1
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Imig JD, Khan MAH, Stavniichuk A, Jankiewicz WK, Goorani S, Yeboah MM, El-Meanawy A. Salt-sensitive hypertension after reversal of unilateral ureteral obstruction. Biochem Pharmacol 2023; 210:115438. [PMID: 36716827 PMCID: PMC10107073 DOI: 10.1016/j.bcp.2023.115438] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 01/28/2023]
Abstract
The incidence of ureter obstruction is increasing and patients recovering from this kidney injury often progress to chronic kidney injury. There is evidence that a long-term consequence of recovery from ureter obstruction is an increased risk for salt-sensitive hypertension. A reversal unilateral ureteral obstruction (RUUO) model was used to study long-term kidney injury and salt-sensitive hypertension. In this model, we removed the ureteral obstruction at day 10 in mice. Mice were divided into four groups: (1) normal salt diet, (2) high salt diet, (3) RUUO normal salt diet, and (4) RUUO high salt diet. At day 10, the mice were fed a normal or high salt diet for 4 weeks. Blood pressure was measured, and urine and kidney tissue collected. There was a progressive increase in blood pressure in the RUUO high salt diet group. RUUO high salt group had decreased sodium excretion and glomerular injury. Renal epithelial cell injury was evident in RUUO normal and high salt mice as assessed by neutrophil gelatinase-associated lipocalin (NGAL). Kidney inflammation in the RUUO high salt group involved an increase in F4/80 positive macrophages; however, CD3+ positive T cells were not changed. Importantly, RUUO normal and high salt mice had decreased vascular density. RUUO was also associated with renal fibrosis that was further elevated in RUUO mice fed a high salt diet. Overall, these findings demonstrate long-term renal tubular injury, inflammation, decreased vascular density, and renal fibrosis following reversal of unilateral ureter obstruction that could contribute to impaired sodium excretion and salt-sensitive hypertension.
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Affiliation(s)
- John D Imig
- Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Drug Discovery Center, Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Md Abdul Hye Khan
- Drug Discovery Center, Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anna Stavniichuk
- Drug Discovery Center, Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA; Department of Integrative Biology and Pharmacology, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Wojciech K Jankiewicz
- Drug Discovery Center, Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Samaneh Goorani
- Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Drug Discovery Center, Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael M Yeboah
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ashraf El-Meanawy
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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2
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Ortega MA, Villiger RK, Harrison-Chau M, Lieu S, Tamashiro KK, Lee AJ, Fujimoto BA, Patwardhan GY, Kepler J, Fogelgren B. Exocyst inactivation in urothelial cells disrupts autophagy and activates non-canonical NF-κB signaling. Dis Model Mech 2022; 15:dmm049785. [PMID: 36004645 PMCID: PMC9586569 DOI: 10.1242/dmm.049785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/28/2022] [Indexed: 12/02/2022] Open
Abstract
Ureter obstruction is a highly prevalent event during embryonic development and is a major cause of pediatric kidney disease. We have previously reported that ureteric bud-specific ablation of the gene expressing the exocyst subunit EXOC5 in late murine gestation results in failure of urothelial stratification, cell death and complete ureter obstruction. However, the mechanistic connection between disrupted exocyst activity, urothelial cell death and subsequent ureter obstruction was unclear. Here, we report that inhibited urothelial stratification does not drive cell death during ureter development. Instead, we demonstrate that the exocyst plays a critical role in autophagy in urothelial cells, and that disruption of autophagy activates a urothelial NF-κB stress response. Impaired autophagy first provokes canonical NF-κB activity, which is progressively followed by increasing levels of non-canonical NF-κB activity and cell death if the stress remains unresolved. Furthermore, we demonstrate that ureter obstructions can be completely rescued in Exoc5 conditional knockout mice by administering a single dose of the pan-caspase inhibitor z-VAD-FMK at embryonic day 16.5 prior to urothelial cell death. Taken together, ablation of Exoc5 disrupts autophagic stress response and activates progressive NF-κB signaling, which promotes obstructive uropathy.
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Affiliation(s)
- Michael A. Ortega
- Center for Biomedical Research at The Queen's Medical Center, Honolulu, Hawaii 96813, USA
- Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medicine, University of Hawaiʿi at Manoa, Honolulu, Hawaii 96813, USA
| | - Ross K. Villiger
- Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medicine, University of Hawaiʿi at Manoa, Honolulu, Hawaii 96813, USA
| | - Malia Harrison-Chau
- Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medicine, University of Hawaiʿi at Manoa, Honolulu, Hawaii 96813, USA
| | - Suzanna Lieu
- Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medicine, University of Hawaiʿi at Manoa, Honolulu, Hawaii 96813, USA
| | - Kadee-Kalia Tamashiro
- Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medicine, University of Hawaiʿi at Manoa, Honolulu, Hawaii 96813, USA
| | - Amanda J. Lee
- Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medicine, University of Hawaiʿi at Manoa, Honolulu, Hawaii 96813, USA
- Math and Sciences Department, Kapiolani Community College, Honolulu, Hawaii 96816, USA
| | - Brent A. Fujimoto
- Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medicine, University of Hawaiʿi at Manoa, Honolulu, Hawaii 96813, USA
| | - Geetika Y. Patwardhan
- Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medicine, University of Hawaiʿi at Manoa, Honolulu, Hawaii 96813, USA
| | - Joshua Kepler
- Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medicine, University of Hawaiʿi at Manoa, Honolulu, Hawaii 96813, USA
| | - Ben Fogelgren
- Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medicine, University of Hawaiʿi at Manoa, Honolulu, Hawaii 96813, USA
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3
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Kumar R, Soni H, Afolabi JM, Kanthakumar P, Mankuzhy PD, Iwhiwhu SA, Adebiyi A. Induction of reactive oxygen species by mechanical stretch drives endothelin production in neonatal pig renal epithelial cells. Redox Biol 2022; 55:102394. [PMID: 35841629 PMCID: PMC9289874 DOI: 10.1016/j.redox.2022.102394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 06/23/2022] [Accepted: 07/01/2022] [Indexed: 11/23/2022] Open
Abstract
Vasoactive endothelin (ET) is generated by ET converting enzyme (ECE)-induced proteolytic processing of pro-molecule big ET to biologically active peptides. H2O2 has been shown to increase the expression of ECE1 via transactivation of its promoter. The present study demonstrates that H2O2 triggered ECE1-dependent ET1-3 production in neonatal pig proximal tubule (PT) epithelial cells. A uniaxial stretch of PT cells decreased catalase, increased NADPH oxidase (NOX)2 and NOX4, and increased H2O2 levels. Stretch also increased cellular ECE1, an effect reversed by EUK-134 (a synthetic superoxide dismutase/catalase mimetic), NOX inhibitor apocynin, and siRNA-mediated knockdown of NOX2 and NOX4. Short-term unilateral ureteral obstruction (UUO), an inducer of renal tubular cell stretch and oxidative stress, increased renal ET1-3 generation and vascular resistance (RVR) in neonatal pigs. Despite removing the obstruction, UUO-induced increase in RVR persisted, resulting in early acute kidney injury (AKI). ET receptor (ETR)-operated Ca2+ entry in renal microvascular smooth muscle (SM) via transient receptor potential channel 3 (TRPC3) channels reduced renal blood flow and increased RVR. Although acute reversible UUO (rUUO) did not change protein expression levels of ETR and TRPC3 in renal microvessels, inhibition of ECE1, ETR, and TRPC3 protected against renal hypoperfusion, RVR increase, and early AKI. These data suggest that mechanical stretch-driven oxyradical generation stimulates ET production in neonatal pig renal epithelial cells. ET activates renal microvascular SM TRPC3, leading to persistent vasoconstriction and reduction in renal blood flow. These mechanisms may underlie rUUO-induced renal insufficiency in infants.
