Micropuncture study of chronic obstructive nephropathy before and after release of obstruction

Laparoscopic ureteral ligation (clipping): a novel, simple procedure for pediatric urinary incontinence due to ectopic ureters associated with non-functioning upper pole renal moieties

OBJECTIVE

A simplified approach for the surgical management of symptomatic ectopic ureters, associated with a non-functioning upper moiety, with laparoscopic ureteric clipping is presented in this research paper.

MATERIALS AND METHODS

Prospectively collected data on nine consecutive girls with ectopic ureters associated with urinary incontinence who underwent laparoscopic clipping between February 2011 and December 2013. Surgical technique consisted of cystoscopy and insertion of ureteral catheter in the lower pole ureter to aid in identification and clipping of the ectopic ureter, which was achieved by standard trans-peritoneal laparoscopy.

RESULTS

Median age was eight years (range 4-17 years). Diagnosis was based on clinical findings, which were supported by: ultrasound (US), nuclear scans and magnetic resonance urography in Cases 9, 8 and 5, respectively. Bilateral complete duplication was present in two patients; the combination of cystoscopy and laparoscopy allowed adequate identification of the ectopic ureter causing incontinence in both. All nine patients were immediately dry after surgery and remain asymptomatic after a maximum follow up of 27 months. Eight out of nine patients had developed some degree of asymptomatic upper pole hydronephrosis on follow-up US.

CONCLUSION

Laparoscopic clipping holds promise as a simple alternative to other more-complex surgical procedures in the treatment of incontinence due to an ectopic ureter. Despite favorable and encouraging initial results, further follow up is warranted in order to determine the fate of expected associated upper-pole hydronephrosis.

Mechanoregulation of intracellular Ca2+ concentration is attenuated in collecting duct of monocilium-impaired orpk mice

Autosomal recessive polycystic kidney disease (ARPKD) is characterized by the progressive dilatation of collecting ducts, the nephron segments responsible for the final renal regulation of sodium, potassium, acid-base, and water balance. Murine models of ARPKD possess mutations in genes encoding cilia-associated proteins, including Tg737 in orpk mice. New findings implicate defects in structure/function of primary cilia as central to the development of polycystic kidney disease. Our group (Liu W, Xu S, Woda C, Kim P, Weinbaum S, and Satlin LM, Am J Physiol Renal Physiol 285: F998-F1012, 2003) recently reported that increases in luminal flow rate in rabbit collecting ducts increase intracellular Ca(2+) concentration ([Ca(2+)](i)) in cells therein. We thus hypothesized that fluid shear acting on the apical membrane or hydrodynamic bending moments acting on the cilium increase renal epithelial [Ca(2+)](i). To further explore this, we tested whether flow-induced [Ca(2+)](i) transients in collecting ducts from mutant orpk mice, which possess structurally abnormal cilia, differ from those in controls. Isolated segments from 1- and 2-wk-old mice were microperfused in vitro and loaded with fura 2; [Ca(2+)](i) was measured by digital ratio fluorometry before and after the rate of luminal flow was increased. All collecting ducts responded to an increase in flow with an increase in [Ca(2+)](i), a response that appeared to be dependent on luminal Ca(2+) entry. However, the magnitude of the increase in [Ca(2+)](i) in 2- but not 1-wk-old mutant orpk animals was blunted. We speculate that this defect in mechano-induced Ca(2+) signaling in orpk mice leads to aberrant structure and function of the collecting duct in ARPKD.

Altered expression of major renal Na transporters in rats with bilateral ureteral obstruction and release of obstruction

Urinary tract obstruction impairs urinary concentrating capacity and reabsorption of sodium. To clarify the molecular mechanisms of these defects, expression levels of renal sodium transporters were examined in rats with 24-h bilateral ureteral obstruction (BUO) or at day 3 or 14 after release of BUO (BUO-R). BUO resulted in downregulation of type 3 Na+/H+ exchanger (NHE3) to 41 +/- 14%, type 2 Na-Pi cotransporter (NaPi-2) to 26 +/- 6%, Na-K-ATPase to 67 +/- 8%, type 1 bumetanide-sensitive Na-K-2Cl cotransporter (BSC-1) to 20 +/- 7%, and thiazide-sensitive cotransporter (TSC) to 37 +/- 9%. Immunocytochemistry confirmed downregulation of NHE3, NaPi-2, Na-K-ATPase, BSC-1, and TSC. Consistent with this downregulation, BUO-R was associated with polyuria, reduced urinary osmolality, and increased urinary sodium and phosphate excretion. BUO-R for 3 days caused a persistant downregulation of NHE3 to 53 +/- 10%, NaPi-2 to 57 +/- 9%, Na-K-ATPase to 62 +/- 8%, BSC-1 to 50 +/- 12%, and TSC to 56 +/- 16%, which was associated with a marked reduction in the net renal reabsorption of sodium (616 +/- 54 vs. 944 +/- 24 micromol x min-1 x kg-1; P < 0.05) and phosphate (6.3 +/- 0.9 vs. 13.1 +/- 0.4 micromol x min-1. kg-1; P < 0.05) demonstrating a defect in renal sodium and phosphate reabsorption capacity. Moreover, downregulation of Na-K-ATPase and TSC persisted in BUO-R for 14 days, whereas NHE3, NaPi-2, and BSC-1 were normalized to control levels. In conclusion, downregulation of renal Na transporters in rats with BUO and release of BUO are likely to contribute to the associated urinary concentrating defect, increased urinary sodium excretion, and postobstructive polyuria.

Effect of flow and stretch on the [Ca2+]i response of principal and intercalated cells in cortical collecting duct

An acute increase in tubular fluid flow rate in the microperfused cortical collecting duct (CCD), associated with a approximately 20% increase in tubular diameter, leads to an increase in intracellular Ca2+ concentration ([Ca2+]i)in both principal and intercalated cells (Woda CB, Leite M Jr, Rohatgi R, and Satlin LM. Am J Physiol Renal Physiol 283: F437-F446, 2002). The apical cilium present in principal but not intercalated cells has been proposed to be a flow sensor. To determine whether flow across the cilium and/or epithelial stretch mediates the [Ca2+]i response, CCDs from New Zealand White rabbits were microperfused in vitro, split-open (to isolate the effect of flow across cilia), or occluded (to examine the effect of stretch and duration/magnitude of the flow impulse), and [Ca2+]i was measured using fura 2. In perfused and occluded CCDs, a rapid (<1 s) but not slow (>3 min) increase in luminal flow rate and/or circumferential stretch led to an approximately threefold increase in [Ca2+]i in both principal and intercalated cells within approximately 10 s. This response was mediated by external Ca2+ entry and inositol 1,4,5-trisphosphate-mediated release of cell Ca2+ stores. In split-open CCDs, an increase in superfusate flow led to an approximately twofold increase in [Ca2+]i in both cell types within approximately 30 s. These experimental findings are interpreted using mathematical models to predict the fluid stress on the apical membranes of the CCD and the forces and torques on and deformation of the cilia. We conclude that rapid increases in luminal flow rate and circumferential stretch, leading to shear or hydrodynamic impulses at the cilium or apical membrane, lead to increases in [Ca2+]i in both principal and intercalated cells.

