
Collapse
Affiliation(s)
- Maria Candida Barisson Villares Fragoso
- Unidade de Suprarrenal, Divisão de Endocrinologia & Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Edoarda Vasco de Albuquerque Albuquerque
- Endocrinologia do Desenvolvimento, Divisão de Endocrinologia & Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ana Luiza de Almeida Cardoso
- Endocrinologia do Desenvolvimento, Divisão de Endocrinologia & Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Paula Waki Lopes da Rosa
- Endocrinologia do Desenvolvimento, Divisão de Endocrinologia & Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Rodrigo Bomeny de Paulo
- Endocrinologia do Desenvolvimento, Divisão de Endocrinologia & Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Maria Heloisa Massola Schimizu
- Laboratório de Pesquisa Básica em Doenças Renais LIM 12, Hospital das Clínicas Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Antonio Carlos Seguro
- Laboratório de Pesquisa Básica em Doenças Renais LIM 12, Hospital das Clínicas Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marisa Passarelli
- Laboratório de Lípides (LIM 10) da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Katrin Koehler
- Klinik für Kinder- und Jugendmedizin, Technische Universität, Dresden, Germany
| | - Angela Huebner
- Klinik für Kinder- und Jugendmedizin, Technische Universität, Dresden, Germany
| | - Madson Q Almeida
- Unidade de Suprarrenal, Divisão de Endocrinologia & Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ana Claudia Latronico
- Endocrinologia do Desenvolvimento, Divisão de Endocrinologia & Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Laboratório de Hormônios e Genética Molecular LIM 42, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ivo Jorge Prado Arnhold
- Endocrinologia do Desenvolvimento, Divisão de Endocrinologia & Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Laboratório de Hormônios e Genética Molecular LIM 42, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Berenice Bilharinho Mendonca
- Endocrinologia do Desenvolvimento, Divisão de Endocrinologia & Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Laboratório de Hormônios e Genética Molecular LIM 42, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
26
|
Amaral LSDB, Souza CS, Volpini RA, Shimizu MHM, de Bragança AC, Canale D, Seguro AC, Coimbra TM, de Magalhães ACM, Soares TDJ. Previous Exercise Training Reduces Markers of Renal Oxidative Stress and Inflammation in Streptozotocin-Induced Diabetic Female Rats. J Diabetes Res 2018; 2018:6170352. [PMID: 29785400 PMCID: PMC5896236 DOI: 10.1155/2018/6170352] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/11/2018] [Indexed: 12/21/2022] Open
Abstract
The aim of this study is to evaluate the effects of regular moderate exercise training initiated previously or after induction of diabetes mellitus on renal oxidative stress and inflammation in STZ-induced diabetic female rats. For this purpose, Wistar rats were divided into five groups: sedentary control (SC), trained control (TC), sedentary diabetic (SD), trained diabetic (TD), and previously trained diabetic (PTD). Only the PTD group was submitted to treadmill running for 4 weeks previously to DM induction with streptozotocin (40 mg/kg, i.v). After confirming diabetes, the PTD, TD, and TC groups were submitted to eight weeks of exercise training. At the end of the training protocol, we evaluated the following: glycosuria, body weight gain, plasma, renal and urinary levels of nitric oxide and thiobarbituric acid reactive substances, renal glutathione, and immunolocalization of lymphocytes, macrophages, and nuclear factor-kappa B (NF-κB/p65) in the renal cortex. The results showed that exercise training reduced glycosuria, renal TBARS levels, and the number of immune cells in the renal tissue of the TD and PTD groups. Of note, only previous exercise increased weight gain and urinary/renal NO levels and reduced NF-κB (p65) immunostaining in the renal cortex of the PTD group. In conclusion, our study shows that exercise training, especially when initiated previously to diabetes induction, promotes protective effects in diabetic kidney by reduction of renal oxidative stress and inflammation markers in female Wistar rats.
Collapse
Affiliation(s)
- Liliany Souza de Brito Amaral
- Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, 45029-094 Vitória da Conquista, BA, Brazil
| | - Cláudia Silva Souza
- Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, 45029-094 Vitória da Conquista, BA, Brazil
| | - Rildo Aparecido Volpini
- Departamento de Nefrologia, Laboratório de Pesquisa Básica-LIM12, Faculdade de Medicina da Universidade de São Paulo, 01246-903 São Paulo, SP, Brazil
| | - Maria Heloisa Massola Shimizu
- Departamento de Nefrologia, Laboratório de Pesquisa Básica-LIM12, Faculdade de Medicina da Universidade de São Paulo, 01246-903 São Paulo, SP, Brazil
| | - Ana Carolina de Bragança
- Departamento de Nefrologia, Laboratório de Pesquisa Básica-LIM12, Faculdade de Medicina da Universidade de São Paulo, 01246-903 São Paulo, SP, Brazil
| | - Daniele Canale
- Departamento de Nefrologia, Laboratório de Pesquisa Básica-LIM12, Faculdade de Medicina da Universidade de São Paulo, 01246-903 São Paulo, SP, Brazil
| | - Antonio Carlos Seguro
- Departamento de Nefrologia, Laboratório de Pesquisa Básica-LIM12, Faculdade de Medicina da Universidade de São Paulo, 01246-903 São Paulo, SP, Brazil
| | - Terezila Machado Coimbra
- Departamento de Fisiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, 14049-900 São Paulo, SP, Brazil
| | - Amélia Cristina Mendes de Magalhães
- Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, 45029-094 Vitória da Conquista, BA, Brazil
| | - Telma de Jesus Soares
- Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, 45029-094 Vitória da Conquista, BA, Brazil
| |
Collapse
|
27
|
Gois PHF, Martines MS, Ferreira D, Volpini R, Canale D, Malaque C, Crajoinas R, Girardi ACC, Massola Shimizu MH, Seguro AC. Allopurinol attenuates acute kidney injury following Bothrops jararaca envenomation. PLoS Negl Trop Dis 2017; 11:e0006024. [PMID: 29155815 PMCID: PMC5714385 DOI: 10.1371/journal.pntd.0006024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 12/04/2017] [Accepted: 10/09/2017] [Indexed: 02/07/2023] Open
Abstract
Snakebites have been recognized as a neglected public health problem in several tropical and subtropical countries. Bothrops snakebites frequently complicate with acute kidney injury (AKI) with relevant morbidity and mortality. To date, the only treatment available for Bothrops envenomation is the intravenous administration of antivenom despite its several limitations. Therefore, the study of novel therapies in Bothrops envenomation is compelling. The aim of this study was to evaluate the protective effect of Allopurinol (Allo) in an experimental model of Bothrops jararaca venom (BJ)-associated AKI. Five groups of Wistar rats were studied: Sham, Allo, BJ, BJ+Allo, BJ+ipAllo. BJ (0.25 mg/kg) was intravenously injected during 40'. Saline at same dose and infusion rate was administered to Sham and Allo groups. Allo and BJ+Allo groups received Allo (300 mg/L) in the drinking water 7 days prior to Saline or BJ infusion respectively. BJ+ipAllo rats received intraperitoneal Allo (25 mg/Kg) 40' after BJ infusion. BJ rats showed markedly reduced glomerular filtration rate (GFR, inulin clearance) associated with intense renal vasoconstriction, hemolysis, hemoglobinuria, reduced glutathione and increased systemic and renal markers of nitro-oxidative stress (Nitrotyrosine). Allo ameliorated GFR, renal blood flow (RBF), renal vascular resistance and arterial lactate levels. In addition, Allo was associated with increased serum glutathione as well as reduced levels of plasma and renal Nitrotyrosine. Our data show that Allo attenuated BJ-associated AKI, reduced oxidative stress, improved renal hemodynamics and organ perfusion. It might represent a novel adjuvant approach for Bothrops envenomation, a new use for an old and widely available drug.
