1
|
Xu R, Zhou J, Zhou Q, Zeng S. Decreased biventricular myocardial deformation in fetuses with lower urinary tract obstruction. BMC Pregnancy Childbirth 2020; 20:459. [PMID: 32787795 PMCID: PMC7424985 DOI: 10.1186/s12884-020-03152-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 08/03/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND To observe myocardial deformations in fetuses with isolated lower urinary tract obstruction (LUTO) and identify the correlation between myocardial deformation and the severity of obstruction. METHODS The strain (S), strain rate in systole (SRs) and strain rate in diastole (SRd) of the left and right ventricles at the first examination were prospectively analyzed and compared between fetuses with isolated LUTO and gestational age (GA)-matched normal control fetuses. Multiple regression analyses were used to assess the obstructive factors for impaired strain and strain rate, and the independent variables included bladder volume, sum of the bilateral pelvic diameters, sum of the bilateral ureteral diameters, mean bilateral renal artery pulsatility index, and amniotic fluid index. RESULTS Thirty-six fetuses with isolated LUTO and 36 normal controls were enrolled. Overall, decreased S, SRs and SRd of both ventricles were noted in fetuses with LUTO (p < 0.001). Moreover, S and SR were significantly negatively related to distended bladder volume (p < 0.001). CONCLUSIONS Fetuses with LUTO demonstrated decreased left and right myocardial deformation, and this impaired cardiac dysfunction was correlated with the urinary bladder volume. Evaluating the myocardial deformation in fetal LUTO could provide information to aid in parental counselling and intervention monitoring.
Collapse
Affiliation(s)
- Ran Xu
- Department of Urology, The Second Xiangya Hospital, Central South University, 410011, Changsha, Hunan, China
| | - Jiawei Zhou
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, 139 Renmin Road (M), Hunan, 410011, Changsha, China
| | - Qichang Zhou
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, 139 Renmin Road (M), Hunan, 410011, Changsha, China
| | - Shi Zeng
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, 139 Renmin Road (M), Hunan, 410011, Changsha, China.
| |
Collapse
|
2
|
Abstract
Long overlooked as the virtual compartment and then strictly characterized through descriptive morphologic analysis, the renal interstitium has finally been associated with function. With identification of interstitial renin- and erythropoietin-producing cells, the most prominent endocrine functions of the kidney have now been attributed to the renal interstitium. This article reviews the functional role of renal interstitium.
Collapse
Affiliation(s)
- Michael Zeisberg
- Department of Nephrology and Rheumatology, Göttingen University Medical Center, Georg August University, Göttingen, Germany; and
| | - Raghu Kalluri
- Department of Cancer Biology and the Metastasis Research Center, University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
3
|
Taranta-Janusz K, Wasilewska A, Dębek W, Fiłonowicz R, Michaluk-Skutnik J. Urinary angiotensinogen as a novel marker of obstructive nephropathy in children. Acta Paediatr 2013; 102:e429-33. [PMID: 23772991 DOI: 10.1111/apa.12324] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 05/13/2013] [Accepted: 06/12/2013] [Indexed: 11/28/2022]
Abstract
AIM Obstructive nephropathy due to congenital or acquired urinary tract obstruction is one of the most important causes of chronic renal failure in children. There is a need for identification of new noninvasive urinary biomarkers to provide the clinician with fast, specific and reliable diagnostic and prognostic tool. The aim of the study was to determine whether urinary angiotensinogen (uAGT) may be a useful marker of obstruction in children with hydronephrosis (HN) caused by ureteropelvic junction obstruction (UPJO). METHODS The study cohort consisted of surgical group (SG): 31 children with severe HN who required surgery; nonsurgical group (NSG): 20 patients with mild HN, and reference group (RG): 19 healthy children. Urinary concentrations of angiotensinogen were measured using immunoenzymatic ELISA commercial kit and were expressed in ng/mg Cre (uAGT/uCre). RESULTS uAGT/uCre level was higher in SG when compared to NSG (p < 0.01) and healthy participants (SG vs. RG: p < 0.01). The difference between the uAGT/uCre in NSG and RG was not statistically significant (p > 0.05). uAGT/uCre was correlated negatively with differential renal function (r = -0.46; p < 0.01). CONCLUSION The present pilot study has clearly demonstrated that children with UPJO showed increased uAGT levels, which correlated negatively with differential renal function in radionuclide scan.
