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McLarnon SR, Johnson C, Sun J, Wei Q, Csanyi G, O'Herron P, Marshall B, Giddens P, Sullivan JC, Barrett A, O'Connor PM. Extravasation of Blood and Blood Toxicity Drives Tubular Injury from RBC Trapping in Ischemic AKI. FUNCTION 2023; 4:zqad050. [PMID: 37753180 PMCID: PMC10519276 DOI: 10.1093/function/zqad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/04/2023] [Accepted: 08/24/2023] [Indexed: 09/28/2023] Open
Abstract
Red blood cell (RBC) trapping is common in ischemic acute kidney injury (AKI) and presents as densely packed RBCs that accumulate within and engorge the kidney medullary circulation. In this study, we tested the hypothesis that "RBC trapping directly promotes tubular injury independent of extending ischemia time." Studies were performed on rats. Red blood cell congestion and tubular injury were compared between renal arterial clamping, venous clamping, and venous clamping of blood-free kidneys. Vessels were occluded for either 15 or 45 min with and without reperfusion. We found that RBC trapping in the medullary capillaries occurred rapidly following reperfusion from renal arterial clamping and that this was associated with extravasation of blood from congested vessels, uptake of blood proteins by the tubules, and marked tubular injury. To determine if this injury was due to blood toxicity or an extension of ischemia time, we compared renal venous and arterial clamping without reperfusion. Venous clamping resulted in RBC trapping and marked tubular injury within 45 min of ischemia. Conversely, despite the same ischemia time, RBC trapping and tubular injury were minimal following arterial clamping without reperfusion. Confirming the role of blood toward tubular injury, injury was markedly reduced in blood-free kidneys with venous clamping. Our data demonstrate that RBC trapping results in the rapid extravasation and uptake of blood components by tubular cells, causing toxic tubular injury. Tubular toxicity from extravasation of blood following RBC trapping appears to be a major component of tubular injury in ischemic AKI, which has not previously been recognized.
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Affiliation(s)
- Sarah R McLarnon
- Department of Physiology, Medical College of Georgia, Augusta University, 30912, Augusta, GA, USA
- Department of Cell Biology and Physiology, School of Medicine, University of North Carolina, 27599, Chapel Hill, NC, USA
| | - Chloe Johnson
- Department of Physiology, Medical College of Georgia, Augusta University, 30912, Augusta, GA, USA
| | - Jingping Sun
- Department of Physiology, Medical College of Georgia, Augusta University, 30912, Augusta, GA, USA
| | - Qingqing Wei
- Department of Anatomy and Cell Biology, Medical College of Georgia, Augusta University, 30912, Augusta, GA, USA
| | - Gabor Csanyi
- Department of Pharmacology and Toxicology, Augusta University, 30912, Augusta, GA, USA
| | - Phillip O'Herron
- Department of Physiology, Medical College of Georgia, Augusta University, 30912, Augusta, GA, USA
| | - Brendan Marshall
- Department of Anatomy and Cell Biology, Medical College of Georgia, Augusta University, 30912, Augusta, GA, USA
| | - Priya Giddens
- Department of Physiology, Medical College of Georgia, Augusta University, 30912, Augusta, GA, USA
| | - Jennifer C Sullivan
- Department of Physiology, Medical College of Georgia, Augusta University, 30912, Augusta, GA, USA
| | - Amanda Barrett
- Department of Pathology, Medical College of Georgia, Augusta University, 30912, Augusta, GA, USA
| | - Paul M O'Connor
- Department of Physiology, Medical College of Georgia, Augusta University, 30912, Augusta, GA, USA
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Zafar F, Iqbal AM, Mubarik A, Rojas M, Muddassir S. Rivaroxaban-Induced Acute Interstitial Nephritis: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1719-1722. [PMID: 31748498 PMCID: PMC6883982 DOI: 10.12659/ajcr.917492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 70 Final Diagnosis: Acute interstitial nephritis Symptoms: Dark color urine, difficult voiding Medication: Rivaroxaban Clinical Procedure: — Specialty: General and Internal Medicine
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Affiliation(s)
- Fahad Zafar
- Department of Internal Medicine, Oak Hill Hospital, Brooksville, FL, USA
| | | | - Ateeq Mubarik
- Department of Internal Medicine, Oak Hill Hospital, Brooksville, FL, USA
| | - Melanie Rojas
- Department of Internal Medicine, Oak Hill Hospital, Brooksville, FL, USA
| | - Salman Muddassir
- Department of Internal Medicine, Oak Hill Hospital, Brooksville, FL, USA
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Henriksen KJ. Autopsy kidneys: an overlooked resource. Autops Case Rep 2018; 8:e2018013. [PMID: 29588908 PMCID: PMC5861983 DOI: 10.4322/acr.2018.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 02/21/2018] [Indexed: 11/23/2022]
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Perrone ME, Chang A, Henriksen KJ. Medical renal diseases are frequent but often unrecognized in adult autopsies. Mod Pathol 2018; 31:365-373. [PMID: 28984299 DOI: 10.1038/modpathol.2017.122] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/27/2017] [Accepted: 08/01/2017] [Indexed: 02/02/2023]
Abstract