Collapse
Affiliation(s)
- Pedro Henrique França Gois
- Laboratory of Medical Research–LIM12, Nephrology Department, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
- Royal Brisbane and Women’s Hospital, Nephrology Department, Brisbane, Australia
- * E-mail:
| | - Monique Silva Martines
- Laboratory of Medical Research–LIM12, Nephrology Department, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Daniela Ferreira
- Laboratory of Medical Research–LIM12, Nephrology Department, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Rildo Volpini
- Laboratory of Medical Research–LIM12, Nephrology Department, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Daniele Canale
- Laboratory of Medical Research–LIM12, Nephrology Department, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Ceila Malaque
- Vital Brazil Hospital, Butantan Institute, Sao Paulo, Brazil
| | - Renato Crajoinas
- Heart Institute (InCor), University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | | | - Maria Heloisa Massola Shimizu
- Laboratory of Medical Research–LIM12, Nephrology Department, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Antonio Carlos Seguro
- Laboratory of Medical Research–LIM12, Nephrology Department, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| |
Collapse
|
28
|
Gois PHF, Ferreira D, Olenski S, Seguro AC. Vitamin D and Infectious Diseases: Simple Bystander or Contributing Factor? Nutrients 2017; 9:E651. [PMID: 28672783 PMCID: PMC5537771 DOI: 10.3390/nu9070651] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/19/2017] [Accepted: 06/22/2017] [Indexed: 02/07/2023] Open
Abstract
Vitamin D (VD) is a fat-soluble steroid essential for life in higher animals. It is technically a pro-hormone present in few food types and produced endogenously in the skin by a photochemical reaction. In recent decades, several studies have suggested that VD contributes to diverse processes extending far beyond mineral homeostasis. The machinery for VD production and its receptor have been reported in multiple tissues, where they have a pivotal role in modulating the immune system. Similarly, vitamin D deficiency (VDD) has been in the spotlight as a major global public healthcare burden. VDD is highly prevalent throughout different regions of the world, including tropical and subtropical countries. Moreover, VDD may affect host immunity leading to an increased incidence and severity of several infectious diseases. In this review, we discuss new insights on VD physiology as well as the relationship between VD status and various infectious diseases such as tuberculosis, respiratory tract infections, human immunodeficiency virus, fungal infections and sepsis. Finally, we critically review the latest evidence on VD monitoring and supplementation in the setting of infectious diseases.
Collapse
Affiliation(s)
- Pedro Henrique França Gois
- Laboratory of Medical Research-LIM12, Nephrology Department, University of São Paulo School of Medicine, São Paulo CEP 01246-903, Brazil.
- Nephrology Department, Royal Brisbane and Women's Hospital, Herston QLD 4029, Australia.
| | - Daniela Ferreira
- Laboratory of Medical Research-LIM12, Nephrology Department, University of São Paulo School of Medicine, São Paulo CEP 01246-903, Brazil.
| | - Simon Olenski
- Nephrology Department, Royal Brisbane and Women's Hospital, Herston QLD 4029, Australia.
| | - Antonio Carlos Seguro
- Laboratory of Medical Research-LIM12, Nephrology Department, University of São Paulo School of Medicine, São Paulo CEP 01246-903, Brazil.
| |
Collapse
|
29
|
Savignano FA, Crajoinas RO, Pacheco BPM, Campos LCG, Shimizu MHM, Seguro AC, Girardi ACC. Attenuated diuresis and natriuresis in response to glucagon-like peptide-1 in hypertensive rats are associated with lower expression of the glucagon-like peptide-1 receptor in the renal vasculature. Eur J Pharmacol 2017; 811:38-47. [PMID: 28576404 DOI: 10.1016/j.ejphar.2017.05.054] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 05/25/2017] [Accepted: 05/29/2017] [Indexed: 12/26/2022]
Abstract
Accumulating evidence from clinical and experimental studies indicates that the incretin glucagon-like peptide-1 (GLP-1) elicits blood-pressure lowering effects via its diuretic, natriuretic and vasodilatory properties. The present study investigated whether acute infusion of GLP-1 induces diuresis and natriuresis in spontaneously hypertensive rats (SHRs). Additionally, we examined whether GLP-1 influences the vascular reactivity of the renal arteries of normotensive and hypertensive rats and elucidated the underlying mechanisms. We found that the increase in urinary output and urinary sodium excretion in response to systemic infusion of GLP-1 for 30min in SHRs was much less pronounced than in normotensive rats. The diuretic and natriuretic actions of GLP-1 in normotensive rats were accompanied by increases in GFR and RBF and a reduction in RVR through activation of the cAMP signaling pathway. However, no changes in renal hemodynamics were observed in SHRs. Similarly, GLP-1 induced an endothelium-independent relaxation effect in the renal arteries of normotensive rats, whereas the renal vasculature of SHRs was unresponsive to this vasodilator. The absence of a GLP-1-induced renal artery vasodilator effect in SHRs was associated with lower expression of the GLP-1 receptor, blunted GLP-1-induced increases in cAMP production and higher activity and expression of the GLP-1 inactivating enzyme dipeptidyl peptidase IV relative to the renal arteries of normotensive rats. Collectively, these results demonstrate that the renal acute responses to GLP-1 are attenuated in SHRs. Thus, chronic treatment with incretin-based agents may rely upon the upregulation of GLP-1/GLP-1 receptor signaling in the kidneys of hypertensive patients and experimental models.
Collapse
Affiliation(s)
- Fernanda A Savignano
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Renato O Crajoinas
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Bruna P M Pacheco
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Luciene C G Campos
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Maria Heloisa M Shimizu
- Department of Nephrology (LIM-12), University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Antonio Carlos Seguro
- Department of Nephrology (LIM-12), University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Adriana C C Girardi
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, São Paulo, Brazil.
| |
Collapse
|
30
|
Shimizu MHM, Gois PHF, Volpini RA, Canale D, Luchi WM, Froeder L, Heilberg IP, Seguro AC. N-acetylcysteine protects against star fruit-induced acute kidney injury. Ren Fail 2016; 39:193-202. [PMID: 27845599 PMCID: PMC6014349 DOI: 10.1080/0886022x.2016.1256315] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: Star fruit (SF) is a popular fruit, commonly cultivated in many tropical countries, that contains large amount of oxalate. Acute oxalate nephropathy and direct renal tubular damage through release of free radicals are the main mechanisms involved in SF-induced acute kidney injury (AKI). The aim of this study was to evaluate the protective effect of N-acetylcysteine (NAC) on SF-induced nephrotoxicity due to its potent antioxidant effect. Materials and methods: Male Wistar rats received SF juice (4 mL/100 g body weight) by gavage after a 12 h fasting and water deprivation. Fasting and water deprivation continued for 6 h thereafter to warrant juice absorption. Thereafter, animals were allocated to three experimental groups: SF (n = 6): received tap water; SF + NAC (n = 6): received NAC (4.8 g/L) in drinking water for 48 h after gavage; and Sham (n = 6): no interventions. After 48 h, inulin clearance studies were performed to determine glomerular filtration rate. In a second series of experiment, rats were housed in metabolic cages for additional assessments. Results: SF rats showed markedly reduced inulin clearance associated with hyperoxaluria, renal tubular damage, increased oxidative stress and inflammation. NAC treatment ameliorated all these alterations. Under polarized light microscopy, SF rats exhibited intense calcium oxalate birefringence crystals deposition, dilation of renal tubules and tubular epithelial degeneration, which were attenuate by NAC therapy. Conclusions: Our data show that therapeutic NAC attenuates renal dysfunction in a model of acute oxalate nephropathy following SF ingestion by reducing oxidative stress, oxaluria, and inflammation. This might represent a novel indication of NAC for the treatment of SF-induced AKI.