Collapse
Affiliation(s)
| | - Anna Wasilewska
- Department of Pediatrics and Nephrology; Medical University of Białystok; Białystok Poland
| | - Wojciech Dębek
- Department of Pediatric Surgery; Medical University of Białystok; Białystok Poland
| | - Renata Fiłonowicz
- Department of Pediatrics and Nephrology; Medical University of Białystok; Białystok Poland
| | | |
Collapse
|
4
|
Local renin–angiotensin systems in the genitourinary tract. Naunyn Schmiedebergs Arch Pharmacol 2011; 385:13-26. [DOI: 10.1007/s00210-011-0706-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 10/18/2011] [Indexed: 02/07/2023]
|
5
|
ZIEG JAKUB, BLAHOVA KVETA, SEEMAN TOMAS, BRONSKY JIRI, DVORAKOVA HANA, PECHOVA MARTA, JANDA JAN, MATOUSOVIC KAREL. Urinary transforming growth factor-β1 in children with obstructive uropathy. Nephrology (Carlton) 2011; 16:595-8. [DOI: 10.1111/j.1440-1797.2011.01459.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
6
|
Stipsanelli A, Daskalakis G, Koutra P, Tsaroucha A, Kounadi E, Papantoniou V, Antsaklis A. Renin-angiotensin system dysregulation in fetuses with hydronephrosis. Eur J Obstet Gynecol Reprod Biol 2010; 150:39-41. [PMID: 20236752 DOI: 10.1016/j.ejogrb.2010.02.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Revised: 01/24/2010] [Accepted: 02/10/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate if fetal hydronephrosis is associated with dysregulation of the renin-angiotensin system (RAS), and if it could represent an early predictor of future renal damage or arterial hypertension. STUDY DESIGN The study consisted of 26 pregnant women and their fetuses. Ultrasound scans were performed to evaluate the renal pelvis in fetuses. Four fetuses with hydronephrosis were included in the study, while the rest were found to have normal renal pelvis. Active and inactive renin was calculated by IRMA method in fetal and maternal blood, during the second trimester of pregnancy. RESULTS A comparison of plasma active and inactive renin levels was made between pregnant women and their fetuses, as well as between fetuses with and without hydronephrosis. Active and inactive renin levels obtained from fetuses with hydronephrosis were significantly higher compared to those obtained from fetuses with normal kidneys. CONCLUSIONS Dilatation of renal pelvis in the second trimester of pregnancy seems to up-regulate the renin and prorenin system in fetal blood. Both factors are indicative of possible future renal pathology.
Collapse
Affiliation(s)
- Aikaterini Stipsanelli
- Department of Nuclear Medicine, Alexandra Maternity Hospital, Athens University, 80 Vas Sophias Av, Athens 115 28, Greece
| | | | | | | | | | | | | |
Collapse
|
7
|
Perinatal 2,3,7,8-tetrachlorodibenzo-p-dioxin exposure sensitizes offspring to angiotensin II-induced hypertension. Cardiovasc Toxicol 2008; 8:145-54. [PMID: 18670907 DOI: 10.1007/s12012-008-9023-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2008] [Accepted: 07/22/2008] [Indexed: 10/21/2022]
Abstract
In utero and lactational exposure of mice to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) leads to cardiac hypertrophy and hydronephrosis in adulthood. We tested the hypothesis that perinatal TCDD exposure increases the susceptibility to cardiovascular disease when offspring are exposed to a common cardiovascular disease risk factor, angiotensin II (Ang II). Pregnant C57BL/6N mice were exposed to corn oil (control) or 6.0 microg/kg TCDD on gestation day 14.5. Male offspring were then exposed to a subpressor (0.1 mg/kg/day) or pressor (0.7 mg/kg/day) dose of Ang II at 3.5 months and cardiac morphology and blood pressure analyzed, respectively. Perinatal TCDD exposure increased left ventricular cavity dilation during diastole, and wall thickness during diastole and systole. While Ang II stimulated an increase in wall thickness, the degree of increase was equivalent between control and TCDD offspring. In contrast, perinatal TCDD exposure did not alter basal blood pressure. However, Ang II increased systolic blood pressure more rapidly and to a greater degree in TCDD offspring. Further, Ang II stimulated renal myofibroblast differentiation and collagen deposition to a greater degree, and tended to increase procollagen I mRNA in TCDD offspring, compared to controls. These data suggest that perinatal TCDD exposure increases the susceptibility of offspring to renal fibrosis and hypertension in adulthood.