Partial unilateral ureteral obstruction in rats

This review comprises an overview of the current knowledge on experimental partial unilateral ureteral obstruction (PUUO) and a summary of our latest original experimental PUUO studies in rats. Neonatal PUUO is the type of obstruction that is most often encountered in pediatric clinical practice. However, the pathogenesis of PUUO is still incompletely understood. Most of our knowledge on PUUO has been derived from experimental studies in a variety of animal models. Although progress has been made, the natural history of congenital hydronephrosis is still incompletely described. The effects on kidney functions of long-term urinary tract obstruction, especially PUUO, have been less intensively studied. Recently, we created models with mild and severe PUUO in young rats by embedding the upper one fourth or the upper two thirds of the left ureter into the psoas muscle, respectively. Thereafter, the technique was used to create mild and severe PUUO in newborn rats and magnetic resonance imaging studies showed that both mild and severe obstruction caused a time-dependent decrease in renal blood flow. Compensatory increase in total kidney volume and renal vein blood flow in contralateral non-obstructed kidneys was not detectable when functional deterioration in the partially obstructed kidneys was present. Finally, we investigated the dynamic changes in renal relative signal intensity (RSI) of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) using magnetic resonance imaging in rats with partial, complete unilateral ureteral obstruction and sham-operated controls. The results showed that changes in Gd-DTPA RSI are compatible with the known physiological and anatomical changes in kidneys in response to ureteral obstruction and useful for distinguishing an obstructed from a non-obstructed collecting system and also for differentiating a partially obstructed from a completely obstructed collecting system.

Oxybutynin lowers elevated renal pelvic pressures in a rat congenital unilateral hydronephrosis

We investigated whether oxybutynin could lower elevated renal pelvic pressures measured in a rat with an inbred unilateral congenital hydronephrosis. Simultaneous renal pelvic and bladder pressures were measured in 8 hydronephrotic rats and compared to those of 10 hydronephrotic rats treated with intravenous injection of 1.6 mg./kg. oxybutynin. Pressures were recorded at different urinary flow rates and during bladder filling and emptying. Hydronephrotic rats not given oxybutynin showed significantly higher renal pelvic pressures (e.g. p-bladder at 50% capacity = 8.9 +/- 3.1 cm. H2O, corresponding p-pelvis = 20.8 +/- 2.1 at very high urinary flow rates) than rats treated with oxybutynin. The latter had renal pelvic pressures similar to rats with normal non-hydronephrotic kidneys (e.g. p-bladder at 50% capacity = 10.1 +/- 3.5 cm. H2O, corresponding p-pelvis = 6.3 +/- 1.1 at very high urinary flow rates). Renal pelvic pressures were, moreover, lower than corresponding bladder pressures in contrast to the untreated hydronephrotic pelvic pressure that exceeded bladder pressure. This effect of oxybutynin in lowering elevated renal pelvic pressures in the obstructed kidney has not been described before and suggests a possible role for oxybutynin in this condition.

Oxybutynin lowers elevated renal pelvic pressures in a rat congenital unilateral hydronephrosis

We investigated whether oxybutynin could lower elevated renal pelvic pressures measured in a rat with an inbred unilateral congenital hydronephrosis. Simultaneous renal pelvic and bladder pressures were measured in 8 hydronephrotic rats and compared to those of 10 hydronephrotic rats treated with intravenous injection of 1.6 mg./kg. oxybutynin. Pressures were recorded at different urinary flow rates and during bladder filling and emptying. Hydronephrotic rats not given oxybutynin showed significantly higher renal pelvic pressures (e.g. p-bladder at 50% capacity = 8.9 +/- 3.1 cm. H2O, corresponding p-pelvis = 20.8 +/- 2.1 at very high urinary flow rates) than rats treated with oxybutynin. The latter had renal pelvic pressures similar to rats with normal non-hydronephrotic kidneys (e.g. p-bladder at 50% capacity = 10.1 +/- 3.5 cm. H2O, corresponding p-pelvis = 6.3 +/- 1.1 at very high urinary flow rates). Renal pelvic pressures were, moreover, lower than corresponding bladder pressures in contrast to the untreated hydronephrotic pelvic pressure that exceeded bladder pressure. This effect of oxybutynin in lowering elevated renal pelvic pressures in the obstructed kidney has not been described before and suggests a possible role for oxybutynin in this condition.

Doppler ultrasound of the kidney

Conventional ultrasound of the kidney is used commonly to depict structural abnormalities. It is limited, however, by a lack of functional and vascular information. Doppler sonography can reduce this limitation of standard sonography quickly and noninvasively. Doppler examinations, although not difficult, must be done property to obtain useful data. Information regarding the presence and direction of flow in renal vessels can be obtained. Vascular stenosis can be identified by several Doppler criteria, although the role of Doppler as a screening measure remains controversial. Assessment of vascular resistance is possible from Doppler waveform analysis, using parameters such as the resistive index. These data may provide hemodynamic and predictive information regarding a dilated collecting system identified by conventional ultrasound. Analysis of the resistive index also may provide helpful clinical information in nonobstructive renal disease. In certain clinical settings, such analysis provides diagnostic data not readily available with other clinical and laboratory assessment methods. Pharmacologically stimulated renal Doppler examinations may lead to even greater benefits in the future. This article reviews renal Doppler ultrasound, including the physiological basis for Doppler examination, the technical principles of renal Doppler sonography, and the clinical applications of Doppler findings.

The effect of pregnancy on rat urinary tract dynamics

We investigated the urodynamics of the renal pelvis and bladder during spontaneous bladder filling and emptying in 13 pregnant and 19 nonpregnant Sprague-Dawley rats to examine the characteristics of the dilated urinary tract in pregnancy. For each group renal pelvic and bladder pressures were measured continuously and simultaneously during various urinary flows, while the bladder was filled and emptied. In pregnant rats the ureter was wider and the renal pelvis was longer and wider than in nonpregnant rats. At urinary flows of 10 to 30 ml/kg. per hour pregnant rats had significantly lower renal pelvic pressures than nonpregnant rats during bladder filling. In addition, pregnant rats had higher bladder compliance and capacity than nonpregnant rats (compliance 0.09 +/- 0.12 ml./cm. water versus 0.05 +/- 0.05 ml./cm. water, p < 0.01 and bladder capacity 0.669 +/- 0.61 ml. versus 0.490 +/- 0.38 ml., p < 0.05). These findings imply that much of the hydroureteronephrosis during pregnancy may relate to increased urinary tract compliance rather than obstruction.