Collapse
Affiliation(s)
| | | | - Rildo Aparecido Volpini
- a Department of Nephrology, School of Medicine , University of São Paulo , São Paulo , Brazil
| | - Daniele Canale
- a Department of Nephrology, School of Medicine , University of São Paulo , São Paulo , Brazil
| | - Weverton Machado Luchi
- a Department of Nephrology, School of Medicine , University of São Paulo , São Paulo , Brazil
| | - Leila Froeder
- b Nephrology Division , Federal University of São Paulo , São Paulo , Brazil
| | | | - Antonio Carlos Seguro
- a Department of Nephrology, School of Medicine , University of São Paulo , São Paulo , Brazil
| |
Collapse
|
31
|
Malaque CMSA, de Bragança AC, Sanches TR, Volpini RA, Shimizu MH, Hiyane MI, Câmara NOS, Seguro AC, Andrade L. The role of dexamethasone in scorpion venom-induced deregulation of sodium and water transport in rat lungs. Intensive Care Med Exp 2015; 3:28. [PMID: 26392398 PMCID: PMC4577493 DOI: 10.1186/s40635-015-0063-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 09/10/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Severe scorpion envenomation can evolve to lung injury and, in some cases, death. The lung injury could be attributed to acute left ventricular failure and increased pulmonary vascular permeability secondary to the release of inflammatory mediators. In clinical practice, corticosteroids have been administered to reduce the early side effects of the anti-venom. We propose to study the effects of Tityus serrulatus venom and dexamethasone on pulmonary expression of sodium and water transporters, as well as on the inflammatory response. METHODS Wistar rats were injected intraperitoneally with saline (control group), dexamethasone, and saline (2.0 mg/kg body weight-60 min before saline injection; dexamethasone + saline group), venom (T. serrulatus venom-3.8 mg/kg body weight), or dexamethasone and venom (2.0 mg/kg body weight-60 min before venom injection; dexamethasone + venom group). At 60 min after venom/saline injection, experiments were performed in ventilated and non-ventilated animals. We analyzed sodium transporters, water transporters, and Toll-like receptor 4 (TLR4) by Western blotting, macrophage infiltration by immunohistochemistry, and serum interleukin (IL) by cytokine assay. RESULTS In the lung tissue of non-ventilated envenomed animals, protein expression of the epithelial sodium channel alpha subunit (α-ENaC) and aquaporin 5 (AQP5) were markedly downregulated whereas that of the Na-K-2Cl cotransporter (NKCC1) and TLR4 was elevated although expression of the Na,K-ATPase alpha 1 subunit was unaffected. Dexamethasone protected protein expression of α-ENaC, NKCC1, and TLR4 but not that of AQP5. We found that IL-6, IL-10, and tumor necrosis factor alpha were elevated in the venom and dexamethasone + venom groups although CD68 expression in lung tissue was elevated only in the venom group. Among the ventilated animals, both envenomed groups presented hypotension at 50 min after injection, and the arterial oxygen tension/fraction of inspired oxygen ratio was lower at 60 min than at baseline. CONCLUSIONS Our results suggest that T. serrulatus venom and dexamethasone both regulate sodium transport in the lung and that T serrulatus venom regulates sodium transport via the TLR4 pathway.
Collapse
Affiliation(s)
- Ceila Maria Sant Ana Malaque
- Nephrology Department, University of São Paulo School of Medicine, São Paulo, Brazil. .,Vital Brazil Hospital, Butantan Institute, São Paulo, Brazil.
| | | | - Talita Rojas Sanches
- Nephrology Department, University of São Paulo School of Medicine, São Paulo, Brazil.
| | | | - Maria Heloisa Shimizu
- Nephrology Department, University of São Paulo School of Medicine, São Paulo, Brazil.
| | - Meire Ioshie Hiyane
- Immunology Department, Biomedical Sciences Institute IV, University of São Paulo, São Paulo, Brazil.
| | | | - Antonio Carlos Seguro
- Nephrology Department, University of São Paulo School of Medicine, São Paulo, Brazil.
| | - Lucia Andrade
- Nephrology Department, University of São Paulo School of Medicine, São Paulo, Brazil.
| |
Collapse
|
32
|
Libório AB, Braz MBM, Seguro AC, Meneses GC, Neves FMDO, Pedrosa DC, Cavalcanti LPDG, Martins AMC, Daher EDF. Endothelial glycocalyx damage is associated with leptospirosis acute kidney injury. Am J Trop Med Hyg 2015; 92:611-6. [PMID: 25624405 DOI: 10.4269/ajtmh.14-0232] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Leptospirosis is a common disease in tropical countries, and the kidney is one of the main target organs. Membrane proteins of Leptospira are capable of causing endothelial damage in vitro, but there have been no studies in humans evaluating endothelial glycocalyx damage and its correlation with acute kidney injury (AKI). We performed a cohort study in an outbreak of leptospirosis among military personnel. AKI was diagnosed in 14 of 46 (30.4%) patients. Leptospirosis was associated with higher levels of intercellular adhesion molecule-1 (ICAM-1; 483.1 ± 31.7 versus 234.9 ± 24.4 mg/L, P < 0.001) and syndecan-1 (73.7 ± 15.9 versus 21.2 ± 7.9 ng/mL, P < 0.001) compared with exposed controls. Patients with leptospirosis-associated AKI had increased level of syndecan-1 (112.1 ± 45.4 versus 41.5 ± 11.7 ng/mL, P = 0.021) and ICAM-1 (576.9 ± 70.4 versus 434.9 ± 35.3, P = 0.034) compared with leptospirosis patients with no AKI. Association was verified between syndecan-1 and ICAM-1 with serum creatinine elevation and neutrophil gelatinase-associated lipocalin (NGAL) levels. This association remained even after multivariate analysis including other AKI-associated characteristics. Endothelial injury biomarkers are associated with leptospirosis-associated renal damage.