Collapse
|
8
|
Schlotmann A, Clorius JH, Rohrschneider WK, Clorius SN, Amelung F, Becker K. Diuretic renography in hydronephrosis: delayed tissue tracer transit accompanies both functional decline and tissue reorganization. J Nucl Med 2008; 49:1196-203. [PMID: 18552148 DOI: 10.2967/jnumed.107.049890] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The significance of delayed tissue tracer transit (TTT) of (99m)Tc-mercaptoacetyltriglycine ((99m)Tc-MAG3) has not been systematically evaluated in hydronephrosis. We sought to demonstrate that delayed TTT accompanies both functional decline and histomorphologic restructuring. METHODS Twenty 2- to 3-mo-old piglets with surgically induced partial unilateral ureteral stenosis were examined with magnetic resonance urography (MRU) to evaluate morphology and with (99m)Tc-MAG3 diuretic renography (DR) to determine single-kidney function (SKF), evaluate the response to furosemide stimulation (RFS), and assess TTT. All animals had DR and MRU before and after surgery and a third DR after surgery. Piglets were sacrificed after the final DR for renal histology. A total histologic score (THS) was generated. RESULTS Preoperative DR demonstrated nonobstructive RFS, timely TTT, and balanced SKF in all 20 kidneys. After ureteral ligature, MRU demonstrated pelvic dilatation in all piglets. The postoperative DRs revealed 12 kidneys with delayed TTT in one or both follow-ups. In these 12 kidneys, the SKF declined from 51% +/- 4% to 18% +/- 14%, and the THS was 9.0 +/- 4.0. Three kidneys always had timely TTT, balanced SKF, and a THS of 1.8 +/- 0.3. The contralateral, nonoperated kidneys had timely TTT and a THS of 1.2 +/- 0.9. Postoperative scintigrams showed that 3 of 8 kidneys (38%) with an obstructive RFS had timely TTT, which demonstrates that TTT and RFS are not equivalent. CONCLUSION In hydronephrosis, a delayed TTT of (99m)Tc-MAG3 accompanies both functional decline and histomorphologic restructuring in obstruction. According to the literature, a delayed TTT is determined by the filtration fraction of the kidneys and appears to identify an obstruction-mediated upregulated renin-angiotensin system.
Collapse
Affiliation(s)
- Andreas Schlotmann
- Department of Nuclear Medicine, University Hospital Freiburg, Freiburg, Germany.
| | | | | | | | | | | |
Collapse
|
9
|
Gokce G, Karboga H, Yildiz E, Ayan S, Gultekin Y. Effect of angiotensin-converting enzyme inhibition and angiotensin II type 1 receptor blockade on apoptotic changes in contralateral testis following unilateral testicular torsion. Int Urol Nephrol 2008; 40:989-95. [PMID: 18320343 DOI: 10.1007/s11255-008-9348-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Accepted: 02/03/2008] [Indexed: 11/24/2022]
Abstract
OBJECTIVES In this experimental study, our aim was to determine whether angiotensin-converting enzyme (ACE) inhibition and angiotensin II type 1 (AT1) receptor blockade affect the apoptotic changes in contralateral testis following unilateral testicular torsion (UTT). METHODS Study groups consisted of 30 adult male Wistar rats. The rats were randomly separated into five groups. Group 1 was maintained as control without manipulation. Group 2 underwent the sham operation. Torsion was created by rotating the left testis 720 degrees clockwise for 4 h and maintained by fixing the testis to the scrotum in the other groups. Group 3 underwent torsion and detorsion, with saline administration after detorsion. In group 4, the same surgical procedure was done as in the detorsion group, but AT1 receptor blocker (losartan 30 mg/kg) was injected intraperitoneally for 60 min before detorsion. In group 5, the same surgical procedure was done as in the detorsion group, but ACE inhibitor (lisinopril 50 mg/kg) was injected intraperitoneally for 60 min before detorsion. Bilateral testes were removed from each rat 24 h after surgery. Apoptosis was assessed in paraffin-embedded sections stained for TUNEL method. Reticulum staining was performed to evaluate the extracellular changes semiquantitatively. Testicular biopsy score counts were performed on these sections according to Johnsen. RESULTS The mean apoptotic scores of group 1, group 2 and group 3 were significantly higher than that of the other groups. There was no difference between the apoptotic scores of groups 1, 2, 4 and 5. Reticulum stain was increased in group 3 as compared to other groups. The mean Johnsen biopsy score of group 3 was significantly lower than that of the other groups. CONCLUSION ACE inhibition and AT1 receptor blockade reduced the tubular damage and apoptosis in the contralateral testes after UTT. The beneficial effect of these drugs may arise from inhibition of ischemic process resulting from increased sympathetic activity and elimination of insults subsequent to dysregulation of RAS. These results suggest that ACE inhibitors and AT1 receptor blockers may be of potential value in patients with UTT.