Congenital unilateral hydronephrosis in a rat model: continuous renal pelvic and bladder pressures

We investigated a rat model with inbred unilateral congenital hydronephrosis. Simultaneous bladder and renal pelvic pressures were measured during different urinary flows, and during bladder filling and voiding in these congenitally hydronephrotic rats (approximately 45 days old) and normal nonhydronephrotic rats from the same colony. Differential pressures between pelvis and proximal ureter were determined. Upon termination of the experiment the urinary tract was removed and processed for histological examination. Hydronephrotic rats had significantly higher renal pelvic pressures throughout bladder filling at all urinary flow rates than normal rats. These elevated renal pelvic pressures exceeded bladder pressures at high flows (for example bladder pressure at 50% capacity was 8.9 +/- 3.1 cm. water and corresponding pelvic pressure was 20.8 +/- 2.1 [hydronephrosis] versus pelvic pressure 7.4 +/- 1.1 [control]). While pressures in the proximal ureter were higher than in the pelvis in normal rats the hydronephrotic rats showed significantly higher pressures in the pelvis, suggesting that the site of obstruction is the ureteropelvic junction. Histological evaluation of the excised kidneys revealed only minimal tubular changes. This study represents a unique animal model with unilateral hydronephrosis from a partially obstructing ureteropelvic junction. Moreover, the data indicate that partial urinary obstruction and the associated renal pelvic pressures should be defined with reference to bladder fullness and urinary flow rates.

Alterations in glomerular dynamics in congenital, unilateral hydronephrosis

We have previously shown that rats with congenital, unilateral hydronephrosis exhibit a reduction in GFR that returns to normal when either the renin angiotensin system or thromboxane A2 (TxA2) is blocked. The current study defines the single nephron defect in congenital, unilateral hydronephrosis and evaluates the roles of angiotensin II (Ang II) and TxA2 in this renal derangement. Renal micropuncture experiments were performed on the right kidney of rats from an inbred colony with unilateral right-sided hydronephrosis (HYDRO), or non-affected litter mates (CONTROL). In addition, four separate groups of hydronephrotic animals were treated with either the TxA2 receptor antagonist SQ-29548 (SQ), one of two Ang II receptor antagonists [saralasin (SAR) or DuP-753 (DUP)]; or combined treatment with DuP-753 and SQ-29,548 (S&D). SNGFR was significantly reduced (P < 0.05) in HYDRO compared to CONTROL (17.6 +/- 2.0 vs. 35.9 +/- 3.7 nl/min, respectively). Treatment with SQ-29,548 normalized SNGFR (29.0 +/- 3.0 nl/min), while saralasin and DuP-753 resulted in only a partial recovery of function (25.6 +/- 1.6 and 27.8 +/- 1.4 nl/min, respectively). Combined SQ-29,548 and DuP-753 treatment resulted in full recovery of SNGFR to 32.9 +/- 4.4 nl/min. The glomerular ultrafiltration coefficient (Kf) was reduced (P < 0.05) approximately 45% in HYDRO compared to CONTROL (1.64 +/- .08 vs. 2.84 +/- .22 nl/min/mm Hg, respectively). Kf returned to control levels in SAR, DUP and SQ, and increased above control in S&D (5.58 +/- 1.6 nl/min/mm Hg). There were no differences (P > 0.05) in hydrostatic or oncotic pressures across the glomerular capillary between any of the groups studied. The observation that Kf increases above CONTROL with combined blockade of TxA2 and Ang II suggests that these regulatory hormones decrease Kf via independent mechanisms. These data indicate that the reduction in SNGFR in congenital, unilateral hydronephrosis is a result of a marked fall in Kf that is mediated by both Ang II and TxA2.

The pathophysiology of ureteral obstruction

Ureteral obstruction can have a variety of causes intrinsic or extrinsic to the kidney. The effects of obstruction are examined from the perspectives of duration, severity, totality, and the presence of complicating factors. There is a difference in the postobstructive pathophysiology depending on whether one or both ureters were obstructed. Atrial natriuretic peptide may be important in postobstructive diuresis, and preliminary evidence suggests a role for it as protection against nephron ischemia in acute obstruction. The potential for recovery of renal function after relief of obstruction depends on the duration and degree of obstruction, the condition of the contralateral kidney, and the presence or absence of infection. Ability to acidify the urine to pH < 6.0 preoperatively may be a good predictor of the recovery potential of an obstructed kidney. Urine concentrations of lysosomal enzymes such as N-acetylglucosaminidase also may be useful for this purpose, as may measurement of creatinine clearance in urine obtained from a nephrostomy tube.

Transport defects of rabbit medullary thick ascending limb cells in obstructive nephropathy

To characterize the sodium transport defect responsible for salt wasting in obstructive nephropathy, the major sodium transporters in the medullary thick ascending limb (mTAL), the apical Na-K-2Cl cotransporter and the basolateral Na-K-ATPase, were studied in fresh suspensions of mTAL cells and outer medulla plasma membranes prepared from obstructed and untreated kidneys. Oxygen consumption (QO2) studies in intact cells revealed marked reductions in the inhibitory effects of both furosemide and ouabain on QO2 in cells from obstructed, as compared with control animals, indicating a reduction in activities of both the Na-K-2Cl cotransporter and the Na-K-ATPase. Saturable [3H]bumetanide binding was reduced in membranes isolated from obstructed kidneys, but the Kd for [3H]bumetanide was unchanged, indicating a decrease in the number of functional luminal Na-K-2Cl cotransporters in obstructed mTAL. Ouabain sensitive Na-K-ATPase activity in plasma membranes was also reduced, and immunoblots using specific monoclonal antibodies directed against the alpha and beta subunits of rabbit Na-K-ATPase showed decreased amounts of both subunits in outer medullas of obstructed kidney. A significant decrease in [3H]bumetanide binding was detected after 4 h of ureteral obstruction, whereas Na-K-ATPase activity at this time was still not different from control. We conclude that ureteral obstruction reduces the amounts of both luminal Na-K-2Cl cotransporter and basolateral Na-K-ATPase in mTAL of obstructed kidney and that these reductions contribute to the salt wasting observed after release of obstruction.

Renal parenchymal function evaluated by scintillation camera renography before and after pyeloplasty for hydronephrosis

Scintillation camera renography with Tc-DTPA was performed before and after pyeloplasty on 16 kidneys with urographic signs of pelviureteric obstruction causing hydronephrosis. Regional parenchymal renograms were generated, and the passage of Tc-DTPA through the parenchyma was measured and correlated to the change in separate glomerular filtration rate. Preoperative parenchymal passage of DTPA was significantly slower (p = 0.02) in kidneys with improved glomerular filtration rate after pyeloplasty than in those without such improvement. Postoperative passage of DTPA in parenchyma was almost identical with that in a reference series. This method seems to be clinically useful for evaluating cases of hydronephrosis and for predicting the outcome of pyeloplasty.

