Renal and hepatic mitochondrial effects of diuretics in the rat

Mitochondrial Dysfunction in Kidney Tubulopathies

Mitochondria play a key role in kidney physiology and pathology. They produce ATP to fuel energy-demanding water and solute reabsorption processes along the nephron. Moreover, mitochondria contribute to cellular health by the regulation of autophagy, (oxidative) stress responses, and apoptosis. Mitochondrial abundance is particularly high in cortical segments, including proximal and distal convoluted tubules. Dysfunction of the mitochondria has been described for tubulopathies such as Fanconi, Gitelman, and Bartter-like syndromes and renal tubular acidosis. In addition, mitochondrial cytopathies often affect renal (tubular) tissues, such as in Kearns-Sayre and Leigh syndromes. Nevertheless, the mechanisms by which mitochondrial dysfunction results in renal tubular diseases are only scarcely being explored. This review provides an overview of mitochondrial dysfunction in the development and progression of kidney tubulopathies. Furthermore, it emphasizes the need for further mechanistic investigations to identify links between mitochondrial function and renal electrolyte reabsorption.

Effect of acetazolamide on renal metabolism and ammoniagenesis in the dog

The effect of acetazolamide (ACZ) on renal metabolism and ammoniagenesis was studied in the dog in vivo and in vitro. ACZ was administered to 10 dogs with normal acid-base status and five with chronic metabolic acidosis induced by NH4Cl. In both groups of dogs, the acute administration of ACZ markedly reduced the urinary excretion of ammonium (from 33 to 10 in normal dogs and from 100 to 23 mumoles/100 ml GFR in acidotic dogs) whereas its release into the renal vein was increased in a reciprocal fashion (from 69 to 95 in normal dogs and from 91 to 152 mumoles/100 ml GFR in acidotic dogs). ACZ did not change the total ammonium production nor the renal glutamine utilization. The renal utilization or production of glutamate, alphaketoglutarate, alanine and citrate also remained unchanged. Despite a marked urinary alkalinization, citraturia remained minimal. However, the renal cortical concentrations of glutamine, glutamate, succinate, fumarate, malate, aspartate and phosphoenolpyruvate fell following ACZ administration, especially in acidotic dogs showing rapid renal utilization of glutamine. ACZ had no effect on the same metabolites in the kidney of normal dogs even when lactate utilization was enhanced by lactate infusion. This study demonstrates that an accelerated ammoniagenic flux can proceed in the dog kidney without the renal cortical changes produced by metabolic acidosis in this species. In vitro, using dog tubules, a selective effect of ACZ on glutamine metabolism as compared to lactate was observed. ACZ reduce the rate of the reactions catalyzed by alphaketoglutarate dehydrogenase and by succinyl CoA synthetase. Other enzymes of the ammoniagenic and gluconeogenic pathways (glutaminase, GLDH, malic enzyme, PEPCK) were not changed by ACZ. The metabolic effects of ACZ observed in the intact kidney in vivo or with tubules in vitro may be in part related to the effect of ACZ on these enzymes critical for the ammoniagenic process.

Effects of ethacrynic acid on ion transport and energy metabolism in slices of avian salt gland and of mammalian liver and kidney cortex

Ethacrynic acid greatly inhibited net transport of ions and aerobic, energy-conserving metabolism in slices of avian salt gland, rat liver, and rat and guinea-pig kidney cortex. The effects of increasing concentrations of ethacrynic acid on the transport of Na+, K+ and Cl- ran closely parallel to its effects on tissue ATP levels and respiration. The concentration needed for maximal inhibition of transport reduced ATP levels by 80--90%. Respiration was reduced by 80--90% in salt gland and kidney cortex, and by a maximum of 30% in liver slices. The effects of low concentrations of ethacrynic acid required time to become fully manifest in some tissues, and the development of transport inhibition followed a similar course to decline of respiration and ATP levels. Ca2+ extrusion by liver cells was inhibited by ethacrynic acid. The concentration dependence of the inhibition was similar to that shown by the other transport systems inhibited. There was no distinction evident between the sensitivity of Na+ extrusion and of K+ accumulation to the diuretic. Lactate production increased as respiration decreased in the presence of increasing concentrations of ethacrynic acid. We conclude that ethacrynic acid acted primarily as an inhibitor of mitochondrial respiration and ATP synthesis in the tissue slices, and that inhibition of ion transport was a nonspecific consequence of the failure of the energy supply.