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Affiliation(s)
- Ravi Kumar
- Department of Physiology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Hitesh Soni
- Department of Physiology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jeremiah M Afolabi
- Department of Physiology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Praghalathan Kanthakumar
- Department of Physiology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Pratheesh D Mankuzhy
- Department of Physiology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Samson A Iwhiwhu
- Department of Physiology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Adebowale Adebiyi
- Department of Physiology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
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4
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Hage D, Iwanaga J, Dumont AS, Tubbs RS. Caudal regression syndrome and a pelvic kidney: case report. Anat Cell Biol 2020; 53:509-511. [PMID: 32647073 PMCID: PMC7769103 DOI: 10.5115/acb.20.057] [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: 03/15/2020] [Revised: 04/25/2020] [Accepted: 05/08/2020] [Indexed: 11/27/2022] Open
Abstract
Caudal regression syndrome (CRS) is a rare congenital variation. A high incidence of renal and genitourinary malformations has been observed in patients with CRS, with the most common being neurogenic bladder and renal agenesis. We report a rare case report documenting both CRS and a pelvic kidney found during a diagnostic magnetic resonance imaging. Although renal anatomy variants are found in patients with CRS, a pelvic kidney is normally not part of the constellation of findings in this malformation. As seen in our patient, a pelvic kidney should be considered in patients suspected of having CRS.
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Affiliation(s)
- Dany Hage
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
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5
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McLeod DJ, Sebastião YV, Ching CB, Greenberg JH, Furth SL, Becknell B. Longitudinal kidney injury biomarker trajectories in children with obstructive uropathy. Pediatr Nephrol 2020; 35:1907-1914. [PMID: 32444926 PMCID: PMC7502482 DOI: 10.1007/s00467-020-04602-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Congenital obstructive uropathy (OU) is a leading cause of pediatric kidney failure, representing a unique mechanism of injury, in part from renal tubular stretch and ischemia. Tubular injury biomarkers have potential to improve OU-specific risk stratification. METHODS Patients with OU were identified in the Chronic Kidney Disease in Children (CKiD) study. "Cases" were defined as individuals receiving any kidney replacement therapy (KRT), while "controls" were age- and time-on-study matched and KRT free at last study visit. Urine and plasma neutrophil gelatinase-associated lipocalin (NGAL), interleukin 18 (IL-18), and liver-type fatty acid-binding protein (L-FABP) levels were measured at enrollment and annually and compared between cases and controls. Urine values were normalized to urine creatinine. RESULTS In total, 22 cases and 22 controls were identified, with median (interquartile range) ages of 10.5 (9.0-13.0) and 15.9 (13.9-16.9) years at baseline and outcome, respectively. At enrollment there were no differences noted between cases and controls for any urine (u) or plasma (p) biomarker measured. However, the mean pNGAL and uL-FABP/creatinine increased throughout the study period in cases (15.38 ng/ml per year and 0.20 ng/ml per mg/dl per year, respectively, p = 0.01 for both) but remained stable in controls. This remained constant after controlling for baseline glomerular filtration rate (GFR). CONCLUSIONS In children with OU, pNGAL and uL-FABP levels increased over the 5 years preceding KRT; independent of baseline GFR. Future studies are necessary to identify optimal cutoff values and to determine if these markers outperform current clinical predictors.
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Affiliation(s)
- Daryl J McLeod
- Section of Urology, Nationwide Children's Hospital, Columbus, OH, 43205, USA.
- Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, 43205, USA.
| | - Yuri V Sebastião
- Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Christina B Ching
- Section of Urology, Nationwide Children's Hospital, Columbus, OH, 43205, USA
- Center for Clinical and Translational Research, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Jason H Greenberg
- Department of Pediatrics, Section of Nephrology, Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Susan L Furth
- Department of Pediatrics, Division of Nephrology, Perelman School of Medicine at the University of Pennsylvania and the Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Brian Becknell
- Center for Clinical and Translational Research, Nationwide Children's Hospital, Columbus, OH, 43205, USA
- Department of Pediatrics, Section of Nephrology, Nationwide Children's Hospital, Columbus, OH, 43205, USA
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6
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McLeod DJ, Ching CB, Sebastião YV, Greenberg JH, Furth SL, McHugh KM, Becknell B. Common clinical markers predict end-stage renal disease in children with obstructive uropathy. Pediatr Nephrol 2019; 34:443-448. [PMID: 30317433 PMCID: PMC6500428 DOI: 10.1007/s00467-018-4107-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/12/2018] [Accepted: 09/28/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Obstructive uropathy (OU) is a common cause of end-stage renal disease (ESRD) in children. Children who escape the newborn period with mild-to-moderate chronic kidney disease (CKD) continue to be at increased risk. The predictive ability of clinically available markers throughout childhood is poorly defined. METHODS Patients with OU were identified in the Chronic Kidney Disease in Children Study. The primary outcome of interest was renal replacement therapy (RRT) (cases). Controls were age matched and defined as patients within the OU cohort who did not require RRT during study follow-up. RESULTS In total, 27 cases and 41 age-matched controls were identified. Median age at baseline and age at outcome measurement were 10 vs. 16 years, respectively. First available glomerular filtration rate (GFR) (36.9 vs. 53.5 mL/min per 1.73 m2), urine protein/creatinine (Cr) (0.40 vs. 0.22 mg/mg) and microalbumin/Cr (0.58 vs. 0.03 mg/mg), and serum CO2 (20 vs. 22 mmol/L) and hemoglobin (12.4 vs. 13.2 g/dL) differed significantly between cases and controls, respectively. GFR declined 3.07 mL/min per 1.73 m2/year faster in cases compared to that in controls (p < 0.0001). Urine protein/Cr and microalbumin/Cr increased by 0.16 and 0.11 per year more in cases compared to those in controls, respectively (p ≤ 0.001 for both). Serum phosphate increased by 0.11 mg/dL and serum albumin and hemoglobin decreased by 0.04 (g/dL) and 0.14 (g/dL) per year more for cases compared to those for controls, respectively (p < 0.05 for all). CONCLUSIONS Age-specific baseline and longitudinal measures of readily available clinical measures predict progression to ESRD in children with mild-to-moderate CKD from OU.