Kidney diseases affect many hospitalized patients and contribute to morbidity and mortality. Therefore, kidney disease should be prevalent, but the frequency and spectrum of medical renal pathology in autopsy specimens has not been well documented. We sought to determine the spectrum of medical renal pathology in adult autopsy specimens and the frequency of overlooked diagnoses. We reviewed the hematoxylin- and eosin-stained kidney sections from 140 adult autopsies performed at a large teaching hospital over a 2-year period. Fifty-eight cases (41%) had findings warranting further analysis, including alterations in glomerular matrix and/or cellularity, atypical or pigmented casts, thrombi, tubulointerstitial or vascular inflammation, or deposition of amorphous material. After additional studies and clinical correlation, the pathologic changes in 43 cases (31%) were categorized as follows: diabetic nephropathy, bile cast nephropathy, thrombotic microangiopathy, infection-related glomerulonephritis, focal necrotizing/crescentic glomerulonephritis, oxalate nephropathy, light-chain cast nephropathy, amyloidosis, urate nephropathy, hemosiderosis, antineutrophil cytoplasmic antibody-associated vasculitis, polyoma virus nephropathy, atheroembolic disease, and nephrocalcinosis. These diagnoses were not reported in 26 (60%) cases during the initial autopsy evaluation. This study demonstrates that medical renal diseases are common in autopsy cases, but significant diagnoses can be easily overlooked. Autopsy kidney specimens are a rich source of renal pathology and their evaluation should be emphasized in anatomic pathology residency training. Ultimately, our understanding of how kidney disease contributes to morbidity and mortality will benefit from accurate recognition of renal pathology in autopsy specimens.
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Affiliation(s)
- Marie E Perrone
- Department of Pathology, The University of Washington, Seattle, WA, USA
| | - Anthony Chang
- Department of Pathology, The University of Chicago, Chicago, IL, USA
| | - Kammi J Henriksen
- Department of Pathology, The University of Chicago, Chicago, IL, USA
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Olson PD, McLellan LK, Liu A, Briden KE, Tiemann KM, Daugherty AL, Hruska KA, Hunstad DA. Renal scar formation and kidney function following antibiotic-treated murine pyelonephritis. Dis Model Mech 2017; 10:1371-1379. [PMID: 28882930 PMCID: PMC5719254 DOI: 10.1242/dmm.030130] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 09/04/2017] [Indexed: 12/19/2022] Open
Abstract
We present a new preclinical model to study treatment, resolution and sequelae of severe ascending pyelonephritis. Urinary tract infection (UTI), primarily caused by uropathogenic Escherichia coli (UPEC), is a common disease in children. Severe pyelonephritis is the primary cause of acquired renal scarring in childhood, which may eventually lead to hypertension and chronic kidney disease in a small but important fraction of patients. Preclinical modeling of UTI utilizes almost exclusively females, which (in most mouse strains) exhibit inherent resistance to severe ascending kidney infection; consequently, no existing preclinical model has assessed the consequences of recovery from pyelonephritis following antibiotic treatment. We recently published a novel mini-surgical bladder inoculation technique, with which male C3H/HeN mice develop robust ascending pyelonephritis, highly prevalent renal abscesses and evidence of fibrosis. Here, we devised and optimized an antibiotic treatment strategy within this male model to more closely reflect the clinical course of pyelonephritis. A 5-day ceftriaxone regimen initiated at the onset of abscess development achieved resolution of bladder and kidney infection. A minority of treated mice displayed persistent histological abscess at the end of treatment, despite microbiological cure of pyelonephritis; a matching fraction of mice 1 month later exhibited renal scars featuring fibrosis and ongoing inflammatory infiltrates. Successful antibiotic treatment preserved renal function in almost all infected mice, as assessed by biochemical markers 1 and 5 months post-treatment; hydronephrosis was observed as a late effect of treated pyelonephritis. An occasional mouse developed chronic kidney disease, generally reflecting the incidence of this late sequela in humans. In total, this model offers a platform to study the molecular pathogenesis of pyelonephritis, response to antibiotic therapy and emergence of sequelae, including fibrosis and renal scarring. Future studies in this system may inform adjunctive therapies that may reduce the long-term complications of this very common bacterial infection. Summary: A new model of antibiotic-treated severe pyelonephritis offers a novel platform to study the molecular pathogenesis of pyelonephritis, response to antibiotic therapy, and sequelae, including fibrosis and renal scarring.
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Affiliation(s)
- Patrick D Olson
- Medical Scientist Training Program, Washington University School of Medicine, St Louis, MO 63110, USA.,Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Lisa K McLellan
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Alice Liu
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Kelleigh E Briden
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Kristin M Tiemann
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Allyssa L Daugherty
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Keith A Hruska
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA.,Department of Cell Biology and Physiology, Washington University School of Medicine, St Louis, MO 63110, USA
| | - David A Hunstad
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA .,Department of Molecular Microbiology, Washington University School of Medicine, St Louis, MO 63110, USA
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