Collapse
Affiliation(s)
- Gokhan Gokce
- Urology, Cumhuriyet University, Sivas, 58140, Turkey.
| | | | | | | | | |
Collapse
|
10
|
Abstract
Congenital urinary tract obstruction is a heterogenous condition with a varying natural history. Accurate diagnosis within the late-first and second trimesters allows for counselling of the parents and planning of multi-disciplinary care for the pregnancy and newborn. Antenatal investigations to predict postnatal renal function are of varying accuracy. However, some factors have been shown to be predictive of poor outcome in terms of renal function at birth and infancy. There is the possibility of in-utero intervention in these fetuses.
Collapse
Affiliation(s)
- R K Morris
- Academic Department of Obstetrics and Gynaecology, Birmingham Women's Hospital, University of Birmingham, Birmingham B15 2TG, UK.
| | | |
Collapse
|
11
|
Huang WY, Peters CA, Zurakowski D, Borer JG, Diamond DA, Bauer SB, McLellan DL, Rosen S. Renal biopsy in congenital ureteropelvic junction obstruction: evidence for parenchymal maldevelopment. Kidney Int 2006; 69:137-43. [PMID: 16374434 DOI: 10.1038/sj.ki.5000004] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The renal histologic changes associated with congenital ureteropelvic junction obstruction (UPJO) and the relationship to clinical imaging have not been well studied. In order to better understand the histologic alterations of congenital UPJO and their relationship with clinical imaging and outcomes, we examined renal biopsies from 61 patients undergoing pyeloplasty for congenital UPJO. Glomeruli were analyzed for various injury patterns and the tubulointerstitium was examined for tubular atrophy/simplification and fibrosis. Two methods were used to evaluate tubular mass: glomerular density and morphometric measurement of tubular size and density. Control specimens were obtained from age-matched autopsy specimens without renal pathology. Glomerular changes were identified in 73% of all biopsies and were present in a range from 1.7 to 91% of glomeruli in each patient. Overt tubulointerstitial changes were present in 26% of all biopsies. Fibrosis was noted to occur with tubulointerstitial changes in a significantly greater fraction of children over the age of 1 year (P=0.026). Increased glomerular density was associated with severe hydronephrosis (P<0.02). Normal glomerular density was inversely correlated with age (P<0.001), but this relationship was more variable in UPJO (P<0.01). Among patients with intact differential function preoperatively (>45%), postoperative functional decline was predicted only by increased glomerular density. 20 biopsies without overt tubulointerstitial changes were analyzed morphometrically and showed a significant reduction in proximal tubular (PT) size, but unchanged density. Distal tubular (DT) size was unchanged in UPJO, but density was increased. The PT/DT ratio was therefore markedly decreased in UPJO (P<0.0001). Both PT and DT sizes were significantly larger in children with a diuretic renogram washout time less than 20 min than those with greater than 20 min, a common threshold for functionally significant obstruction (P<0.05). Capsular thickness was significantly increased in UPJO. In all, 36% of biopsies had a thickness >0.5 mm and this was associated with greater degrees of tubulointerstitial changes and glomerular alterations. Congenital UPJO produces a variety of renal parenchymal changes, which may in part reflect abnormal development. Some of these alternations are seen in clinical imaging and may help predict outcomes, but there is significant discordance between conventional imaging and histological findings.