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Affiliation(s)
- Daryl J. McLeod
- Section of Urology, Nationwide Children’s Hospital, Columbus, OH 43205, USA,Center for Surgical Outcomes Research, Nationwide Children’s Hospital, Columbus, OH 43205, USA
| | - Christina B. Ching
- Section of Urology, Nationwide Children’s Hospital, Columbus, OH 43205, USA,Center for Clinical and Translational Research, Nationwide Children’s Hospital, Columbus, OH 43205, USA
| | - Yuri V. Sebastião
- Center for Surgical Outcomes Research, Nationwide Children’s Hospital, Columbus, OH 43205, USA
| | - Jason H. Greenberg
- Department of Pediatrics, Section of Nephrology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Susan L. Furth
- Department of Pediatrics, Division of Nephrology, Perelman School of Medicine at the University of Pennsylvania and the Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Kirk M. McHugh
- Center for Clinical and Translational Research, Nationwide Children’s Hospital, Columbus, OH 43205, USA,Department of Biomedical Education & Anatomy, Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Brian Becknell
- Center for Clinical and Translational Research, Nationwide Children’s Hospital, Columbus, OH 43205, USA,Department of Pediatrics, Section of Nephrology, Nationwide Children’s Hospital, Columbus, OH 43205, USA
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7
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Chen WY, Yang JL, Wu YH, Li LC, Li RF, Chang YT, Dai LH, Wang WC, Chang YJ. IL-33/ST2 axis mediates hyperplasia of intrarenal urothelium in obstructive renal injury. Exp Mol Med 2018; 50:1-11. [PMID: 29674622 PMCID: PMC5938009 DOI: 10.1038/s12276-018-0047-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 11/20/2017] [Accepted: 12/21/2017] [Indexed: 12/14/2022] Open
Abstract
The monolayered intrarenal urothelium covers the renal papilla and ureteropelvic junction (UPJ). In response to increased renal pressure during obstruction or ischemic injuries, intrarenal urothelial cells begin to proliferate and form a multilayered urothelium. Little is known regarding the mechanism and pathophysiological role of urothelium hyperplasia during renal obstruction. In this study, we investigated the expression of interleukin (IL)-33, an IL-1 family cytokine, in kidneys with unilateral ureteral obstruction (UUO)-induced obstructive injury. IL-33 levels in hydronephrotic urine and serum were upregulated 2 days after UUO. The number of ST2-expressing immune cells was increased in the UUO kidney. We found that IL-33 was upregulated in vimentin-positive cells in the cortical and medullar layers and the UPJ stroma. Moreover, IL-33 expression was predominantly induced in multilayered keratin 5-positive urothelial cells in the UPJ. IL-33 was not detected in terminally differentiated superficial umbrella cells expressing uroplakin 3a. In vivo, we confirmed that deficiency of IL33 or its receptor ST2 attenuated UUO-induced hyperplasia of the UPJ urothelium. Deficiency of IL33 attenuated the expression of UUO-induced type 2 inflammatory cytokines and upregulated uroplakins and urothelial differentiation signaling in UPJ tissues. Our results collectively suggest that the IL-33/ST2 axis mediates the activation of innate immune responses and contributes to urothelial hyperplasia by regulating urothelial differentiation in obstructive kidney injury.
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Affiliation(s)
- Wei-Yu Chen
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
| | - Jenq-Lin Yang
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yi-Hsiu Wu
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Lung-Chih Li
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ru-Fang Li
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ya-Ting Chang
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Lo-Hsin Dai
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wan-Chen Wang
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ya-Jen Chang
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.
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8
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Is hydrogen sulfide a potential novel therapy to prevent renal damage during ureteral obstruction? Nitric Oxide 2018; 73:15-21. [DOI: 10.1016/j.niox.2017.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/12/2017] [Accepted: 12/17/2017] [Indexed: 12/28/2022]
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9
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Chronic kidney disease-associated cardiovascular disease: scope and limitations of animal models. Cardiovasc Endocrinol 2017; 6:120-127. [PMID: 31646129 DOI: 10.1097/xce.0000000000000132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 08/21/2017] [Indexed: 01/01/2023] Open
Abstract
Chronic kidney disease (CKD) is a heterogeneous range of disorders affecting up to 11% of the world's population. The majority of patients with CKD die of cardiovascular disease (CVD) before progressing to end-stage renal disease. CKD patients have an increased risk of atherosclerotic disease as well as a unique cardiovascular phenotype. There remains no clear aetiology for these issues and a better understanding of the pathophysiology of CKD-associated CVD is urgently needed. Although nonanimal studies can provide insights into the nature of disease, the whole-organism nature of CKD-associated CVD means that high-quality animal models, at least for the immediate future, are likely to remain a key tool in improving our understanding in this area. We will discuss the methods used to induce renal impairment in rodents and the methods available to assess cardiovascular phenotype and in each case describe the applicability to humans.
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10
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Magalhães P, Schanstra JP, Carrick E, Mischak H, Zürbig P. Urinary biomarkers for renal tract malformations. Expert Rev Proteomics 2016; 13:1121-1129. [PMID: 27791437 DOI: 10.1080/14789450.2016.1254555] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Renal tract malformations (RTMs) are congenital anomalies of the kidneys and urinary tract, which are the major cause of end-stage renal disease in children. Using immunoassay-based approaches (ELISA, western blot), individual urinary proteins including transforming growth factor β, tumor necrosis factor and monocyte attractant proteins 1 were found to be associated to RTMs. However, only mass spectrometry (MS) based methods leading to the identification of panels of protein-based markers composed of fragments of the extracellular matrix allowed the prediction of progression of RTMs and its complications. Areas covered: In this review, we summarized relevant studies identified in "Pubmed" using the keywords "urinary biomarkers" and "proteomics" and "renal tract malformations" or "hydronephrosis" or "ureteropelvic junction obstruction" or "posterior urethral valves" or "vesicoureteral reflux". These publications represent studies on potential protein-based biomarkers, either individually or combined in panels, of RTMs in human and animal models. Expert commentary: Successful use in the clinic of these protein-based biomarkers will need to involve larger scale studies to reach sufficient power. Improved performance will potentially come from combining immunoassay- and MS-based markers.