Urinary PGE2 in rats with chronic partial unilateral ureteral obstruction

Urinary prostaglandin E2 (PGE2) was measured in Munich-Wistar rats with surgically created chronic partial unilateral ureteral obstruction (UUO). Mean values of bladder urine PGE2 were higher in sham than in UUO (24.5 +/- 14.4 vs 12.9 +/- 8.2 ng/mg creatinine, respectively, P less than 0.05). Following diuresis, both ureters were cannulated and urine was collected. PGE2 excretion was increased in sham (66.5 +/- 34.4 and 70.1 +/- 44.5 ng/mg creatinine, left and right, respectively). But in UUO, the obstructed kidney excreted less PGE2 than the contralateral kidney (32.1 +/- 6.0 vs 62.3 +/- 40.4 ng/mg creatinine, obstructed vs contralateral, respectively, P = 0.08). PGE2 synthesis was then determined in separated renal medullary and cortical slices. Renal medullary slices from kidneys with severe obstruction synthesized less PGE2 than the contralateral unobstructed side (3.30 +/- 1.22 vs 10.52 +/- 3.23 ng/mg wet wt-30 min, respectively, P less than 0.05) and failed to respond to arachidonic acid stimulation with any significant increase in PGE2 synthesis (3.30 +/- 1.22 vs 4.47 +/- 1.04 ng/mg wet wt-30 min, baseline vs stimulated). In contrast, contralateral unobstructed kidney slices responded with a significant increase in PGE2 synthesis (10.52 +/- 3.23 vs 21.10 +/- 2.50 ng/mg wet wt-30 min, baseline vs stimulated, P less than 0.05). We conclude that chronic partial UUO in the Munich-Wistar rats resulted in significantly less PGE2 elaboration.

The recovery of renal function in rats after release of unilateral ureteral obstruction: the effects of moderate isotonic saline loading

Following 24 h of ureteral obstruction in the rat, renal blood flow and glomerular filtration rate are markedly depressed. The effect of saline loading on post-obstructive glomerular filtration (GFR) was studied in 15 female Sprague-Dawley rats in the awake state, 4 h following the release of 24 h of unilateral ureteral obstruction. Group I (n = 8) received 39 microliters min-1 of 0.9% saline only for 1 h prior to study and Group II (n = 7) received 78 microliters min-1 of 0.9% saline for the whole 4 h prior to study. The Cin and CPAH of the post-obstructed kidney were significantly reduced over control values in both groups. Saline loading (Group II) resulted in an improvement in Cin in the post-obstructed kidney compared with group I (3.22 +/- 0.14 vs. 2.19 +/- 0.14 ml/min/kg BW, P less than 0.001). This was independent of any change in CPAH. In two further groups of rats the saline loading protocol was shown to cause a rise in the excretion of urinary cGMP in the post-obstructed kidney, but not the contralateral control kidney. In addition, administration of exogenous atriopeptin (1-24) to non-saline loaded animals resulted in a qualitatively similar alteration in renal function to saline loading, namely a rise in Cin and an increase in excretion of cGMP by the post-obstructed kidney, and no change in CPAH.(ABSTRACT TRUNCATED AT 250 WORDS)

Hydronephrotic atrophy after stable mild or severe partial ureteral obstruction: natural history and recovery after relief of obstruction

After stable mild or severe partial unilateral ureteral obstruction in rats, the ratio of renal dry weight to whole body weight changes in two phases. In a "destructive phase" of two to six weeks, slight weight reduction occurs in the kidneys with mild obstruction and pronounced weight reduction occurs in those with severe obstruction. Then, in a "steady-state phase", there is no further weight reduction in kidneys with either mild or severe obstruction. Relief of ureteral obstruction during the steady-state phase does not result in an increase in renal dry weight. We conclude that the development of hydronephrotic atrophy after stable mild or severe partial unilateral ureteral obstruction can not be influenced by relief of obstruction in the steady-state phase.

A new test to predict reversibility of hydronephrotic atrophy after stable partial unilateral ureteral obstruction

In previous studies we showed that hydronephrotic atrophy develops only in the first weeks after stable partial ureteral obstruction, and does not progress thereafter. Relief of obstruction only in the "destructive phase" and not in the later "steady-state phase" seems to improve or prevent hydronephrotic atrophy. Since the duration of partial ureteral obstruction is often not known, we studied urinary enzymes of rat kidneys after stable partial unilateral ureteral obstruction to identify the destructive phase. We chose as an example of the tubular lysosomal enzyme N-acetyl glucosaminidase (NAG) and as an example of the brush border enzyme gamma-glutamyl-transferase (Gamma-GT). NAG concentration but not so much Gamma-GT concentration was higher in the urine of the obstructed kidneys than in the urine of the contralateral control kidney, in the first two weeks after operation, and then returned to normal. These observations lead to the conclusion that the "destructive phase" after ureteral obstruction can be identified by the appearance of high urinary tubular lysosomal enzyme content. The clinical implication is that the timing of relief of asymptomatic stable partial ureteral obstruction of unknown duration can be based on the concentrations of urinary lysosomal enzymes.

Developmental determinants of recovery after relief of partial ureteral obstruction

Although obstructive nephropathy is a major cause of renal insufficiency at all ages, the functional consequences of relief of obstruction on the developing kidney are poorly understood. To evaluate recovery from chronic partial ureteral obstruction (CPUO) in the neonatal period, the left ureter of guinea pigs was constricted within the first 48 hours of life, and the obstruction was relieved 10 days later. At three and eight weeks of age, intraureteral pressure, number of perfused glomeruli (NPG), renal blood flow (RBF), and glomerular filtration rate (GFR) were measured. These animals were compared with sham-operated and unrelieved groups. Two additional groups underwent CPUO at five weeks of age, with persistent obstruction or relief in 10 days, and were also studied at eight weeks. In all animals, intraureteral pressure increased during ipsilateral ureteral obstruction and normalized following its release. Recovery of RBF and GFR after relief of ipsilateral CPUO in the newborns was only partial at eight weeks, with no renal growth or increase in NPG from three to eight weeks of age. In contrast, recovery of RBF in the adult was complete 10 days after relief of obstruction, with significant increase in GFR, and no decrease in renal mass or NPG. We conclude that if delayed, relief of CPUO in the neonate may not restore renal growth and functional maturation which have been impaired by CPUO.

Partial ureteric obstruction in the pubescent rat. I. Long-term effects on renal function

A partial obstruction of the left ureter was created in six-week-old rats. The effects on renal function were studied after three, nine and 15 weeks, first in normal hydration, and then after extracellular volume expansion. Moderate hydronephrosis without parenchymal weight reduction developed within three weeks. The hydronephrotic kidney i) excreted during normal hydration less urine and sodium than the intact one, because of increased reabsorption, ii) was capable of reacting fully on volume expansion and iii) had, after volume expansion, a higher renal blood flow and GFR but also a higher reabsorption of water, sodium, potassium and osmoles, resulting in excretions similar to those on the intact side. The differences noted were small (less than 20%) except for sodium excretion. The hydronephrotic kidney seemed to tolerate an increase in ureteral resistance better than the intact one would do. There were no significant differences between the three, nine and 15-week groups, with regard to the effects on the hydronephrotic kidney. Thus, except for a tendency to sodium retention, the effects of partial ureteric obstruction in young rats seem to be relatively harmless and do not increase with time.