Collapse
Affiliation(s)
- W-Y Huang
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Carello KA, Whitesall SE, Lloyd MC, Billecke SS, D'Alecy LG. Asymmetrical dimethylarginine plasma clearance persists after acute total nephrectomy in rats. Am J Physiol Heart Circ Physiol 2005; 290:H209-16. [PMID: 16113067 DOI: 10.1152/ajpheart.00208.2005] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Elevated plasma concentrations of symmetrical dimethylarginine (SDMA) and asymmetrical dimethylarginine (ADMA) are repeatedly associated with kidney failure. Both ADMA and SDMA can be excreted in urine. We tested whether renal excretion is necessary for acute, short-term maintenance of plasma ADMA and SDMA. Sprague-Dawley rats underwent sham operation, bilateral nephrectomy (NPX), ureteral ligation, or ureteral section under isoflurane anesthesia. Tail-snip blood samples (250 microl) were taken before and at 6- or 12-h intervals for 72 h after operation. Plasma clearance was assessed in intact and NPX rats. High-performance liquid chromatography determined SDMA and ADMA concentrations. Sodium, potassium, creatinine, blood urea nitrogen (BUN), and body weight were also measured. Forty-eight hours after NPX, SDMA increased 25 times (0.23 +/- 0.03 to 5.68 +/- 0.30 microM), whereas ADMA decreased (1.17 +/- 0.08 to 0.73 +/- 0.08 microM) by 38%. Creatinine and BUN increased, paralleling SDMA. Sham-operated animals showed no significant changes. Increased SDMA confirms continuous systemic production of SDMA and its obligatory renal excretion, much like creatinine. In contrast, decreased plasma ADMA suggests that acute total NPX either reduced systemic ADMA formation and/or systemic hydrolysis of ADMA increased 48-h post-NPX. However, plasma clearance of ADMA appeared unchanged 48 h after NPX. We conclude that renal excretory function is needed for SDMA elimination but not needed for acute, short-term ADMA elimination in that systemic hydrolysis is fully capable of clearing plasma ADMA.
Collapse
Affiliation(s)
- Katari A Carello
- Dept. of Molecular and Integrative Physiology, Univ. of Michigan Medical School, Ann Arbor, MI 48109-0622, USA
| | | | | | | | | |
Collapse
|
13
|
Saez F, Légaré C, Laflamme J, Sullivan R. Vasectomy-dependent dysregulation of a local renin-angiotensin system in the epididymis of the cynomolgus monkey (Macaca fascicularis). ACTA ACUST UNITED AC 2005; 25:784-96. [PMID: 15292112 DOI: 10.1002/j.1939-4640.2004.tb02857.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The mammalian epididymis is a fundamental organ for sperm cell maturation; it allows mammals to acquire their fertilizing ability. We have previously shown that during obstruction in cases of vasectomy, gene expression profiles were modified in human and cynomolgus monkey epididymides. Paracrine factors thus appear to be key elements in local gene expression along the epididymis. Local renin-angiotensin systems (RAS) have been described in many other organs as paracrine regulators of gene expression. This work demonstrates the presence of a local RAS in the epididymis of the cynomolgus monkey and investigates the vasectomy-dependent changes occurring in this system. After unilateral vasectomy in 4 monkeys (two for 3 days and two others for 7 days), the presence of two major components of the RAS (ie, angiotensinogen [ANG] and the type 1 receptor to angiotensin II [AT-I]) was evaluated in the vasectomized and the normal controlateral epididymides of each monkey. We also show by in situ hybridization that the principal cells of the epididymis express ANG and AT-I mRNAs and immunohistochemistry permitted to verify the co-localization of the AT-I protein and mRNA. Quantitative comparisons of individual variations in the mRNA and protein profiles for ANG and AT-I revealed that vasectomy altered the RAS expression profiles in an individual manner, thus confirming its role as a local system. This study provides a good basis for further investigation of the possible implications of the RAS in the physiology of the epididymis. Furthermore, the individual dependent modifications are in accordance with the very fluctuating results obtained in the fertility status of human patients undergoing a vasectomy reversal. The variations observed in the RAS expression profiles may be a good model to study the causes of the overall epididymal gene expression dysregulation that follows vasectomy and potentially affects fertility.