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Affiliation(s)
- Pedro Magalhães
- a Mosaiques Diagnostics GmbH , Hannover , Germany.,b Department of Pediatric Nephrology, Hannover Medical School , Hannover , Germany
| | - Joost P Schanstra
- c Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institute of Cardiovascular and Metabolic Disease , Toulouse , France.,d Université Toulouse III Paul-Sabatier , Toulouse , France
| | - Emma Carrick
- e BHF Glasgow Cardiovascular Research Centre , Institute of Cardiovascular and Medical Sciences, University of Glasgow , Glasgow , UK
| | - Harald Mischak
- a Mosaiques Diagnostics GmbH , Hannover , Germany.,e BHF Glasgow Cardiovascular Research Centre , Institute of Cardiovascular and Medical Sciences, University of Glasgow , Glasgow , UK
| | - Petra Zürbig
- a Mosaiques Diagnostics GmbH , Hannover , Germany
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11
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Lee AJ, Polgar N, Napoli JA, Lui VH, Tamashiro KK, Fujimoto BA, Thompson KS, Fogelgren B. Fibroproliferative response to urothelial failure obliterates the ureter lumen in a mouse model of prenatal congenital obstructive nephropathy. Sci Rep 2016; 6:31137. [PMID: 27511831 PMCID: PMC4980620 DOI: 10.1038/srep31137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 07/12/2016] [Indexed: 01/02/2023] Open
Abstract
Congenital obstructive nephropathy (CON) is the most prevalent cause of pediatric chronic kidney disease and end-stage renal disease. The ureteropelvic junction (UPJ) region, where the renal pelvis transitions to the ureter, is the most commonly obstructed site in CON. The underlying causes of congenital UPJ obstructions remain poorly understood, especially when they occur in utero, in part due to the lack of genetic animal models. We previously showed that conditional inactivation of Sec10, a central subunit of the exocyst complex, in the epithelial cells of the ureter and renal collecting system resulted in late gestational bilateral UPJ obstructions with neonatal anuria and death. In this study, we show that without Sec10, the urothelial progenitor cells that line the ureter fail to differentiate into superficial cells, which are responsible for producing uroplakin plaques on the luminal surface. These Sec10-knockout urothelial cells undergo cell death by E17.5 and the urothelial barrier becomes leaky to luminal fluid. Also at E17.5, we measured increased expression of TGFβ1 and genes associated with myofibroblast activation, with evidence of stromal remodeling. Our findings support the model that a defective urothelial barrier allows urine to induce a fibrotic wound healing mechanism, which may contribute to human prenatal UPJ obstructions.
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Affiliation(s)
- Amanda J Lee
- Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medicine, University of Hawaii at Manoa, HI 96813, USA
| | - Noemi Polgar
- Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medicine, University of Hawaii at Manoa, HI 96813, USA
| | - Josephine A Napoli
- Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medicine, University of Hawaii at Manoa, HI 96813, USA
| | - Vanessa H Lui
- Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medicine, University of Hawaii at Manoa, HI 96813, USA
| | - Kadee-Kalia Tamashiro
- Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medicine, University of Hawaii at Manoa, HI 96813, USA
| | - Brent A Fujimoto
- Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medicine, University of Hawaii at Manoa, HI 96813, USA
| | - Karen S Thompson
- Department of Pathology, John A. Burns School of Medicine, University of Hawaii at Manoa, HI 96813, USA
| | - Ben Fogelgren
- Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medicine, University of Hawaii at Manoa, HI 96813, USA
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Lilly MA, Kulkulka NA, Firmiss PR, Ross MJ, Flum AS, Santos GBD, Bowen DK, Dettman RW, Gong EM. The Murine Bladder Supports a Population of Stromal Sca-1+/CD34+/lin- Mesenchymal Stem Cells. PLoS One 2015; 10:e0141437. [PMID: 26540309 PMCID: PMC4634995 DOI: 10.1371/journal.pone.0141437] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 10/08/2015] [Indexed: 01/15/2023] Open
Abstract
Bladder fibrosis is an undesired end point of injury of obstruction and often renders the smooth muscle layer noncompliant. In many cases, the long-term effect of bladder fibrosis is renal failure. Despite our understanding of the progression of this disease, little is known about the cellular mechanisms that lead to a remodeled bladder wall. Resident stem (progenitor) cells have been identified in various organs such as the brain, heart and lung. These cells function normally during organ homeostasis, but become dysregulated after organ injury. Here, we aimed to characterize a mesenchymal progenitor cell population as a first step in understanding its role in bladder fibrosis. Using fluorescence activated cell sorting (FACS), we identified a Sca-1+/ CD34+/ lin- (PECAM-: CD45-: Ter119-) population in the adult murine bladder. These cells were localized to the stromal layer of the adult bladder and appeared by postnatal day 1. Cultured Sca-1+/ CD34+/ lin- bladder cells self-renewed, formed colonies and spontaneously differentiated into cells expressing smooth muscle genes. These cells differentiated into other mesenchymal lineages (chondrocytes, adipocytes and osteocytes) upon culture in induction medium. Both acute and partial obstruction of the bladder reduced expression of CD34 and changed localization of Sca-1 to the urothelium. Partial obstruction resulted in upregulation of fibrosis genes within the Sca-1+/CD34+/lin- population. Our data indicate a resident, mesenchymal stem cell population in the bladder that is altered by bladder obstruction. These findings provide new information about the cellular changes in the bladder that may be associated with bladder fibrosis.