Tubuloglomerular feedback in animals with unilateral, partial ureteral occlusion

Previous experiments have shown that the sensitivity of the tubuloglomerular feedback system (TGF) is reduced by volume expansion in normal rats. This reduction in sensitivity is probably mediated by changes in the renal interstitial pressure. The present study was designed to investigate the TGF control system during volume expansion in rats with chronic, partial ureteral occlusion--hydronephrosis. Hydronephrosis was induced on the left or right side according to the method described by Ulm and Miller, in weanling Sprague-Dawley rats three weeks old. Three to six weeks later the rats were prepared for whole kidney and micropuncture experiments. Sham-operated animals were used as controls. Net interstitial pressure (that is, interstitial hydrostatic pressure minus interstitial oncotic pressure) was higher in the hydronephrotic, volume expanded animals than in the volume expanded controls. From findings in earlier investigations this increase in interstitial pressure would have been expected to reduce TGF sensitivity but this sensitivity was increased in the hydronephrotic kidneys, as indicated by a reduction in the turning point, the tubular flow rate at which 50% of the maximal stop-flow pressure response was observed (14.4 nl/min, sham-operated control 33.4 nl/min). Strong activity of the TGF mechanism was also indicated by a large proximal-distal difference in the single-nephron glomerular filtration rate (11.9 nl/min versus 3.3 nl/min in sham-operated controls) in the hydronephrotic kidney during volume expansion. Thus, in hydronephrotic kidneys in the latter condition the TGF mechanism was highly sensitive and activated to reduce the glomerular filtration rate. This mechanism may protect the diseased kidney from high intrapelvic pressures which otherwise could damage the kidney during saline volume expansion.

Comparison of dynamic computed tomography, diuresis renography and DTPA parenchymal transit time in the assessment of dilatation of the upper urinary tract

Three methods of assessment of upper urinary tract dilatation were compared prospectively. Forty-eight dilated renal units (35 patients) were studied, the majority being idiopathic pelvic hydronephrosis (69%). Dynamic computed tomography (CT) involves rapid sequence CT after injection of contrast medium. The maximum enhancement of a medullary region of interest (MMR) and its rate of enhancement (SMS) were derived from dynamic CT. Dynamic CT was compared with diuresis probe renography and measurement of parenchymal transit time (PTT) from DTPA imaging. The MMR (70.1 +/- 10.6 HU) and SMS (2.0 +/- 0.5 HU/s) in controls were significantly greater than in patients with upper tract dilatation (52.8 +/- 18.5 and 1.43 +/- 0.85 HU/s; both P less than 0.001). A significant association was observed between impairment of renal function in patients with upper tract dilatation and a low SMS and MMR (P less than 0.01). Statistically significant agreement was observed between the results of diuresis renography and PTT (P less than 0.025). However, no significant agreement was found when the results of dynamic CT were compared with either diuresis renography or with PTT. Dynamic CT as performed in the present study has no useful contribution to make in the diagnosis of patients with dilatation of the upper urinary tract.

Long-term effects of 24-hr unilateral ureteral obstruction on renal function in the rat

To characterize the pattern of recovery following release of unilateral ureteral obstruction of 24-hr duration, rats were studied with whole kidney clearance techniques, 3 hrs, 8, 14, and 60 days after release. The single nephron glomerular filtration rate (SNGFR) of superficial and juxtamedullary nephrons was estimated with a modification of Hanssen's technique in rats studied 8 and 60 days after ureteral release. The whole kidney glomerular filtration rates (GFR) were decreased markedly 3 hrs after relief of obstruction, but gradually increased and by 14 days, the GFR of the postobstructed kidney (POK) and the contralateral kidney (CK) were comparable. This recovery of GFR was not a consequence of a homogeneous improvement in SNGFR. At 8 days, more than 15% of superficial and juxtamedullary nephrons were not filtering in the POK. This decrease in the percent of filtering nephrons persisted to 60 days post release, indicating a permanent loss of nephron units. The SNGFR of the residual nephrons of the POK was significantly greater than that of the CK at 8 and 60 days following ureteral release. Thus, acute unilateral ureteral obstruction results in a permanent loss of filtering nephrons, which is offset by hyperfiltration of those remaining. Abnormalities in renal tubule function persisted beyond the time (14 days) when whole kidney GFR had returned to normal. These abnormalities were in distal tubule function. Urine osmolality was consistently lower at all time intervals post release, as was net acid excretion. The results of the present study suggest that these abnormalities are a consequence of the reduction in the number of filtering juxtamedullary nephrons and/or to abnormalities in collecting duct function.

Experimental obstructive hydronephrosis in newborn rats. VI. Long-term effects on glomerular filtration and distribution

Partial obstruction of one ureter was created in newborn rats and its effects were studied after the rats matured. The obstructed pelvis was found to be considerably enlarged. The parenchymal weight was 19 per cent lower and the whole kidney glomerular filtration rate was 43 per cent lower than on the contralateral intact side (p less than 0.001); however, these figures probably include a compensatory increase on the intact side. In the central part of the cortex, the glomerular filtration rate/mg. cortex was 21 per cent lower in the hydronephrotic kidney (p less than 0.02), but there was no intracortical redistribution. The glomerular density in this region was 24 per cent higher on the hydronephrotic side (p less than 0.001), because the glomeruli were crammed together in the distended cortex. No redistribution of glomeruli was found. The results are discussed and compared with previous findings from our laboratory. In this model, partially obstructive uropathy was found to cause only a moderate depression, but no redistribution, of the filtration.

Quantitative ultrastructure of human proximal tubules and cortical interstitium in chronic renal disease (hydronephrosis)

Surgically removed perfusion-fixed human kidneys with chronic renal disease (hydronephrosis) were studied by electron microscopy in order to determine whether there is a quantitative relationship between ultrastructural changes in proximal tubules in atrophy and changes in the surrounding cortical interstitium. Morphometric techniques were applied to montages of electron micrographs each covering several tubular profiles in the cortical labyrinth and to montages representing cross-sections of individual proximal convoluted tubules at a higher magnification. In order to enable a quantification of the spatial relations between individual tubular cross-sections and adjacent peritubular capillaries a tubulo-capillary index (TCI) was defined. This index was based on the mean distances between individual tubular cross-sections and adjacent peritubular capillaries and on the fraction of tubular circumference facing capillaries. Normal tissue from similarly fixed human nephrectomy specimens, which had been removed mainly because of neoplastic disorders, served as control material. In the hydronephrotic kidneys the relative volume of cortical interstitium (excluding capillaries) covered a range from 19.2-70.3%. Inverse correlations were demonstrated between the relative volume of cortical interstitium and various structural variables of proximal convoluted tubules, including tubular wall volume, the volume of mitochondria and the surface area of basolateral membranes. The TCI showed positive correlations with these tubular variables. No significant correlation was found between the volume fractions of cortical interstitium and capillaries. Finally, it was found that an increase in the volume fraction of the cortical interstitium from 16.2% in controls to 24.7% in cortical areas of hydronephrotic kidneys was associated with a 40-50% reduction in the volume of mitochondria and in the surface area of basolateral membranes in proximal tubules. The results are consistent with a pathogenic interrelationship between tubular and interstitial changes. An important factor in this relationship might be disturbed topographic associations between tubules and blood capillaries caused by the increase in cortical interstitium. The results further show that even slight increases in the cortical interstitial volume are associated with significant quantitative changes in tubular fine structure suggesting impaired tubular functions.