Collapse
Affiliation(s)
- Fabrice Saez
- Centre de Recherche en Biologie de la Reproduction et Département d'Obstétrique-Gynécologie, Faculté de Médecine, Université Laval, Québec, Canada
| | | | | | | |
Collapse
|
14
|
Shi Y, Pedersen M, Li C, Wen JG, Thomsen K, Stødkilde-Jørgensen H, Jørgensen TM, Knepper MA, Nielsen S, Djurhuus JC, Frøkiaer J. Early release of neonatal ureteral obstruction preserves renal function. Am J Physiol Renal Physiol 2004; 286:F1087-99. [PMID: 14722012 DOI: 10.1152/ajprenal.00201.2003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The incidence of congenital hydronephrosis is approximately 1% and is often associated with renal insufficiency. It is unknown whether early release is essential to prevent deterioration of renal function. Rats were subjected to partial unilateral ureteral obstruction (PUUO) on postnatal day 2. The obstruction was left in place or released after 1 or 4 wk. Renal blood flow (RBF) and kidney size were measured sequentially over 24 wk using MRI. In rats in which the obstruction was left in place, RBF of the obstructed kidney was progressively reduced to 0.92 +/- 0.17 vs. 1.79 +/- 0.12 ml.min(-1).100 g body wt(-1) (P < 0.05) after 24 wk. Similarly, glomerular filtration rate of the obstructed kidney was severely reduced at 24 wk: 172 +/- 36 vs. 306 +/- 42 microl.min(-1).100 g body wt(-1) (P < 0.05). These changes were preceded by development of severe hydronephrosis and obstructive nephropathy with a reduction in total protein content: 45 +/- 3 vs. 58 +/- 4 mg/kidney. Moreover, nonreleased PUUO caused a marked natriuresis (0.32 +/- 0.07 vs. 0.11 +/- 0.02 micromol.min(-1).100 g body wt(-1), P < 0.05) and impaired solute free water reabsorption (0.47 +/- 0.16 vs. 2.71 +/- 0.67 microl.min(-1).100 g body wt(-1), P < 0.05), consistent with a significant downregulation of Na-K-ATPase to 62 +/- 7%, aquaporin-1 to 53 +/- 3%, and aquaporin-3 to 53 +/- 7% of sham levels. Release after 1 wk completely prevented development of hydronephrosis, reduction in RBF and glomerular filtration rate, and downregulation of renal transport proteins, whereas release after 4 wk had no effect. These results suggest that early release of neonatal obstruction provides dramatically better protection of renal function than release of obstruction after the maturation process is completed.
Collapse
Affiliation(s)
- Yimin Shi
- The Water and Salt Research Center, Institute of Experimental Clinical Research, Aarhus Univ. Hospital-Skejby, DK-8200 Aarhus, Denmark
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Choi YK, Kim YJ, Park HS, Choi K, Paik SG, Lee YI, Park JG. Suppression of glomerulosclerosis by adenovirus-mediated IL-10 expression in the kidney. Gene Ther 2003; 10:559-68. [PMID: 12646861 DOI: 10.1038/sj.gt.3301926] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Glomerulosclerosis is a common morphologic result seen in almost all progressed renal diseases, and is the characteristic change in focal segmental glomerulosclerosis (FSGS). The most convincing hypothesis for glomerulosclerosis is cytokine-mediated injury by infiltrating immune cells in the glomerulus and tubulointerstitial area. This study investigated whether the anti-inflammatory effect of interleukin-10 (IL-10) when expressed by a recombinant adenoviral vector can prevent the onset of glomerulosclerosis in FGS/Kist mice (an animal model with naturally occurring renal failure initiated by FSGS). Each group of mice received recombinant adenoviruses encoding human IL-10 (Ad:hIL-10) by intraparenchymal injection at 6 weeks and were examined for cytokine expression, glomerular sclerotic index, and proteinuria. After injection of Ad:hIL-10 to the kidney, IL-10 expression was found to last over 20 days. Mice treated with Ad:hIL-10 were shown to have a significant reduction in the glomerular sclerotic index at 10 weeks when compared to control groups. The level of proteinuria in Ad:hIL-10-treated mice was also significantly reduced. About 50% of the urine samples of naive and Ad:LacZ-treated groups had severe levels of proteinuria. By contrast, at 10 weeks the group treated with Ad:hIL-10 had lower levels of proteinuria and transforming growth factor-beta1 (TGF-beta1) expression. These results demonstrate that IL-10 effectively prevents the development of glomerulosclerosis in FGS/Kist mice, and IL-10 gene therapy may be of use for the treatment of renal failure.