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Affiliation(s)
- Meredith A. Lilly
- Developmental Biology, Stanley Manne Children’s Research Institute, Anne and Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave. Box 225, Chicago, Illinois, 60611, United States of America
| | - Natalie A. Kulkulka
- Developmental Biology, Stanley Manne Children’s Research Institute, Anne and Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave. Box 225, Chicago, Illinois, 60611, United States of America
| | - Paula R. Firmiss
- Developmental Biology, Stanley Manne Children’s Research Institute, Anne and Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave. Box 225, Chicago, Illinois, 60611, United States of America
| | - Michael J. Ross
- Loyola University Health System, Department of Urology, 2160 S. First St., Maywood, Illinois, United States of America
| | - Andrew S. Flum
- Northwestern University, Feinberg School of Medicine, Department of Urology, 303 E. Chicago Ave., 16–703, Chicago, Illinois, 60611, United States of America
- Developmental Biology, Stanley Manne Children’s Research Institute, Anne and Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave. Box 225, Chicago, Illinois, 60611, United States of America
| | - Grace B. Delos Santos
- Loyola University Health System, Department of Urology, 2160 S. First St., Maywood, Illinois, United States of America
| | - Diana K. Bowen
- Northwestern University, Feinberg School of Medicine, Department of Urology, 303 E. Chicago Ave., 16–703, Chicago, Illinois, 60611, United States of America
- Developmental Biology, Stanley Manne Children’s Research Institute, Anne and Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave. Box 225, Chicago, Illinois, 60611, United States of America
| | - Robert W. Dettman
- Northwestern University, Feinberg School of Medicine, Department of Urology, 303 E. Chicago Ave., 16–703, Chicago, Illinois, 60611, United States of America
- Developmental Biology, Stanley Manne Children’s Research Institute, Anne and Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave. Box 225, Chicago, Illinois, 60611, United States of America
- * E-mail: (RWD); (EMG)
| | - Edward M. Gong
- Northwestern University, Feinberg School of Medicine, Department of Urology, 303 E. Chicago Ave., 16–703, Chicago, Illinois, 60611, United States of America
- Developmental Biology, Stanley Manne Children’s Research Institute, Anne and Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave. Box 225, Chicago, Illinois, 60611, United States of America
- * E-mail: (RWD); (EMG)
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Urothelial Defects from Targeted Inactivation of Exocyst Sec10 in Mice Cause Ureteropelvic Junction Obstructions. PLoS One 2015; 10:e0129346. [PMID: 26046524 PMCID: PMC4457632 DOI: 10.1371/journal.pone.0129346] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 05/07/2015] [Indexed: 01/12/2023] Open
Abstract
Most cases of congenital obstructive nephropathy are the result of ureteropelvic junction obstructions, and despite their high prevalence, we have a poor understanding of their etiology and scarcity of genetic models. The eight-protein exocyst complex regulates polarized exocytosis of intracellular vesicles in a large variety of cell types. Here we report generation of a conditional knockout mouse for Sec10, a central component of the exocyst, which is the first conditional allele for any exocyst gene. Inactivation of Sec10 in ureteric bud-derived cells using Ksp1.3-Cre mice resulted in severe bilateral hydronephrosis and complete anuria in newborns, with death occurring 6-14 hours after birth. Sec10 FL/FL;Ksp-Cre embryos developed ureteropelvic junction obstructions between E17.5 and E18.5 as a result of degeneration of the urothelium and subsequent overgrowth by surrounding mesenchymal cells. The urothelial cell layer that lines the urinary tract must maintain a hydrophobic luminal barrier again urine while remaining highly stretchable. This barrier is largely established by production of uroplakin proteins that are transported to the apical surface to establish large plaques. By E16.5, Sec10 FL/FL;Ksp-Cre ureter and pelvic urothelium showed decreased uroplakin-3 protein at the luminal surface, and complete absence of uroplakin-3 by E17.5. Affected urothelium at the UPJ showed irregular barriers that exposed the smooth muscle layer to urine, suggesting this may trigger the surrounding mesenchymal cells to overgrow the lumen. Findings from this novel mouse model show Sec10 is critical for the development of the urothelium in ureters, and provides experimental evidence that failure of this urothelial barrier may contribute to human congenital urinary tract obstructions.
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Manson SR, Song JB, Guo Q, Liapis H, Austin PF. Cell type specific changes in BMP-7 expression contribute to the progression of kidney disease in patients with obstructive uropathy. J Urol 2015; 193:1860-1869. [PMID: 25813565 DOI: 10.1016/j.juro.2014.10.117] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2014] [Indexed: 10/23/2022]
Abstract
PURPOSE Congenital urinary tract obstruction is a leading cause of renal maldevelopment and pediatric kidney disease. Nonetheless, few groups have examined its molecular pathogenesis in humans. We evaluated the role of BMP-7, a protein required for renal injury repair and nephrogenesis, in disease progression in patients with obstructive uropathy. MATERIALS AND METHODS Whole kidney and cell specific BMP-7 expression was examined in a murine model of unilateral ureteral obstruction and in patients with congenital ureteropelvic junction obstruction. Findings were correlated with molecular markers of renal injury and clinical parameters. RESULTS Unilateral ureteral obstruction led to a dramatic decrease in BMP-7 expression in the proximal and distal tubules before the onset of significant loss of renal architecture and fibrosis, suggesting that this is a critical molecular event that drives early stage disease progression. Loss of BMP-7 expression then extended to the collecting ducts and glomeruli in end stage kidney disease. When translating these findings to patients with ureteropelvic junction obstruction, global loss of BMP-7 expression correlated with a decreased number of nephrons, loss of renal architecture, severe renal fibrosis and loss of kidney function. CONCLUSIONS Given that BMP-7 has a critical role in renal injury repair and nephrogenesis, these findings show that cell specific changes in BMP-7 expression contribute to the onset of irreversible renal injury and impaired kidney development secondary to congenital urinary tract obstruction. Accordingly therapies that target these cell populations to restore BMP-7 activity may limit disease progression in patients with obstructive uropathy.
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Affiliation(s)
- Scott R Manson
- Department of Surgery, Division of Urology, St. Louis Children's Hospital and Department of Pathology and Immunology, Barnes-Jewish Hospital (HL), Washington University, St. Louis, Missouri
| | - Joseph B Song
- Department of Surgery, Division of Urology, St. Louis Children's Hospital and Department of Pathology and Immunology, Barnes-Jewish Hospital (HL), Washington University, St. Louis, Missouri
| | - Qiusha Guo
- Department of Surgery, Division of Urology, St. Louis Children's Hospital and Department of Pathology and Immunology, Barnes-Jewish Hospital (HL), Washington University, St. Louis, Missouri
| | - Helen Liapis
- Department of Surgery, Division of Urology, St. Louis Children's Hospital and Department of Pathology and Immunology, Barnes-Jewish Hospital (HL), Washington University, St. Louis, Missouri
| | - Paul F Austin
- Department of Surgery, Division of Urology, St. Louis Children's Hospital and Department of Pathology and Immunology, Barnes-Jewish Hospital (HL), Washington University, St. Louis, Missouri
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Kajbafzadeh AM, Sabetkish N, Sabetkish S, Javan-Farazmand N, Harsini S, Tavangar SM. The ameliorative effect of various antioxidants on Adriamycin-induced fetal renal abnormalities. J Pediatr Urol 2013; 9:1084-92. [PMID: 23665376 DOI: 10.1016/j.jpurol.2013.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 03/18/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the efficacy of nine antiapoptotic compounds in preventing the development of Adriamycin-induced fetal renal abnormalities or ameliorating the resultant renal damage in a rat model. METHODS Thirty-three Sprague-Dawley rats were randomly divided into sham-control, Adriamycin and prevention groups. The prevention group was divided into 9 subgroups. The rats were time mated and experimental rats were injected with Adriamycin on gestational day 7-9. Sham-control rats were injected with saline on the same days. The preventive medications were administered to the prevention group from 7 days prior to mating to the end of pregnancy. Samples were prepared from fetuses for histological and biochemical analyses. RESULTS A total of 331 fetuses were recovered. There were no resorptions in the Deferoxamine, Amifostine and sham-control groups. Significant decrease of antioxidant activities was noted in the Adriamycin group compared to the sham-control group. In all prevention groups, antioxidant activities were significantly increased compared to the Adriamycin group. The highest rate of hydronephrosis was observed in the Adriamycin group (82%). The lowest rates of renal abnormalities were noted with Deferoxamine and Amifostine: 8% and 11%. CONCLUSION Oxidant injury plays a critical role in the development and progression of Adriamycin-induced fetal renal abnormalities. Some antiapoptotic medications, notably Deferoxamine and Amifostine, may have preventive and therapeutic potential in the management of fetal renal abnormalities.