Pathophysiological changes in rat kidneys with partial ureteral obstruction since infancy

A partial ureteral obstruction (PUO) was created in 5-day-old rats by implanting the left ureter in the psoas muscle. The surgical technique was modified to produce mild or severe hydronephrosis [Hn (m) and Hn (s)]. The rats were studied at ages between 45 and 65 days with regard to kidney weight, number of functioning glomeruli, mean arterial blood pressure (MAP), total glomerular filtration rate (GFR), nephron filtration rate (SNGFR), tubular free-flow pressure (PT, and stop-flow pressure (SFP). Total GFR was determined after the release of obstruction. The other studies were performed in the obstructed state. Reference values were obtained from sham-operated and untouched control rats. The number of functioning nephrons was depressed 38% in Hn (m) and 73% in Hn (s). Total GFR was preserved in Hn (m) and depressed 54% in Hn (s). SNGFR in the remaining nephrons was significantly elevated in Hn (m) and normal in Hn (s). SFP was significantly elevated in Hn (s). The Hn (s) rats were hypertensive. The glomerular density was lower in the hydronephrotic than in the contralateral kidneys. This suggests a compensatory growth of the remaining nephrons in the Hn kidneys. We conclude that PUO present since infancy will either destroy the nephrons or elicit an adaptive response that will tend to preserve GFR.

Impact of age on effects of ureteral obstruction on renal function

Chronic partial ureteral obstruction of the urinary tract is a common congenital abnormality. Yet, its impact on the function of the kidney in the young has not been examined. To determine the relationship between age at the time of injury and outcome, partial ureteral obstruction was produced in guinea pigs during the first, second, third, fourth, or fifth week of life, and several variables of glomerular, proximal and distal tubular functions were measured 4 weeks later. The results were compared with those obtained in the contralateral kidney and with those observed in age-matched sham-operated animals. There was a significant impairment in the growth of the obstructed kidney. The weight of the contralateral kidney in the experimental animals was significantly greater than that of the obstructed (P less than 0.001) or control (P less than 0.005) kidney, but compensatory hypertrophy decreased progressively with age, being 30% of control when the obstruction was produced in the second week of life and only 2% when the obstruction occurred at 5 weeks of age. Obstruction resulted in a marked reduction in GFR at all ages, the impairment being inversely proportional with age. Conversely, the increase in GFR on the contralateral side, which was proportional with the increase in renal mass, diminished from 60.1 to 20.5% (r = 0.96, P less than 0.001) as a function age. Tubular reabsorption of phosphate was significantly lower in obstructed kidneys, particularly so in the animals sustaining obstruction during the first 2 weeks of life.(ABSTRACT TRUNCATED AT 250 WORDS)

Reversibility of preglomerular active vasoconstriction in the first weeks after complete unilateral ureteral obstruction by inhibition of prostaglandin synthesis

In previous studies our group has shown that unilateral complete ureteral ligation is followed by flow reduction, which clearly precedes renal atrophy and contributes to hydronephrotic renal cortical damage by ischemia. Long-term followup studies in dogs have demonstrated that increased hydronephrotic vascular resistance could be eliminated by infusion of 2-benzyl-2-imidazole, an inhibitor of thromboxane A2 synthesis. This was shown after 1 and 4 weeks of complete renal obstruction, and there was no such effect on the vascular resistance of the contralateral, unobstructed kidney. Flow reduction and vascular resistance were not influenced by the same inhibition of prostaglandin synthesis after 8 weeks of ureteral occlusion, although renal perfusion still responded to a nonspecific vasodilator, such as dopamine. Thus, active preglomerular vasoconstriction, influenced by imidazole, is present only when renal atrophy develops. Irreversible parenchymal loss, judged by renal cortical thickness, begins after 1 to 2 weeks and is complete 6 to 8 weeks after ureteral ligation. Once renal atrophy is established (that is, after 8 weeks of ureteral occlusion), flow reduction represents loss of renal parenchyma, and not active vasoconstriction. The specificity of the possible thromboxane A2 reaction in flow reduction is shown by its absence in the kidney that has been obstructed for 5 to 8 hours when postglomerular vasoconstriction is the cause of flow reduction (indicated by high renal pelvic pressure and intrarenal pressure). If we accept that imidazole selectively inhibits thromboxane A2 synthesis, we reach 2 conclusions that are clinically relevant: 1) thromboxane A2-mediated active vasoconstriction is 1 factor in the pathophysiology of hydronephrotic atrophy, and 2) the presence of thromboxane A2-mediated active vasoconstriction indicates when hydronephrotic atrophy develops and (more importantly) when it is still reversible, with respect to renal function. These findings can be used as a physiologic basis of a clinical test to predict reversibility of hydronephrotic damage.

Hydronephrosis: a new method to visualize vas afferens, efferens, and glomerular network

We have developed a new preparation for in vivo visualization of the glomerular microcirculation, the vas afferens and the vas efferens. This preparation utilizes postischemic hydronephrosis (PIH) to destroy the renal tubular system while preserving a portion of the cortex. In this preparation, glomeruli and associated vasculature remained intact. Observations can be made with either incident light or transillumination. The inner diameter of the vas afferens, measured within 50 microns of the glomerular vascular pole, was 7.9 +/- 0.5 microns (N = 12; SEM) while that of the vas efferens was 7.7 +/- 0.5 microns (N = 12). Both vessels were narrower adjacent to the glomerulus; minimal diameters in this region were 4.5 +/- 0.5 microns (N = 10) and 4.3 +/- 0.5 microns (N = 11), respectively. A specialized round cell, which may act as a sphincter, was seen in the vas efferens. In a second series of experiments, blood velocity was measured in the vas afferens and efferens about 100 microns from the vascular pole. Mean control velocities at these sites were 5.9 +/- 0.9 (N = 14) and 4.6 +/- 1.3 (N = 9) mm X sec-1, respectively; diameters at these same sites were 10.3 +/- 0.6 microns and 11.2 +/- 0.7. During angiotensin II infusion (first series, 0.2 to 0.4 micrograms X min-1 X kg-1, i.v.) the vas efferens in the vicinity of the glomerulus constricted by 22% whereas the corresponding vas afferens showed no consistent response. During angiotensin II infusion, the filtration fraction (GFR/RPF) may, therefore, be elevated by an increased resistance in the vas efferens, particularly at the outflow point of the glomerulus. In the second series of experiments higher dosages of angiotensin II caused vasoconstriction of both vessels, especially at sites more distant from the glomerulus. Furthermore, the new approach is suitable for observing the flow direction within single capillaries of one third to one half of the glomerulus. Therefore, for the first time it is possible to determine the real flow direction in a three-dimensional way.