Collapse
Affiliation(s)
- Y-K Choi
- Department of Medical Genetic Engineering, Keimyung University School of Medicine, Daegu, Republic of Korea
| | | | | | | | | | | | | |
Collapse
|
16
|
N/A. N/A. Shijie Huaren Xiaohua Zazhi 2003; 11:334-337. [DOI: 10.11569/wcjd.v11.i3.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
17
|
|
18
|
Bajpai M, Puri A, Tripathi M, Maini A. Prognostic significance of captopril renography for managing congenital unilateral hydronephrosis. J Urol 2002; 168:2158-61; discussion 2161. [PMID: 12394747 DOI: 10.1016/s0022-5347(05)64341-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE In this prospective study we evaluated the results of captopril enhanced diuretic renography in patients with congenital unilateral ureteropelvic junction type hydronephrosis. Captopril renography helps to distinguish patients who have renin-angiotensin system activation from those in whom it is not yet activated. Renin-angiotensin system activation heralds the beginning of compensatory vasoactive response in the kidney. Identifying grades of such activation may help in determine the end points of nonoperative management. MATERIALS AND METHODS We prospectively studied 25 patients with suspected unilateral ureteropelvic junction obstruction treated at our department. A prenatal diagnosis was made in 60% of cases. Patient age was 1 to 144 months (mean 40) and the male-to-female ratio was 4:1. Followup was 6 to 72 months (mean 30). Patient evaluation and analysis included sonography, standard diuretic and captopril renography, glomerular filtration rate, serum creatinine and blood pressure. The indications for surgery were symptoms, differential function below 35%, or a documented decrease of 10% or more during followup. Activation of the renin-angiotensin system was considered positive when split renal function decreased significantly by 5% or more in an obstructed system on a post-captopril study. The results of captopril renography were examined retrospectively in patients who required surgery according to preexisting criteria. RESULTS Society for Fetal Urology hydronephrosis grade was II to IV in 8, 10 and 7 renal units, respectively. The renin-angiotensin system was activated in 8 of the 25 cases (32%) of unilateral ureteropelvic junction obstruction. In 15 patients there was no change on pre-captopril and post-captopril studies and in 2 split renal function on the obstructed side marginally increased on the post-captopril study. Surgical correction was required in only 6 of the 8 patients with renin-angiotensin system activation. Of those who required surgery hydronephrosis was grades II to IV in 3, 1 and in 2 patients, respectively. CONCLUSIONS In the current study renin-angiotensin system activation correlated with the need for surgery in 75% of the cases of congenital unilateral ureteropelvic type hydronephrosis. Since captopril serves to identify patients who have renin-angiotensin system activation, it may also be possible to grade this activation. Our preliminary results show that there may be a role for captopril renography for identifying the risk group for surgical intervention.
Collapse
Affiliation(s)
- Minu Bajpai
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | | | | | | |
Collapse
|
19
|
Abstract
Fetal models of urinary tract disease have been used for many years and have provided unique and important insights into the pathophysiology of these conditions. This review will summarize the principal model systems used and the current directions of investigation. These models (including rabbit, opossum, sheep and recently swine) have demonstrated that in utero obstruction of the urinary tract alters renal growth, differentiation and produces stereotypical patterns of tissue response, particularly fibrosis. New molecular understanding of these processes has identified specific mechanisms that may be key elements in the development of renal dysfunction due to obstruction. These factors include the renin-angiotensin system (RAS) and its interaction with TGF-beta in altering growth regulation and tissue fibrosis. These factors offer the prospect of clinical utility as markers of disease progression as well as pharmacologic therapy. Gene knockout systems have opened a new horizon of molecular models of congenital obstructive uropathy with insights into the role of the RAS in particular. It remains to be defined how closely these knockouts represent the human conditions they resemble. Continued application of fetal models of urinary obstruction, integrating large animal and knockout systems offers promise for improved diagnosis and treatment in these challenging conditions.
Collapse
Affiliation(s)
- C A Peters
- Department of Urology, Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
| |
Collapse
|