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Affiliation(s)
- Abdol-Mohammad Kajbafzadeh
- Pediatric Urology Research Center, Department of Pediatric Urology, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
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Klein J, Lacroix C, Caubet C, Siwy J, Zurbig P, Dakna M, Muller F, Breuil B, Stalmach A, Mullen W, Mischak H, Bandin F, Monsarrat B, Bascands JL, Decramer S, Schanstra JP. Fetal Urinary Peptides to Predict Postnatal Outcome of Renal Disease in Fetuses with Posterior Urethral Valves (PUV). Sci Transl Med 2013; 5:198ra106. [DOI: 10.1126/scitranslmed.3005807] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Manson SR, Song JB, Hruska KA, Austin PF. HDAC dependent transcriptional repression of Bmp-7 potentiates TGF-β mediated renal fibrosis in obstructive uropathy. J Urol 2013; 191:242-52. [PMID: 23820056 DOI: 10.1016/j.juro.2013.06.110] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2013] [Indexed: 12/21/2022]
Abstract
PURPOSE Recombinant BMP-7 inhibits the pathogenesis of renal injury in response to various stimuli. However, little is known about the molecular regulation of endogenous BMP-7 and its renal protective functions. We examined transcriptional regulation of Bmp-7 and its role in the pathogenesis of renal injury resulting from urinary tract dysfunction. MATERIALS AND METHODS Obstruction induced renal injury was modeled in vivo in mice by unilateral ureteral obstruction and in vitro in primary kidney cells by treatment with transforming growth factor-β, a profibrotic cytokine that is increased in the obstructed kidney. RESULTS Unilateral ureteral obstruction resulted in the loss of BMP-7 expression in conjunction with histone deacetylation and transcriptional repression of the Bmp-7 promoter. The histone deacetylase inhibitor trichostatin A stimulated Bmp-7 expression in primary kidney cells. Trichostatin A also inhibited the expression of transforming growth factor-β dependent profibrotic genes in a manner that depended on BMP receptor signaling. These findings extended to the obstructed kidney in vivo, in which trichostatin A treatment restored the expression of Bmp-7 along with BMP-7 mediated suppression of transforming growth factor-β dependent signaling pathways. Finally, trichostatin A stimulated activation of the BMP-7 pathway the ameliorated obstruction induced renal injury by preventing disruption of the renal architecture and the development of renal fibrosis. CONCLUSIONS These findings show that histone deacetylase dependent repression of Bmp-7 transcription is a critical event during the pathogenesis of renal injury in obstructive uropathy. Accordingly, treatment with histone deacetylase inhibitors represents a potentially effective strategy to restore BMP-7 expression and its renal protective functions during treatment of obstructive uropathy.
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Affiliation(s)
- Scott R Manson
- Division of Urology, Department of Surgery and Division of Pediatric Nephrology, Departments of Medicine and Pediatrics (KAH), Washington University, St. Louis Children's Hospital, St. Louis, Missouri
| | - Joseph B Song
- Division of Urology, Department of Surgery and Division of Pediatric Nephrology, Departments of Medicine and Pediatrics (KAH), Washington University, St. Louis Children's Hospital, St. Louis, Missouri
| | - Keith A Hruska
- Division of Urology, Department of Surgery and Division of Pediatric Nephrology, Departments of Medicine and Pediatrics (KAH), Washington University, St. Louis Children's Hospital, St. Louis, Missouri
| | - Paul F Austin
- Division of Urology, Department of Surgery and Division of Pediatric Nephrology, Departments of Medicine and Pediatrics (KAH), Washington University, St. Louis Children's Hospital, St. Louis, Missouri.
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Abstract
Unilateral ureteropelvic junction obstruction (UPJO) is the most common prenatally detected disease leading to hydronephrosis. The obstructive anatomic lesion leads to varying degrees of hydronephrosis, ranging from no apparent effect on renal function to atrophy. Furthermore, the natural course of hydronephrosis varies from spontaneous resolution to progressive deterioration and may take upwards of 3 years for a kidney to declare itself. The objectives of this article are to update our knowledge regarding the evaluation and management of UPJO in depth and to discuss the emerging value of urinary proteome analysis to the clinical arena.
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Affiliation(s)
- Hrair-George O Mesrobian
- Division of Pediatric Urology, Department of Urology, Medical College and Children's Hospital of Wisconsin, Milwaukee, WI 53226, USA.
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19
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Dodson JL, Jerry-Fluker JV, Ng DK, Moxey-Mims M, Schwartz GJ, Dharnidharka VR, Warady BA, Furth SL. Urological disorders in chronic kidney disease in children cohort: clinical characteristics and estimation of glomerular filtration rate. J Urol 2011; 186:1460-6. [PMID: 21855938 PMCID: PMC3718457 DOI: 10.1016/j.juro.2011.05.059] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Indexed: 11/17/2022]
Abstract
PURPOSE Urological disorders are the most common cause of pediatric chronic kidney disease. We determined the characteristics of children with urological disorders and assessed the agreement between the newly developed bedside glomerular filtration rate estimating formula with measured glomerular filtration rate in 586 patients in the Chronic Kidney Disease in Children study. MATERIALS AND METHODS The Chronic Kidney Disease in Children study is a prospective, observational cohort of children recruited from 48 sites in the United States and Canada. Eligibility requirements include age 1 to 16 years and estimated glomerular filtration rate by original Schwartz formula 30 to 90 ml/min/1.73 m(2). Baseline demographics, clinical variables and glomerular filtration rate were assessed. Bland-Altman analysis was conducted to assess agreement between estimated and measured glomerular filtration rates. RESULTS Of the 586 participants with at least 1 glomerular filtration rate measurement 348 (59%) had an underlying urological diagnosis (obstructive uropathy in 118, aplastic/hypoplastic/dysplastic kidneys in 104, reflux in 87 and other condition in 39). Among these patients median age was 9 years, duration of chronic kidney disease was 7 years and age at first visit with a urologist was less than 1 year. Of the patients 67% were male, 67% were white and 21% had a low birth weight. Median height was in the 24th percentile. Median glomerular filtration rate as measured by iohexol plasma disappearance was 44.8 ml/min/1.73 m(2). Median glomerular filtration rate as estimated by the Chronic Kidney Disease in Children bedside equation was 44.3 ml/min/1.73 m(2) (bias = -0.5, 95% CI -1.7 to 0.7, p = 0.44). CONCLUSIONS Underlying urological causes of chronic kidney disease were present in 59% of study participants. These children were diagnosed early in life, and many had low birth weight and growth delay. There is good agreement between the newly developed Chronic Kidney Disease in Children estimating equations and measured glomerular filtration rate in this population.
