The mechanisms of target cell injury by nephrotoxins

Renal papillary necrosis--40 years on

Analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) are well recognized as a major class of therapeutic agent that causes renal papillary necrosis (RPN). Over the last decade a broad spectrum of other therapeutic agents and many chemicals have also been reported that have the potential to cause this lesion in animals and man. There is consensus that RPN is the primary lesion that can progress to cortical degeneration; and it is only at this stage that the lesion is easily diagnosed. In the absence of sensitive and selective noninvasive biomarkers of RPN there is still no clear indication of which compound, under what circumstances, has the greatest potential to cause this lesion in man. Attempts to mimic RPN in rodents using analgesics and NSAIDs have not provided robust models of the lesion. Thus, much of the research has concentrated on those compounds that cause an acute or subacute RPN as the basis by which to study the pathogenesis of the lesion. Based on the mechanistic understanding gleaned from these model compounds it has been possible to transpose an understanding of the underlying processes to the analgesics and NSAIDs. The mechanism of RPN is still controversial. There are data that support microvascular changes and local ischemic injury as the underlying cause. Alternatively, several model papillotoxins, some analgesics, and NSAIDs target selectively for the medullary interstitial cells, which is the earliest reported aberration, after which there are a series of degenerative processes affecting other renal cell types. Many papillotoxins have the potential to undergo prostaglandin hydroperoxidase-mediated metabolic activation, specifically in the renal medullary interstitial cells. These reactive intermediates, in the presence of large quantities of polyunsaturated lipid droplets, result in localized and selective injury of the medullary interstitial cells. These highly differentiated cells do not repair, and it is generally accepted that continuing insult to these cells will result in their progressive erosion. The loss of these cells is thought to be central to the degenerative cascade that affects the cortex. There is still a need to understand better the primary mechanism and the secondary consequences of RPN so that the risk of chemical agents in use and novel molecules can be fully assessed.

Normal ultrastructure of the kidney and lower urinary tract

The mammalian urinary tract includes the kidneys, ureters, urinary bladder, and urethra. The renal parenchyma is composed of the glomeruli and a heterogeneous array of tubule segments that are specialized in both function and structure and are arranged in a specific spatial distribution. The ultrastructure of the glomeruli and renal tubule epithelia have been well characterized and the relationship between the cellular structure and the function of the various components of the kidney have been the subject of intense study by many investigators. The lower urinary tract, the ureters, urinary bladder, and urethra, which are histologically similar throughout, are composed of a mucosal layer lined by transitional epithelium, a tunica muscularis, and a tunica serosa or adventitia. The present manuscript reviews the normal ultrastructural morphology of the kidney and the lower urinary tract. The normal ultrastructure is illustrated using transmission electron microscopy of normal rat kidney and urinary bladder preserved by in vivo perfusion with glutaraldehyde fixative and processed in epoxy resin.

The application of proton nuclear magnetic resonance imaging for the in vivo characterisation of chemically induced renal lesions in rats over a prolonged time study

Renal cortical and medullary spin-lattice (T1) relaxation times were measured at various time points over a period of 56 days following the administration of a single i.p. injection of 100 mg/kg 2-bromoethanamine hydrobromide (BEA), 200 mg/kg hexachloro-1,3-butadiene (HCBD) or 100 mg/kg puromycin aminonucleoside (PAN) to male Wistar rats. Administration of a single injection of HCBD caused a dramatic, immediate rise in the cortical T1 values above control values, and these levels remained elevated until, by Day 28 postinjection the levels were back to control values. Administration of BEA also caused an elevation in cortical T1 values, but in this case these values remained above control values for the rest of the study. The administration of PAN did not produce any significant increases in cortical T1 values until 14 days postinjection. The elevated T1 values remained above control values for the rest of the study. These increases observed in cortical T1 values appeared to be mirrored by decreases in medullary T1 values. Increases in cortical T1 values were accompanied by visual changes in the NMR images and enlargement of the kidneys. The histological findings were consistent with the NMR data, confirming that morphologically the tissues did show a full recovery by Day 28 in the HCBD-treated animals. This was not the case following injection of both BEA and PAN, where necrosis was not reversible and there was no recovery of the tissues.

Detection of chemically induced renal injury: the cascade of degenerative morphological and functional changes that follow the primary nephrotoxic insult and evaluation of these changes by in-vitro methods

A diversity of chemicals cause discrete lesions in the kidney by a number of different mechanisms, and similar types of chemicals may give rise to more than one target cell injury. Screening for these lesions in vivo may be unreliable if a single noninvasive or invasive criterion is used. Instead, evidence of nephrotoxicity must be based on an array of tests, applied over a period of time. These should include biochemical, pathological and histochemical tests conducted in tandem. A primary toxic injury to the kidney may give rise to recovery, to permanently altered functional reserve or to a clinically identifiable effect, such as acute or chronic renal failure or malignancy. These clinical effects occur as a result of a cascade of degenerative changes which are a consequence of a primary lesion but also affect other parts of the kidney. A number of factors can modulate the progression of the primary insult to the end-effect. In-vitro nephrotoxicity screening is also difficult, but a rational approach can be based on current understanding of how chemicals target for and damage cells in anatomically well-defined regions of the kidney. In-vitro techniques can provide answers to specific questions about the mechanisms by which chemicals damage these discrete cell types. It is essential that a number of different in-vitro systems be developed in parallel to address the mechanistic aspects and screening of nephrotoxicity properly. Data generated in vitro must be related to the situation in vivo and used to devise reliable noninvasive tests for assessing nephrotoxicity in man.

In vitro screens from CNS, liver and kidney for systemic toxicity

The development and evaluation of in vitro systems from target organs for preliminary assessments of the potential for systemic toxic effects has been receiving increased attention. This review presents a synopsis of progress made in developing toxicity screens for three common target organs and identifies further work needed for more complete validation.