Collapse
Affiliation(s)
- Alexandre Braga Libório
- Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Medical Sciences Post-Graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Laboratório de Investigação Médica (LIM 12) do Hospital das Clínicas da Faculdade de Medicina USP, São Paulo, SP, Brazil; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil; Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil
| | - Marcelo Boecker Munoz Braz
- Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Medical Sciences Post-Graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Laboratório de Investigação Médica (LIM 12) do Hospital das Clínicas da Faculdade de Medicina USP, São Paulo, SP, Brazil; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil; Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil
| | - Antonio Carlos Seguro
- Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Medical Sciences Post-Graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Laboratório de Investigação Médica (LIM 12) do Hospital das Clínicas da Faculdade de Medicina USP, São Paulo, SP, Brazil; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil; Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil
| | - Gdayllon C Meneses
- Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Medical Sciences Post-Graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Laboratório de Investigação Médica (LIM 12) do Hospital das Clínicas da Faculdade de Medicina USP, São Paulo, SP, Brazil; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil; Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil
| | - Fernanda Macedo de Oliveira Neves
- Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Medical Sciences Post-Graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Laboratório de Investigação Médica (LIM 12) do Hospital das Clínicas da Faculdade de Medicina USP, São Paulo, SP, Brazil; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil; Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil
| | - Danielle Carvalho Pedrosa
- Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Medical Sciences Post-Graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Laboratório de Investigação Médica (LIM 12) do Hospital das Clínicas da Faculdade de Medicina USP, São Paulo, SP, Brazil; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil; Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil
| | - Luciano Pamplona de Góes Cavalcanti
- Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Medical Sciences Post-Graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Laboratório de Investigação Médica (LIM 12) do Hospital das Clínicas da Faculdade de Medicina USP, São Paulo, SP, Brazil; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil; Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil
| | - Alice Maria Costa Martins
- Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Medical Sciences Post-Graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Laboratório de Investigação Médica (LIM 12) do Hospital das Clínicas da Faculdade de Medicina USP, São Paulo, SP, Brazil; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil; Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil
| | - Elizabeth de Francesco Daher
- Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Medical Sciences Post-Graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Laboratório de Investigação Médica (LIM 12) do Hospital das Clínicas da Faculdade de Medicina USP, São Paulo, SP, Brazil; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil; Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil
| |
Collapse
|
33
|
Gois PHF, Canale D, Luchi WM, Volpini RA, Veras MM, Costa NDSX, Shimizu MHM, Seguro AC. Tenofovir during pregnancy in rats: a novel pathway for programmed hypertension in the offspring. J Antimicrob Chemother 2014; 70:1094-105. [PMID: 25492393 DOI: 10.1093/jac/dku483] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To evaluate the occurrence of systemic and renal abnormalities in the offspring of Wistar rats exposed to tenofovir disoproxil fumarate (DF) during pregnancy. METHODS Female Wistar rats received a standard diet, with or without addition of tenofovir DF (100 mg/kg diet), 1 week before mating and during pregnancy. Offspring from the tenofovir DF group were placed with an untreated foster mother during breastfeeding and compared with offspring from rats maintained on a standard diet during mating and pregnancy (control). Control and tenofovir DF were followed up at 3 and 6 months of age. Monthly body weight and systolic blood pressure (SBP), glomerular counts, renal function, biochemical parameters, angiotensin II, renal renin angiotensin aldosterone system (RAAS) and renal sodium transporters were analysed. RESULTS Tenofovir DF offspring showed lower birth weight compared with the control group. After the third month, growth among the tenofovir DF group experienced a rapid catch-up. SBP increased progressively after the second month of age in the tenofovir DF group. Nephron number did not differ between the groups; however, the tenofovir DF group showed glomerular structural changes. Plasma aldosterone was higher in the tenofovir DF group, associated with a significant increase in renal expression of RAAS. The tenofovir DF rats showed up-regulation of renal sodium transporters and consequently lower urinary sodium excretion. CONCLUSIONS This is the first demonstration using an experimental model that maternal exposure to tenofovir DF during gestation results in overactivation of RAAS, up-regulation of renal sodium transporters and hypertension in the offspring.
Collapse
Affiliation(s)
- Pedro Henrique França Gois
- Laboratory for Medical Research-LIM12, Nephrology Department, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Daniele Canale
- Laboratory for Medical Research-LIM12, Nephrology Department, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Weverton Machado Luchi
- Laboratory for Medical Research-LIM12, Nephrology Department, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Rildo Aparecido Volpini
- Laboratory for Medical Research-LIM12, Nephrology Department, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Mariana Matera Veras
- Laboratory of Experimental Air Pollution-LIM05, Department of Pathology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Natália de Souza Xavier Costa
- Laboratory of Experimental Air Pollution-LIM05, Department of Pathology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Maria Heloisa Massola Shimizu
- Laboratory for Medical Research-LIM12, Nephrology Department, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Antonio Carlos Seguro
- Laboratory for Medical Research-LIM12, Nephrology Department, University of São Paulo School of Medicine, São Paulo, Brazil
| |
Collapse
|
34
|
Canale D, de Bragança AC, Gonçalves JG, Shimizu MHM, Sanches TR, Andrade L, Volpini RA, Seguro AC. Vitamin D deficiency aggravates nephrotoxicity, hypertension and dyslipidemia caused by tenofovir: role of oxidative stress and renin-angiotensin system. PLoS One 2014; 9:e103055. [PMID: 25048368 PMCID: PMC4105615 DOI: 10.1371/journal.pone.0103055] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 06/25/2014] [Indexed: 02/05/2023] Open
Abstract
Vitamin D deficiency (VDD) is prevalent among HIV-infected individuals. Vitamin D has been associated with renal and cardiovascular diseases because of its effects on oxidative stress, lipid metabolism and renin-angiotensin-aldosterone system (RAAS). Tenofovir disoproxil fumarate (TDF), a widely used component of antiretroviral regimens for HIV treatment, can induce renal injury. The aim of this study was to investigate the effects of VDD on TDF-induced nephrotoxicity. Wistar rats were divided into four groups: control, receiving a standard diet for 60 days; VDD, receiving a vitamin D-free diet for 60 days; TDF, receiving a standard diet for 60 days with the addition of TDF (50 mg/kg food) for the last 30 days; and VDD+TDF receiving a vitamin D-free diet for 60 days with the addition of TDF for the last 30 days. TDF led to impaired renal function, hyperphosphaturia, hypophosphatemia, hypertension and increased renal vascular resistance due to downregulation of the sodium-phosphorus cotransporter and upregulation of angiotensin II and AT1 receptor. TDF also increased oxidative stress, as evidenced by higher TBARS and lower GSH levels, and induced dyslipidemia. Association of TDF and VDD aggravated renovascular effects and TDF-induced nephrotoxicity due to changes in the redox state and involvement of RAAS.
Collapse
Affiliation(s)
- Daniele Canale
- Nephrology Department, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | | | | | - Talita Rojas Sanches
- Nephrology Department, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Lúcia Andrade
- Nephrology Department, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Antonio Carlos Seguro
- Nephrology Department, University of São Paulo School of Medicine, São Paulo, Brazil
- * E-mail:
| |
Collapse
|
35
|
Pache de Faria Guimaraes L, Seguro AC, Shimizu MHM, Lopes Neri LA, Sumita NM, de Bragança AC, Aparecido Volpini R, Cunha Sanches TR, Macaferri da Fonseca FA, Moreira Filho CA, Vaisbich MH. N-acetyl-cysteine is associated to renal function improvement in patients with nephropathic cystinosis. Pediatr Nephrol 2014; 29:1097-102. [PMID: 24326786 DOI: 10.1007/s00467-013-2705-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 10/25/2013] [Accepted: 11/11/2013] [Indexed: 01/02/2023]
Abstract
BACKGROUND Nephropathic cystinosis is an autosomal recessive systemic severe disease characterized by intralysosomal cystine storage. Cysteamine is an essential component of treatment. There is solid evidence that cystine accumulation itself is not responsible for all abnormalities in cystinosis; there is also a deficiency of glutathione in the cytosol. Patients with cystinosis can be more susceptible to oxidative stress. CASE-DIAGNOSIS/TREATMENT The patient cohort comprised 23 cystinosis patients (16 males) aged <18 years (mean age 8.0 ± 3.6 years) with chronic kidney disease class I-IV with good adherence to treatment, including cysteamine. Oxidative stress was evaluated based on the levels of serum thiobarbituric acid-reactive substances (TBARS), and renal function was evaluated based on serum creatinine and cystatin C levels and creatinine clearance (Schwartz formula). N-Acetylcysteine (NAC), an antioxidant drug was given to all patients for 3 months (T1) at 25 mg/kg/day divided in three doses per day. The measured values at just before the initiation of NAC treatment (T0) served as the control for each patient. RESULTS Median serum TBARS levels at T0 and T1 were 6.92 (range 3.3-29.0) and 1.7 (0.6-7.2) nmol/mL, respectively (p < 0.0001). In terms of renal function at T0 and T1, serum creatinine levels (1.1 ± 0.5 vs. 0.9 ± 0.5 mg/dL, respectively; p < 0.0001), creatinine clearance (69.7 ± 32.2 vs. T1 = 78.5 ± 33.9 mL/min/1.73 m(2), respectively; p = 0.006), and cystatin c level (1.33 ± 0.53 vs. 1.15 ± 0.54 mg/l, respectively; p = 0.0057) were all significantly different at these two time points. Serum creatinine measurements at 6 (T -6) and 3 months (T -3) before NAC initiation and at 3 (T +3) and 6 months (T +6) after NAC had been withdrawn were also evaluated. CONCLUSION During the 3-month period that our 23 cystinosis patients were treated with NAC, oxidative stress was reduced and renal function significantly improved. No side-effects were detected. Larger and controlled studies are needed to confirm these findings.