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Affiliation(s)
- Jennifer L Dodson
- Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-2101, USA.
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20
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Klein J, Gonzalez J, Miravete M, Caubet C, Chaaya R, Decramer S, Bandin F, Bascands JL, Buffin-Meyer B, Schanstra JP. Congenital ureteropelvic junction obstruction: human disease and animal models. Int J Exp Pathol 2011; 92:168-92. [PMID: 20681980 PMCID: PMC3101490 DOI: 10.1111/j.1365-2613.2010.00727.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 06/03/2010] [Indexed: 02/06/2023] Open
Abstract
Ureteropelvic junction (UPJ) obstruction is the most frequently observed cause of obstructive nephropathy in children. Neonatal and foetal animal models have been developed that mimic closely what is observed in human disease. The purpose of this review is to discuss how obstructive nephropathy alters kidney histology and function and describe the molecular mechanisms involved in the progression of the lesions, including inflammation, proliferation/apoptosis, renin-angiotensin system activation and fibrosis, based on both human and animal data. Also we propose that during obstructive nephropathy, hydrodynamic modifications are early inducers of the tubular lesions, which are potentially at the origin of the pathology. Finally, an important observation in animal models is that relief of obstruction during kidney development has important effects on renal function later in adult life. A major short-coming is the absence of data on the impact of UPJ obstruction on long-term adult renal function to elucidate whether these animal data are also valid in humans.
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Affiliation(s)
- Julie Klein
- Institut National de la Santé et de la Recherche Médicale (INSERM)Toulouse, France
- Université Toulouse III Paul-Sabatier, Institut de Médecine Moléculaire de RangueilToulouse, France
| | - Julien Gonzalez
- Institut National de la Santé et de la Recherche Médicale (INSERM)Toulouse, France
- Université Toulouse III Paul-Sabatier, Institut de Médecine Moléculaire de RangueilToulouse, France
| | - Mathieu Miravete
- Institut National de la Santé et de la Recherche Médicale (INSERM)Toulouse, France
- Université Toulouse III Paul-Sabatier, Institut de Médecine Moléculaire de RangueilToulouse, France
| | - Cécile Caubet
- Institut National de la Santé et de la Recherche Médicale (INSERM)Toulouse, France
- Université Toulouse III Paul-Sabatier, Institut de Médecine Moléculaire de RangueilToulouse, France
| | - Rana Chaaya
- Institut National de la Santé et de la Recherche Médicale (INSERM)Toulouse, France
- Université Toulouse III Paul-Sabatier, Institut de Médecine Moléculaire de RangueilToulouse, France
| | - Stéphane Decramer
- Institut National de la Santé et de la Recherche Médicale (INSERM)Toulouse, France
- Université Toulouse III Paul-Sabatier, Institut de Médecine Moléculaire de RangueilToulouse, France
- Department of Pediatric Nephrology, Hôpital des Enfants, Centre de Référence du Sud Ouest des Maladies Rénales RaresToulouse, France
| | - Flavio Bandin
- Department of Pediatric Nephrology, Hôpital des Enfants, Centre de Référence du Sud Ouest des Maladies Rénales RaresToulouse, France
| | - Jean-Loup Bascands
- Institut National de la Santé et de la Recherche Médicale (INSERM)Toulouse, France
- Université Toulouse III Paul-Sabatier, Institut de Médecine Moléculaire de RangueilToulouse, France
| | - Bénédicte Buffin-Meyer
- Institut National de la Santé et de la Recherche Médicale (INSERM)Toulouse, France
- Université Toulouse III Paul-Sabatier, Institut de Médecine Moléculaire de RangueilToulouse, France
| | - Joost P Schanstra
- Institut National de la Santé et de la Recherche Médicale (INSERM)Toulouse, France
- Université Toulouse III Paul-Sabatier, Institut de Médecine Moléculaire de RangueilToulouse, France
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Manson SR, Niederhoff RA, Hruska KA, Austin PF. The BMP-7-Smad1/5/8 pathway promotes kidney repair after obstruction induced renal injury. J Urol 2011. [PMID: 21527199 DOI: 0.1016/j.juro.2011.01.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Urinary tract obstruction causes hydroureteronephrosis and requires surgical intervention to prevent permanent renal injury. While many studies have focused on the development of renal injury, we examined the molecular mechanisms that promote renal recovery after correcting obstruction. MATERIALS AND METHODS A reversible murine model of ureteral obstruction was used to examine the bone morphogenic protein-7 and transforming growth factor-β signaling pathways during renal recovery after obstruction induced injury. Analysis was done using standard molecular techniques, including reverse transcriptase-polymerase chain reaction, enzyme-linked immunosorbent assay, immunoblotting and co-immunoprecipitation. RESULTS After correcting obstruction the up-regulation of bone morphogenic protein-7 inhibited the transforming growth factor-β dependent profibrotic pathways that are central to renal injury pathogenesis. The inhibitory effects of bone morphogenic protein-7 were mediated in part by the activation of its downstream target proteins, SMA and MAD related proteins 1, 5 and 8, which suppress the activity of transforming growth factor-β dependent Smad proteins and in turn inhibit the expression of transforming growth factor-β dependent genes. Activation of the bone morphogenic protein-7-Smad related protein 1/5/8 pathway during renal recovery promoted renal architecture restoration and fibrosis resolution in the kidney after correcting obstruction. CONCLUSIONS Together these findings show that the bone morphogenic protein-7-Smad1/5/8 pathway promotes kidney repair after obstruction induced injury. Accordingly the pathway represents an important therapeutic target to stimulate this innate repair mechanisms of the kidney during treatment for obstruction induced renal injury.