"The distal nephron index": a measure of obstructive nephropathy in experimental hydronephrosis

An experimental model is described in rabbits where chronic partial ureteric occlusion and permanent renal pelvic cannulation were performed. For periods of up to three months, parameters of distal nephron function were measured repeatedly and pressure-flow studies performed. Fractional water clearance, free water clearance/GFR ratio and the relative intrapelvic pressure (IPP) on perfusion were increased (P less than 0.01) as a result of partial ureteric occlusion. A new parameter, "the distal nephron index", is described which is also raised in obstruction (P less than 0.01) and which exhibits a linear correlation with relative IPP (r = +0.40; P less than 0.05) not demonstrated by the other distal nephron function measurements. The implications of this relationship in the assessment of upper tract dilatation are discussed.

Experimental obstructive hydronephrosis in newborn rats. III. Long-term effects on renal function

A partial obstruction of 1 ureter was created in newborn rats and its effects were studied in the adult rat. The obstructed pelvis was found to be considerably enlarged. Nevertheless, the GFR (glomerular filtration rate) was only slightly decreased (10 per cent), completely compensated by increase on the contralateral, non-obstructed side. The reduction in GFR was less than the reduction in number of glomeruli (19 per cent), indicating a raised filtration rate per glomerulus. Water excretion was slightly increased and potassium excretion moderately decreased; sodium and osmolar excretion were not significantly affected. There was no correlation between these changes and the degree of pelvic enlargement. Thus, in this model, in which there is no urinary tract infection or pyelonephritis, partial obstructive uropathy caused less damage to the kidney function than might have been expected.

The effect of experimental hydronephrosis on clearance data

Partial obstruction of one ureter was created in newborn rats and its effects were studied in the adult rat. The obstructed renal pelvis was found to be enlarged 2-3 times. The weight of the kidney on this side was 85% of the contralateral one. Inulin clearance was measured in a way, which allowed comparison between the conventional technique and a modified technique, designed to circumvent the dilution in the enlarged pelvis. With the conventional technique, filtration was 32% of that in the contralateral kidney, whereas with the new technique true filtration of the hydronephrotic kidney was 82% (p less than 0.001). The modified technique is evaluated and the implications of the functional results are discussed.

Kidney function and histopathological changes in unilateral hydronephrosis with special reference to bilharzial ureter

Fifty-six patients with unilateral hydronephrosis were the subject of this study. The patients were classified into 4 groups according to the stage of hydronephrosis as assessed by radiological criteria. Split kidney function, histopathological studies, and measurement of intraureteral pressure were performed. Urinary Bilharziasis was held responsible for obstructive nephropathy in 77% of cases. Complicating urinary infection was present in 66%. The study has shown that creatinine excretion was slightly decreased in early, moderate, and moderately advanced hydronephrosis. On the other hand, a marked lowering of urine osmolality was found even in the early stages of hydronephrosis. The hydronephrotic kidney was found to be a salt losing one only in early, moderate, and moderately advanced hydronephroses, but not in the very advanced cases. The histopathological changes were mainly tubular, but some cases showed proliferative changes in the glomeruli. Eradication of urinary Bilharziasis and early treatment of this disease would markedly contribute to the prevention of obstructive nephropathies in countries where this disease is endemic.

A micropuncture study of renal sodium retention in nephrotic syndrome in rats: evidence for increased resistance to tubular fluid flow

Micropuncture studies were carried out in surface nephrons of rats with nephrotoxic-serum (NTS)-induced nephrotic syndrome during a period of active sodium and water retention. It was found that hydrostatic pressure and tubular diameter were increased in the proximal tubules (13.4 +/- 0.2 vs. 10.4 +/- 0.2 mm Hg; 31.3 +/- 0.9 vs. 18.4 +/- 0.7 mu), whereas pressure and tubular diameter were normal in the distal tubules. Single nephron glomerular filtration rate (SNGFR) was decreased and fractional reabsorption of fluid was markedly increased in the proximal tubules (74.1 vs. 61.7%). The increased pressure gradient between the proximal and distal tubules suggests a condition of increased resistance to flow between the proximal and distal tubules. Microinfusion of proximal tubules with an isotonic "equilibrium" solution led to little or no rise in intratubular pressure in normal rats but it led to a significant rise in nephrotic rats. When proximal tubules of normal rats were infused with a solution containing 100 mg/100 ml albumin, pressure rose to levels observed in nephrotic rats. The mechanism of the increased resistance to flow appeared to be related, therfore, to the presence of protein in the tubular fluid. Sodium retention in the nephrotic animals might be attributed to the reduction in GFR. In other types of renal disease in animals and man with comparable or greater reductions in GFR, sodium retention does not occur, however, and fractional excretion of sodium in the urine is increased in proportion to the reduction in GFR. Thus, the rise in proximal fractional reabsorption secondary to impaired fluid flow could be an important factor in the sodium retention of this disease.

Nephron obstruction in nordihydroguaiaretic acid-induced renal cystic disease

Studies were performed to characterize conditions in rat kidneys whose nephrons were made cystic by feeding 2% nordihydroguaiaretic acid (NDGA) to the animals. Using two micropipettes, we monitored intratubular hydrostatic pressures while perfusing single surface nephrons in NDGA-exposed (5 to 7 weeks) and normal rat kidneys. The introduction of 50 nl of Ringers solution labeled with 3H-inulin at a flow rate of 25 nl/min was associated with a significant mean (+/- SEM) increase (167 +/- 61%; P less than 0.02) in pressure in cystic but not in nondilated (-0.5 +/- 27.2%) or normal (31 +/- 23%) nephrons, respectively. The relative amount of 3H-inulin excreted in 40 min from cystic (4.0 +/- 2.0%) was less than that excreted from either nondilated (19 +/- 7%; P less than 0.05) or normal (105 +/- 26%; P less than 0.01) nephrons. Intralumenal pressures in nondilated but not other nephron groups correlated with urinary flow rates (r = 0.51; P less than 0.02). Single nephron filtration rates and tubular-fluid-to-plasma 3H-inulin rations in additional rats were similar among all groups of tubules. Concluding that these data reflected increased resistance to outflow from cystic nephrons, we examined these and additional NDGA-exposed (1 to 24 weeks) kidneys. 3H-thymidine radioautography demonstrated maximum collecting tubular cell hyperplasia (13% labeling) at 2 to 3 weeks of NDGA-exposure. Microscopy and microdissection demonstrated tiny mural polyps along outer medullary segments of collecting tubules. Thirteen tubules were traced to their outlets; polyps impinging on outflow lumens were found in all 13 instances. We conclude that partial nephron obstruction exists in NDGA-exposed kidneys and that obstruction is a likely contributor to cyst formation in this model.