Collapse
Affiliation(s)
- Luciana Pache de Faria Guimaraes
- Pediatric Nephrology Unit, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Machado JT, Iborra RT, Fusco FB, Castilho G, Pinto RS, Machado-Lima A, Nakandakare ER, Shimizu MHM, Seguro AC, Catanozi S, Passarelli M. Abstract 656: N-acetylcystein Reduces Lipid Peroxidation and Advanced Glycation Related to Prevention of Macrophage Endoplasmic Reticulum Stress Induced by Albumin Isolated from Rats With Chronic Kidney Disease. Arterioscler Thromb Vasc Biol 2014. [DOI: 10.1161/atvb.34.suppl_1.656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
We analyzed the influence of N-acetylcysteine (NAC) in chronic kidney disease (CKD) rats on the plasma concentration of lipid peroxides (TBARS) and advanced glycation end products (AGE) and on the impact of serum CKD-albumin in the development of macrophage endoplasmic reticulum stress (ERS).
Methods:
CKD was induced by 5/6 nephrectomy in 2-month old male Wistar rats. Controls (C) were sham operated. Animals were treated or not with NAC (600mg/L of water). FPLC isolated serum albumin was purified by alchoolic extraction. J774 macrophages were incubated with serum albumin (1mg/mL; 18h) from all groups, and the expression of ERS markers (protein disulfide isomerase - PDI and Grp94 chaperone) determined by immunoblot. Comparisons were done by one-way ANOVA, Student t test.
Results:
After 60 days of CKD, body weight was 10% lower in CKD compared to C (p<0.01). This was prevented by NAC. Urea, creatinine, total cholesterol (TC), triglycerides (TG) (mg/dL), urinary protein excretion (mg/24h) (C, n= 31; C+NAC, n=20; CKD, n=74; CKD+NAC, n=32), total AGE and pentosidine (n= 8; fluorescence arbitrary unit) and TBARS (n= 7; nmoL/mL) were higher in CKD (122±8; 0.9±0.07; 151±6; 83±4; 46±2.5; 32620±673; 16700±1370; 6.6±0.5, respectively) and in CKD+NAC (91.4±5; 0.6±0.02; 126±7.5; 73±6; 51±3.5; 24,720±1,114; 10,080±748; 4.5±0.5, respectively) in comparison to C (41±0.9; 0.4±0.03; 76±2.7; 51.5±3; 14±0.9; 21,750±960; 5,314±129; 2±0.2, respectively; p<0.001) and C+NAC (40±0.9; 0.3±0.02; 76±2.6; 68±4; 18.4±1.5; 20,040±700; 5,050±267; 1.8±0.2, respectively; p<0,001). TC, urea, creatinine, total AGE, pentosidine and TBARS were respectively, 17%, 25%, 33%, 24%, 40% and 28% (p<0.01) lower in CKD+NAC, than in CKD. Glycemia was higher in C+NAC (107±4.6) and CKD+NAC (107±2.6) than in C (96±1.8; p<0.05) and CKD (98±1.6; p<0.01), respectively. In macrophages (n=6), CKD albumin increased PDI (5 and 7 times, p<0.01) and Grp94 (66% and 80%, p<0.01) in comparison to C and CKD+NAC-albumin treated cells, respectively.
Conclusion:
NAC reduces plasma lipid peroxidation and AGE and abrogates ERS induced by CKD-albumin. This may contribute to attenuate the deleterious effects of CKD-albumin on lipid accumulation in macrophages helping preventing atherogenesis in CKD.
Collapse
Affiliation(s)
- Juliana T Machado
- Lipids Laboratory (LIM 10), Faculty of Medicine of Univ of São Paulo, São Paulo, Brazil
| | - Rodrigo T Iborra
- Lipids Laboratory (LIM 10), Faculty of Medicine of Univ of São Paulo, São Paulo, Brazil
| | - Fernanda B Fusco
- Lipids Laboratory (LIM 10), Faculty of Medicine of Univ of São Paulo, São Paulo, Brazil
| | - Gabriela Castilho
- Lipids Laboratory (LIM 10), Faculty of Medicine of Univ of São Paulo, São Paulo, Brazil
| | - Raphael S Pinto
- Lipids Laboratory (LIM 10), Faculty of Medicine of Univ of São Paulo, São Paulo, Brazil
| | - Adriana Machado-Lima
- Lipids Laboratory (LIM 10), Faculty of Medicine of Univ of São Paulo, São Paulo, Brazil
| | - Edna R Nakandakare
- Lipids Laboratory (LIM 10), Faculty of Medicine of Univ of São Paulo, São Paulo, Brazil
| | - Maria Heloisa M Shimizu
- Laboratory of Basic Rsch in Kidney Disease (LIM 12), Faculty of Medicine of Univ of São Paulo, São Paulo, Brazil
| | - Antonio Carlos Seguro
- Laboratory of Basic Rsch in Kidney Disease (LIM 12), Faculty of Medicine of Univ of São Paulo, São Paulo, Brazil
| | - Sergio Catanozi
- Lipids Laboratory (LIM 10), Faculty of Medicine of Univ of São Paulo, São Paulo, Brazil
| | - Marisa Passarelli
- Lipids Laboratory (LIM 10), Faculty of Medicine of Univ of São Paulo, São Paulo, Brazil
| |
Collapse
|
37
|
Shimizu MH, Volpini RA, de Bragança AC, Campos R, Canale D, Sanches TR, Andrade L, Seguro AC. Corrigendum to: “N-acetylcysteine attenuates renal alterations induced by senescence in the rat.” [Exp Gerontol. 2013 Feb;48(2):298–303]. Exp Gerontol 2013. [DOI: 10.1016/j.exger.2013.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
38
|
De Brito T, Aiello VD, da Silva LFF, Gonçalves da Silva AM, Ferreira da Silva WL, Castelli JB, Seguro AC. Human hemorrhagic pulmonary leptospirosis: pathological findings and pathophysiological correlations. PLoS One 2013; 8:e71743. [PMID: 23951234 PMCID: PMC3741125 DOI: 10.1371/journal.pone.0071743] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 06/26/2013] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Leptospirosis is a re-emerging zoonosis with protean clinical manifestations. Recently, the importance of pulmonary hemorrhage as a lethal complication of this disease has been recognized. In the present study, five human necropsies of leptospirosis (Weil's syndrome) with extensive pulmonary manifestations were analysed, and the antibodies expressed in blood vessels and cells involved in ion and water transport were used, seeking to better understand the pathophysiology of the lung injury associated with this disease. PRINCIPAL FINDINGS Prominent vascular damage was present in the lung microcirculation, with decreased CD34 and preserved aquaporin 1 expression. At the periphery and even inside the extensive areas of edema and intraalveolar hemorrhage, enlarged, apparently hypertrophic type I pneumocytes (PI) were detected and interpreted as a non-specific attempt of clearence of the intraalveolar fluid, in which ionic transport, particularly of sodium, plays a predominant role, as suggested by the apparently increased ENaC and aquaporin 5 expression. Connexin 43 was present in most pneumocytes, and in the cytoplasm of the more preserved endothelial cells. The number of type II pneumocytes (PII) was slightly decreased when compared to normal lungs and those of patients with septicemia from other causes, a fact that may contribute to the progressively low PI count, resulting in deficient restoration after damage to the alveolar epithelial integrity and, consequently, a poor outcome of the pulmonary edema and hemorrhage. CONCLUSIONS Pathogenesis of lung injury in human leptospirosis was discussed, and the possibility of primary non-inflammatory vascular damage was considered, so far of undefinite etiopathogenesis, as the initial pathological manifestation of the disease.
Collapse
Affiliation(s)
- Thales De Brito
- Institute of Tropical Medicine, São Paulo University Medical School, São Paulo, Brazil.
| | | | | | | | | | | | | |
Collapse
|
39
|
Campos R, Shimizu MHM, Volpini RA, de Bragança AC, Andrade L, Lopes FDTQDS, Olivo C, Canale D, Seguro AC. N-acetylcysteine prevents pulmonary edema and acute kidney injury in rats with sepsis submitted to mechanical ventilation. Am J Physiol Lung Cell Mol Physiol 2012; 302:L640-50. [PMID: 22268121 DOI: 10.1152/ajplung.00097.2011] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Sepsis is a common cause of acute kidney injury (AKI) and acute lung injury. Oxidative stress plays as important role in such injury. The aim of this study was to evaluate the effects that the potent antioxidant N-acetylcysteine (NAC) has on renal and pulmonary function in rats with sepsis. Rats, treated or not with NAC (4.8 g/l in drinking water), underwent cecal ligation and puncture (CLP) 2 days after the initiation of NAC treatment, which was maintained throughout the study. At 24 h post-CLP, renal and pulmonary function were studied in four groups: control, control + NAC, CLP, and CLP + NAC. All animals were submitted to low-tidal-volume mechanical ventilation. We evaluated respiratory mechanics, the sodium cotransporters Na-K-2Cl (NKCC1) and the α-subunit of the epithelial sodium channel (α-ENaC), polymorphonuclear neutrophils, the edema index, oxidative stress (plasma thiobarbituric acid reactive substances and lung tissue 8-isoprostane), and glomerular filtration rate. The CLP rats developed AKI, which was ameliorated in the CLP + NAC rats. Sepsis-induced alterations in respiratory mechanics were also ameliorated by NAC. Edema indexes were lower in the CLP + NAC group, as was the wet-to-dry lung weight ratio. In CLP + NAC rats, α-ENaC expression was upregulated, whereas that of NKCC1 was downregulated, although the difference was not significant. In the CLP + NAC group, oxidative stress was significantly lower and survival rates were significantly higher than in the CLP group. The protective effects of NAC (against kidney and lung injury) are likely attributable to the decrease in oxidative stress, suggesting that NAC can be useful in the treatment of sepsis.
Collapse
Affiliation(s)
- Renata Campos
- Laboratory for Medical Research, Nephrology Department, University of SãoPaulo School of Medicine, São Paulo, Brazil
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Souza ACCPD, Volpini RA, Shimizu MH, Sanches TR, Camara NOS, Semedo P, Rodrigues CE, Seguro AC, Andrade L. Erythropoietin prevents sepsis-related acute kidney injury in rats by inhibiting NF-κB and upregulating endothelial nitric oxide synthase. Am J Physiol Renal Physiol 2012; 302:F1045-54. [PMID: 22237800 DOI: 10.1152/ajprenal.00148.2011] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The pathophysiology of sepsis involves complex cytokine and inflammatory mediator networks, a mechanism to which NF-κB activation is central. Downregulation of endothelial nitric oxide synthase (eNOS) contributes to sepsis-induced endothelial dysfunction. Erythropoietin (EPO) has emerged as a major tissue-protective cytokine in the setting of stress. We investigated the role of EPO in sepsis-related acute kidney injury using a cecal ligation and puncture (CLP) model. Wistar rats were divided into three primary groups: control (sham-operated); CLP; and CLP+EPO. EPO (4,000 IU/kg body wt ip) was administered 24 and 1 h before CLP. Another group of rats received N-nitro-l-arginine methyl ester (l-NAME) simultaneously with EPO administration (CLP+EPO+l-NAME). A fifth group (CLP+EPOtreat) received EPO at 1 and 4 h after CLP. At 48 h postprocedure, CLP+EPO rats presented significantly higher inulin clearance than did CLP and CLP+EPO+l-NAME rats; hematocrit levels, mean arterial pressure, and metabolic balance remained unchanged in the CLP+EPO rats; and inulin clearance was significantly higher in CLP+EPOtreat rats than in CLP rats. At 48 h after CLP, creatinine clearance was significantly higher in the CLP+EPO rats than in the CLP rats. In renal tissue, pre-CLP EPO administration prevented the sepsis-induced increase in macrophage infiltration, as well as preserving eNOS expression, EPO receptor (EpoR) expression, IKK-α activation, NF-κB activation, and inflammatory cytokine levels, thereby increasing survival. We conclude that this protection, which appears to be dependent on EpoR activation and on eNOS expression, is attributable, in part, to inhibition of the inflammatory response via NF-κB downregulation.
Collapse
|
41
|
Sanches TR, Volpini RA, Massola Shimizu MH, Bragança ACD, Oshiro-Monreal F, Seguro AC, Andrade L. Sildenafil reduces polyuria in rats with lithium-induced NDI. Am J Physiol Renal Physiol 2012; 302:F216-25. [PMID: 22031848 DOI: 10.1152/ajprenal.00439.2010] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Lithium (Li)-treated patients often develop urinary concentrating defect and polyuria, a condition known as nephrogenic diabetes insipidus (NDI). In a rat model of Li-induced NDI, we studied the effect that sildenafil (Sil), a phosphodiesterase 5 (PDE5) inhibitor, has on renal expression of aquaporin-2 (AQP2), urea transporter UT-A1, Na(+)/H(+) exchanger 3 (NHE3), Na(+)-K(+)-2Cl(-) cotransporter (NKCC2), epithelial Na channel (ENaC; α-, β-, and γ-subunits), endothelial nitric oxide synthase (eNOS), and inducible nitric oxide synthase. We also evaluated cGMP levels in medullary collecting duct cells in suspension. For 4 wk, Wistar rats received Li (40 mmol/kg food) or no treatment (control), some receiving, in weeks 2-4, Sil (200 mg/kg food) or Li and Sil (Li+Sil). In Li+Sil rats, urine output and free water clearance were markedly lower, whereas urinary osmolality was higher, than in Li rats. The cGMP levels in the suspensions of medullary collecting duct cells were markedly higher in the Li+Sil and Sil groups than in the control and Li groups. Semiquantitative immunoblotting revealed the following: in Li+Sil rats, AQP2 expression was partially normalized, whereas that of UT-A1, γ-ENaC, and eNOS was completely normalized; and expression of NKCC2 and NHE3 was significantly higher in Li rats than in controls. Inulin clearance was normal in all groups. Mean arterial pressure and plasma arginine vasopressin did not differ among the groups. Sil completely reversed the Li-induced increase in renal vascular resistance. We conclude that, in experimental Li-induced NDI, Sil reduces polyuria, increases urinary osmolality, and decreases free water clearance via upregulation of renal AQP2 and UT-A1.