The early phase of experimental acute renal failure. I. Intratubular pressure and obstruction

Tubular obstruction in acute renal failure, postulated to cause the restricted excretory function, is suggested by raising intratubular pressure, to lower effective filtration pressure and diminish urine output. To examine the applicability of the obstruction hypothesis to the pathogenesis of experimental acute renal failure, proximal intratubular pressure and renal function were measured after renal insults of different origins and severity. Obstruction in acute renal failure kidneys should manifest itself as an increase in intratubular pressure for a least 12 h, for within this time period following ureteral occlusion, elevated pressures were found to reflect obstruction. The consistent existence of raised proximal intratubular pressure in acute renal failure kidneys could not be detected; ischaemic and nephrototoxic models were found in which no rise in intratubular pressure could be demonstrated. The oliguric nature of acute renal failure kidneys could not be verified; ischaemic and nephrotoxic models were found in which urine output was either normal or enhanced. Only for methaemoglobin induced renal failure were raised intratubular pressure, oliguria and casts concurrent. It is concluded that obstruction is not a consistent feature of experimental acute renal failure and that the obstruction hypothesis may be specifically applicable to only a few models, which include haeme pigment and folic acid induced renal failure.

Intrarenal distribution of blood flow and glomerular filtration during chronic unilateral ureteral obstruction

Paired hydronephrotic (HN) and hypertrophic (HT) rat kidneys were studied after 6 days with complete unilateral ureteral obstruction without exposing the kidneys. Total HN renal blood flow (RBF), estimated by total microsphere (MS) uptake and from local 125I-antipyrine (Ap) uptake, averaged about 3/4 of control. HN kidney GFR was reduced to about 1/2 of control level as estimated from inulin clearance of HT kidney times the HN to HT ratio for mean single nephron filtration rate, determined by 14C-ferrocyanide. Whereas blood flow (Ap) was proportionately reduced in outer and inner cortex (OC and IC), fractional flow to the outer medulla (OM) was doubled as compared to controls (p less than 0.01). Filtration was well preserved in deep as compared to superficial glomeruli with a smaller deep nonfiltering fraction (p less than 0.02). Thus the results oppose the current concept that HN is characterized by disproportionate circulatory damage to IC and OM with little or no filtration in deep nephrons. In HT kidneys average RBF (MS) and GFR rose by about 1/2. Whereas total blood flow (Ap) rose proportionately in OC and IC, it remained at control level in OM, indicating dissociation between the total RBF and GFR and the effective blood flow to the OM zone.

The renin-angiotensin system in rats with hereditary hydronephrosis

The renin-angotensin system was studied in rats suffering from hereditary hydronephrosis in which normal blood pressure, hyperkalemia, and damage to the renal medulla and distal tubules were found. An increased serum creatinine level, decreased creatinine clearance and increased 24 hrs urine volume were observed in rats with bilateral hydronephrosis. When compared to rats with normal kidneys, bilaterally hydronephrotic animals exhibited elevated plasma renin activity (9.9 +/- 1.3/S.E./ng AI/ml/hr vs. 2.4 +/- 0.4 in rats with normal kidneys), and decreased renal renin concentration (78 +/- 4 mug AII/g vs. 132 +/- 5). No correlation between the extent of kidney damage and renal renic concentration was found. After the hyperkalemia of the hydronephrotic rats was corrected, there were significant increases in both plasma renin activity and renal renin concentration, but the renal renin concentration remained significantly lower than that observed in animals with normal kidneys. The results suggest that renin production and/or storage capacity are diminished in hydronephrotic kidneys.

Nature of the acidifying defect after the relief of ureteral obstruction

Nature of the acidifying defect observed after relief of ureteral obstruction. The acidifying capacity of the normal and experimental kidney was studied in rats three hours after release of complete unilateral ureteral obstruction or after unilateral release of unilateral ureteral obstruction, mean plasma bicarbonate concentration was 23.5 mEq/liter, and plasma pH, 7.45. Urine pH from the postreleased kidney was 7.47 and 6.01 from the control side. Net acid escretion averaged 0.97 muEq/min in the experimental kidney. Fractional excretion of bicarbonate averaged 0.02% in the control and 3.17% in the experimental kidney. In eight animals with unilateral release of bilateral ureteral obstruction, mean plasma bicarbonate was 16.9 mEq/min and plasma pH was7.35. Mean urine pH in the postreleased Kidney was 6.11, net acid excretion averaged 2.01 plus or minus 0.69 muEq/min and fractional bicarbonate excretion averaged 0.84%.

Renal function after release of chronic unilateral hydronephrosis in man

Differential renal function studies performed on ten patients after release of unilateral hydronephrosis revealed that the previously obstructed kidney exhibits abnormalities in a number of physiological indexes. Many of the obstructed kidneys had an impairment of glomerular filtration rate, concentrating ability, acidification, sodium reabsorption and tubular maximal secretion of para-aminohippurate with normal urinary dilution. Despite impairment of sodium and water reabsorption, none of these patients, nor 20 additional patients, had a significant postobstructive diuresis from the previously obstructed kidney. All of the patients had normal total renal function. Thus, the changes observed were a result of the obstructive injury and were not related to azotemia or aberrations in water or sodium metabolism.

Nephron functional heterogeneity in the postobstructive kidney

The purpose of this study was to determine the distribution of nephron filtration rates between superficial and juxtamedullary nephrons (S/J ratio) in kidneys studied immediately after relief of 24 hr total obstruction (acute) and after relief of prolonged partial obstruction (chronic). Injection of 14C-ferrocyanide and microdissection (modified Hanssen's technique) was used to provide an index of superficial and deep nephron glomerular filtration rate (GFR), and standard clearance determinations were done. In normal kidneys S/J ratio of 14C content (nephron GFR) was 0.73 plus or minus 0.03, a value similar to those obtained by other workers. After relief of acute obstruction, nephron GFR was too low for accurate measurement in 22% of superficial and 13% of deep nephrons. The mean S/J ratio of 14C content was similar to control, being 0.67 plus or minus 0.07, with only three of seven kidney showing loss of the normal S/J ratio. Since redistribution of nephron GFR was an inconsistent finding, while marked diuresis and natriuresis occurred in all rats, it appears that redistribution of nephron GFR is not an important factor in the phenomenon of postobstructive diuresis. After relief of chronic obstruction, diuresis and natriuresis were less marked but the mean S/J ratio of 14C content was 0.95 plus or minus 0.11, and in the majority of kidneys (six of eight), there was loss of distinction between superficial and deep nephron GFR. This redistribution of nephron function after relief of chronic, rather than acute, obstruction may be due to the more severe structural damage to the renal medulla of such kidneys and, although not responsible for postobstructive diuresis, it may be important in the diminished capacity of the chronically hydronephrotic kidney to conserve salt and water.