Collapse
Affiliation(s)
- Talita Rojas Sanches
- Nephrology Dept., Univ. of São Paulo School of Medicine, Av. Dr. Arnaldo, 455, 3° andar, sala 3310, CEP 01246-903, São Paulo, Brazil
| | | | | | | | | | | | | |
Collapse
|
42
|
Favaro VF, Oshiro-Monreal FM, de Bragança AC, Andrade L, Seguro AC, Helou CMB. High cholesterol feeding may induce tubular dysfunction resulting in hypomagnesemia. Kidney Blood Press Res 2011; 35:137-46. [PMID: 22104091 DOI: 10.1159/000332399] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 08/28/2011] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND/AIMS Hypomagnesemia may induce hypercholesterolemia, but the contrary has not been described yet. Thus, magnesium homeostasis was evaluated in rats fed a cholesterol-enriched diet for 8 days. This study has a relevant clinical application if hypomagnesemia, due to hypercholesterolemia, is confirmed in patients with long-term hypercholesterolemia. METHODS Both hypercholesterolemic (HC) and normocholesterolemic rats (NC) were divided into sets of experiments to measure hemodynamic parameters, physiological data, maximum capacity to dilute urine (C(H)((2))(O)), variations (Δ) in [Ca(2+)](i) and the expression of transporter proteins. RESULTS HC developed hypomagnesemia and showed high magnesuria in the absence of hemodynamic abnormalities. However, the urinary sodium excretion and C(H)((2))(O) in HC was similar to NC. On the other hand, the responses to angiotensin II by measuring Δ [Ca(2+)](i) were higher in the thick ascending limb of Henle's loop (TAL) of HC than NC. Moreover, high expression of the cotransporter NKCC2 was found in renal outer medulla fractions of HC. Taken together, the hypothesis of impairment in TAL was excluded. Actually, the expression of the epithelial Mg(2+) channel in renal cortical membrane fractions was reduced in HC. CONCLUSION Impairment in distal convoluted tubule induced by hypercholesterolemia explains high magnesuria and hypomagnesemia observed in HC.
Collapse
Affiliation(s)
- Vanessa F Favaro
- Laboratório de Pesquisa Básica (LIM-12), Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | | |
Collapse
|
43
|
Abstract
Background/Aims Nephropathic cystinosis (NC) is a severe systemic disease and cysteamine improves its prognosis. Lysosomal cystine accumulation is the hallmark of cystinosis and is regarded as the primary defect due to mutations in the CTNS gene. However, there is great evidence that cystine accumulation itself is not responsible for all abnormalities observed in NC. Studies have demonstrated altered ATP metabolism, increased apoptosis, and cell oxidation. An increased number of autophagosomes and autophagic vacuoles have been observed in cystinotic fibroblasts and renal epithelial cells, suggesting that altered autophagy plays a role in NC, leading to increased production of reactive oxygen species. Therefore, cystinosis patients can be more susceptible to oxidative stress (OS) and it can contribute to the progression of the renal disease. Our goal was to evaluate a marker of OS (serum TBARS) in NC children, and to compare the results with those observed in healthy controls and correlated with renal function parameters. Methods The study included patients aged under 18 years, with good adherence to the treatment and out of renal replacement therapy. The following parameters were evaluated: serum creatinine, BUN, creatinine clearance estimated by stature and serum TBARS levels. Results We selected 20 patients aged 8.0 ±3.6 years and observed serum TBARS levels of 4.03 ±1.02 nmol/ml. Serum TBARS levels in the 43 healthy controls, aged 7.4 ±1.1 years, were 1.60 ±0.04 nmol/ml. There was a significant difference between the plasma TBARS levels among the 2 groups (p < 0.0001). We detected no significant correlation between plasma TBARS levels and renal function. Conclusion An increased level of serum TBARS in patients with NC was observed and this abnormality was not correlated with the renal function status degree. This is the first report that shows increased oxidative stress in serum of NC patients.
Collapse
Affiliation(s)
- Maria Helena Vaisbich
- Pediatric Nephrology Unit, Instituto da Criança, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | |
Collapse
|
44
|
Seguro AC, Poli de Figueiredo LF, Shimizu MHM. N-acetylcysteine (NAC) protects against acute kidney injury (AKI) following prolonged pneumoperitoneum in the rat. J Surg Res 2011; 175:312-5. [PMID: 21764077 DOI: 10.1016/j.jss.2011.05.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 05/13/2011] [Accepted: 05/25/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) following prolonged laparoscopy is a documented phenomenon. Carbon dioxide pneumoperitoneum induces oxidative stress. Previous experimental studies have shown that the antioxidant, N-acetylcysteine, protects the rat from AKI following ischemia-reperfusion. The aim of this study was to evaluate the effects of N-acetylcysteine (NAC) on rat renal function after prolonged pneumoperitoneum. METHODS Normal rats treated or not with NAC were submitted to abdominal CO(2) insufflation of 10 mmHg, at short and long periods of time of 1 and 3 h, respectively, and evaluated at 24, 72 h, and 1 wk after deinsufflation. Glomerular filtration rate (GFR) was measured by inulin clearance and oxidative stress was evaluated by serum thiobarbituric acid reactive substances (TBARS) RESULTS: No significant alterations in GFR were observed in normal animals submitted to the pneumoperitoneum of 1 h and evaluated after 24 h desufflation. With 3 h of pneumoperitoneum, a significant and progressive decrease in GFR occurred 24 and 72 h after desufflation with an increase in serum TBARS. GFR returned to normal levels a week later. In the NAC-treated rats, a complete protection against GFR drops was observed 24 and 72 h following 3 h of pneumoperitoneum associated with a decrease in TBARS. CONCLUSION These results suggest that NAC protects against acute kidney injury following prolonged pneumoperitoneum. These findings have significant clinical implications.
Collapse
Affiliation(s)
- Antonio Carlos Seguro
- Department of Nephrology, University of São Paulo-School of Medicine, São Paulo, Brazil.
| | | | | |
Collapse
|
45
|
Neves M, Gualano B, Roschel H, Lima FR, Lúcia de Sá-Pinto A, Seguro AC, Shimizu MH, Sapienza MT, Fuller R, Lancha AH, Bonfá E. Effect of creatine supplementation on measured glomerular filtration rate in postmenopausal women. Appl Physiol Nutr Metab 2011; 36:419-22. [DOI: 10.1139/h11-014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We aimed to investigate whether creatine supplementation affects the measured glomerular filtration rate in postmenopausal women (age, 58 ± 3 years). Subjects were randomly assigned to receive either creatine (20 g·day–1 for 1 week and 5 g·day–1 thereafter) or a placebo. Kidney function was assessed at baseline and after 12 weeks. [51Cr]EDTA clearance remained unchanged (CR-PRE: 86.16 ± 14.36 mL·min–1 per 1.73 m2, POST: 87.25 ± 17.60 mL·min–1 per 1.73 m2; PL-PRE: 85.15 ± 8.54 mL·min–1 per 1.73 m2, POST: 87.18 ± 9.64 mL·min–1 per 1.73 m2; p = 0.81). Thus, we concluded that creatine supplementation does not affect glomerular filtration rate in postmenopausal women.
Collapse
Affiliation(s)
- Manoel Neves
- Division of Rheumatology, School of Medicine, University of São Paulo, São Paulo 01246-903, Brazil
| | - Bruno Gualano
- Division of Rheumatology, School of Medicine, University of São Paulo, São Paulo 01246-903, Brazil
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Hamilton Roschel
- Division of Rheumatology, School of Medicine, University of São Paulo, São Paulo 01246-903, Brazil
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Fernanda Rodrigues Lima
- Division of Rheumatology, School of Medicine, University of São Paulo, São Paulo 01246-903, Brazil
| | - Ana Lúcia de Sá-Pinto
- Division of Rheumatology, School of Medicine, University of São Paulo, São Paulo 01246-903, Brazil
| | - Antonio Carlos Seguro
- Division of Nephrology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Maria Heloisa Shimizu
- Division of Nephrology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marcelo Tatit Sapienza
- Division of Nuclear Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ricardo Fuller
- Division of Rheumatology, School of Medicine, University of São Paulo, São Paulo 01246-903, Brazil
| | | | - Eloisa Bonfá
- Division of Rheumatology, School of Medicine, University of São Paulo, São Paulo 01246-903, Brazil
| |
Collapse
|
46
|
Santos MSB, Seguro AC, Andrade L. Hypomagnesemia is a risk factor for nonrecovery of renal function and mortality in AIDS patients with acute kidney injury. Braz J Med Biol Res 2010; 43:316-23. [PMID: 20401440 DOI: 10.1590/s0100-879x2010007500002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 01/07/2010] [Indexed: 11/22/2022] Open
Abstract
The objective of the present study was to determine the prevalence of electrolyte disturbances in AIDS patients developing acute kidney injury in the hospital setting, as well as to determine whether such disturbances constitute a risk factor for nephrotoxic and ischemic injury. A prospective, observational cohort study was carried out. Hospitalized AIDS patients were evaluated for age; gender; coinfection with hepatitis; diabetes mellitus; hypertension; time since HIV seroconversion; CD4 count; HIV viral load; proteinuria; serum levels of creatinine, urea, sodium, potassium and magnesium; antiretroviral use; nephrotoxic drug use; sepsis; intensive care unit (ICU) admission, and the need for dialysis. Each of these characteristics was correlated with the development of acute kidney injury, with recovery of renal function and with survival. Fifty-four patients developed acute kidney injury: 72% were males, 59% had been HIV-infected for >5 years, 72% had CD4 counts <200 cells/mm(3), 87% developed electrolyte disturbances, 33% recovered renal function, and 56% survived. ICU admission, dialysis, sepsis and hypomagnesemia were all significantly associated with nonrecovery of renal function and with mortality. Nonrecovery of renal function was significantly associated with hypomagnesemia, as was mortality in the multivariate analysis. The risks for nonrecovery of renal function and for death were 6.94 and 6.92 times greater, respectively, for patients with hypomagnesemia. In hospitalized AIDS patients, hypomagnesemia is a risk factor for nonrecovery of renal function and for in-hospital mortality. To determine whether hypomagnesemia is a determinant or simply a marker of critical illness, further studies involving magnesium supplementation in AIDS patients are warranted.
Collapse
|
47
|
Gualano B, de Salles Painelli V, Roschel H, Lugaresi R, Dorea E, Artioli GG, Lima FR, da Silva MER, Cunha MR, Seguro AC, Shimizu MH, Otaduy MCG, Sapienza MT, da Costa Leite C, Bonfá E, Lancha Junior AH. Creatine supplementation does not impair kidney function in type 2 diabetic patients: a randomized, double-blind, placebo-controlled, clinical trial. Eur J Appl Physiol 2010; 111:749-56. [DOI: 10.1007/s00421-010-1676-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2010] [Indexed: 10/18/2022]
|
48
|
de Souza AL, Seguro AC. The fundamental nature of meningococcal disease. J Adolesc Health 2010; 46:613. [PMID: 20472222 DOI: 10.1016/j.jadohealth.2010.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2010] [Accepted: 03/02/2010] [Indexed: 11/29/2022]
|
49
|
Semedo P, Correa-Costa M, Antonio Cenedeze M, Maria Avancini Costa Malheiros D, Antonia dos Reis M, Shimizu MH, Seguro AC, Pacheco-Silva A, Saraiva Camara NO. Mesenchymal stem cells attenuate renal fibrosis through immune modulation and remodeling properties in a rat remnant kidney model. Stem Cells 2010; 27:3063-73. [PMID: 19750536 DOI: 10.1002/stem.214] [Citation(s) in RCA: 201] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Mesenchymal stem cells (MSCs) have regenerative properties in acute kidney injury, but their role in chronic kidney diseases is still unknown. More specifically, it is not known whether MSCs halt fibrosis. The purpose of this work was to investigate the role of MSCs in fibrogenesis using a model of chronic renal failure. MSCs were obtained from the tibias and femurs of male Wistar-EPM rats. Female Wistar rats were subjected to the remnant model, and 2|x|10(5) MSCs were intravenously administrated to each rat every other week for 8 weeks or only once and followed for 12 weeks. SRY gene expression was observed in female rats treated with male MSCs, and immune localization of CD73(+)CD90(+) cells at 8 weeks was also assessed. Serum and urine analyses showed an amelioration of functional parameters in MSC-treated animals at 8 weeks, but not at 12 weeks. Masson's trichrome and Sirius red staining demonstrated reduced levels of fibrosis in MSC-treated animals. These results were corroborated by reduced vimentin, type I collagen, transforming growth factor beta, fibroblast specific protein 1 (FSP-1), monocyte chemoattractant protein 1, and Smad3 mRNA expression and alpha smooth muscle actin and FSP-1 protein expression. Renal interleukin (IL)-6 and tumor necrosis factor alpha mRNA expression levels were significantly decreased after MSC treatment, whereas IL-4 and IL-10 expression levels were increased. All serum cytokine expression levels were decreased in MSC-treated animals. Taken together, these results suggested that MSC therapy can indeed modulate the inflammatory response that follows the initial phase of a chronic renal injury. The immunosuppressive and remodeling properties of MSCs may be involved in the decreased fibrosis in the kidney.
Collapse
Affiliation(s)
- Patricia Semedo
- Nephrology Division, Medicine Department, Federal University of São Paulo, 05508-900 São Paulo, SP, Brazil
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Araujo ER, Seguro AC, Spichler A, Magaldi AJ, Volpini RA, De Brito T. Acute kidney injury in human leptospirosis: an immunohistochemical study with pathophysiological correlation. Virchows Arch 2010; 456:367-75. [PMID: 20217429 DOI: 10.1007/s00428-010-0894-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 01/26/2010] [Accepted: 02/11/2010] [Indexed: 10/19/2022]
Abstract
Tubulointerstitial nephritis is a common clinicopathological finding in leptospirosis. Clinically, nonoliguric acute kidney injury (AKI), hypokalemia, sodium, and magnesium wasting frequently occur in leptospirosis. The exact mechanisms of renal involvement remain largely unclear. Immunohistochemistry to detect expression of the endogenous sodium/hydrogen exchanger isoform 3 (NHE 3), aquaporin 1 and 2, alpha-Na(+)K(+)ATPase, and sodium-potassium-chloride cotransporter in its NKCC2 isoform was performed on kidneys removed during autopsy of human leptospirosis cases and kidneys removed during autopsy of human non-leptospirosis cases with and without evidence of acute tubular necrosis (ATN). A decrease in NHE 3, aquaporin 1, and alpha-Na(+)K(+)ATPase expression occurred in proximal convoluted tubule cells. Expression of aquaporin 1 was preserved along the descending thin limb of the loop of Henle in the outer medulla. alpha-Na(+)K(+)ATpase expression was essentially preserved in the distal tubules, i.e., the thick ascending limb of the loop of Henle, macula densa, and distal convoluted tubule. Aquaporin 2 expression in the collecting tubules was enhanced compared to those of non-leptospirotic kidneys. NKCC2 cotransport isoform was expressed in the thick ascending limb of the loop of Henle and was essentially preserved in leptospirotic kidneys. Primary injury of the proximal convoluted tubules is regarded as the hallmark of the kidney in leptospirosis. Sodium and water transport are particularly affected with increased distal potassium excretion, hypokalemia, and polyuria. Enhanced expression of aquaporin 2 in medullary collecting tubules is probably an attempt to retain water during the nonoliguric phase of renal failure.
Collapse
Affiliation(s)
- Eduardo Rocha Araujo
- Department of Pathology, S. Paulo University Medical School, Av. Dr. Enéas de Carvalho Aguiar 470, São Paulo, Brazil
| | | | | | | | | | | |
Collapse
|