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Affiliation(s)
- Scott R Manson
- Division of Pediatric Urology, Department of Surgery, Washington University, St. Louis Children's Hospital, St. Louis, Missouri, USA
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22
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Manson SR, Niederhoff RA, Hruska KA, Austin PF. The BMP-7-Smad1/5/8 pathway promotes kidney repair after obstruction induced renal injury. J Urol 2011; 185:2523-30. [PMID: 21527199 DOI: 10.1016/j.juro.2011.01.034] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Indexed: 12/12/2022]
Abstract
PURPOSE Urinary tract obstruction causes hydroureteronephrosis and requires surgical intervention to prevent permanent renal injury. While many studies have focused on the development of renal injury, we examined the molecular mechanisms that promote renal recovery after correcting obstruction. MATERIALS AND METHODS A reversible murine model of ureteral obstruction was used to examine the bone morphogenic protein-7 and transforming growth factor-β signaling pathways during renal recovery after obstruction induced injury. Analysis was done using standard molecular techniques, including reverse transcriptase-polymerase chain reaction, enzyme-linked immunosorbent assay, immunoblotting and co-immunoprecipitation. RESULTS After correcting obstruction the up-regulation of bone morphogenic protein-7 inhibited the transforming growth factor-β dependent profibrotic pathways that are central to renal injury pathogenesis. The inhibitory effects of bone morphogenic protein-7 were mediated in part by the activation of its downstream target proteins, SMA and MAD related proteins 1, 5 and 8, which suppress the activity of transforming growth factor-β dependent Smad proteins and in turn inhibit the expression of transforming growth factor-β dependent genes. Activation of the bone morphogenic protein-7-Smad related protein 1/5/8 pathway during renal recovery promoted renal architecture restoration and fibrosis resolution in the kidney after correcting obstruction. CONCLUSIONS Together these findings show that the bone morphogenic protein-7-Smad1/5/8 pathway promotes kidney repair after obstruction induced injury. Accordingly the pathway represents an important therapeutic target to stimulate this innate repair mechanisms of the kidney during treatment for obstruction induced renal injury.
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Affiliation(s)
- Scott R Manson
- Division of Pediatric Urology, Department of Surgery, Washington University, St. Louis Children's Hospital, St. Louis, Missouri, USA
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Therapeutic implications of mesenchymal stem cells transfected with hepatocyte growth factor transplanted in rat kidney with unilateral ureteral obstruction. J Pediatr Surg 2011; 46:537-45. [PMID: 21376206 DOI: 10.1016/j.jpedsurg.2010.09.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 08/31/2010] [Accepted: 09/20/2010] [Indexed: 12/28/2022]
Abstract
PURPOSE The purpose of the study was to establish whether bone marrow mesenchymal stem cells (MSCs) transfected with hepatocyte growth factor (HGF) can migrate and localize in the rat's kidney with unilateral ureteral obstruction (UUO) and contribute to repair of renal fibrosis. METHODS We separated and cultured bone marrow-derived MSCs of male rats in vitro and transfected them with adenovirus-mediated HGF (Ad-HGF). The expression of HGF was measured with enzyme-linked immunosorbent assay. Sixty female rats were sham operated (n = 24) or subjected to left UUO: Ad-HGF-transfected MSCs, uninfected MSCs, or saline was injected into the rat's tail vein. Kidney tissue was collected at the end of the seventh or 14th day after operation. The distribution of Y chromosome in the kidney after Ad-HGF-transfected MSCs transplantation was determined by an in situ hybridization method. As the hallmark of myofibroblasts, α-smooth muscle actin (expression of which significantly increases in the presence of renal fibrosis) was detected by immunohistochemistry in all UUO rats' left kidney tissue. RESULTS Y chromosome-positive cells were found only in the obstructed kidney of the transplantation group. The positive cells were mainly distributed in the tubular cells. The average intensity of immunolabeling for α-smooth muscle actin in the transplanted group significantly decreased compared with sham-transplanted group (P < .05), and the expression in the rats injected with uninfected MSCs was higher than that in the rats with MSCs transfected with HGF (P < .05). CONCLUSIONS Mesenchymal stem cells transfected with HGF can migrate to the rat kidney with UUO and are mainly distributed in the region of renal tubular epithelial cells. The data indicate that MSCs transfected with HGF contribute to a reduction of renal fibrosis after ureteral obstruction and suggest that this may be exploited therapeutically.
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Dodson JL, Cohn SE, Cox C, Hmiel PS, Wood E, Mattoo TK, Warady BA, Furth SL. Urinary incontinence in the CKiD cohort and health related quality of life. J Urol 2009; 182:2007-14. [PMID: 19695588 DOI: 10.1016/j.juro.2009.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Indexed: 11/24/2022]
Abstract
PURPOSE Many children with chronic kidney disease have urinary incontinence due to urological disorders and/or a urine concentrating defect. We determined the prevalence and impact of incontinence on health related quality of life in children with chronic kidney disease. MATERIALS AND METHODS The Chronic Kidney Disease in Children study is a prospective, observational cohort of children recruited from 47 sites in the United States and Canada. Eligibility requirements are age 1 to 16 years and an estimated glomerular filtration rate of 30 to 90 ml per minute per 1.73 m(2). Demographics, continence status, glomerular filtration rate and physical examination were assessed at study entry. Health related quality of life was measured using the parent and child versions of PedsQL. PedsQL scores in participants 5 years old or older were compared among children who were toilet trained and not bed-wetting, bed-wetting or not toilet trained using multivariate linear regression. RESULTS Overall median age of the 329 participants was 12.5 years, 61.4% were male, 70% were white and 55.5% had a urological disorder. Of participants 71.4% were toilet trained at study enrollment, 23.1% had bed-wetting and 5.5% were not toilet trained. Children who were not yet toilet trained had an average total score that was 13.5 points lower (95% CI -25.2, -1.8) on the PedsQL child report than in those who were toilet trained (p = 0.02). Physical functioning (-15.0, 95% CI -28.2, -1.9) and school functioning (-15.3, 95% CI -29.8, -0.8) were also lower in this group (p = 0.03 and 0.04, respectively). On the PedsQL parent proxy report physical functioning (-14.2, 95% CI -26.7, -1.6) was similarly affected by child incontinence (p = 0.03). CONCLUSIONS Urinary incontinence is common in pediatric patients with chronic kidney disease and associated with lower health related quality of life on the PedsQL child and parent proxy reports. Early recognition of and treatment for urinary incontinence may improve health related quality of life in this population.
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Affiliation(s)
- Jennifer L Dodson
- Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-2101, USA.
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Ercolani M, Sahota A, Schuler C, Yang M, Evan AP, Reimer D, Barone JG, Tischfield JA, Levin RM. Bladder outlet obstruction in male cystinuria mice. Int Urol Nephrol 2009; 42:57-63. [PMID: 19484501 DOI: 10.1007/s11255-009-9597-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Accepted: 05/19/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cystinuria is the most common inherited cause of urinary tract stones in children. It can lead to obstructive uropathy, which is a major cause of renal failure. Genetic studies have identified two genes, SLC3A1 and SLC7A9, to be directly involved in cystine stone formation. Slc3a1 knockout male mice develop cystine stones in the bladder and, to a lesser extent, in the kidney. Slc3a1 knockout female mice also develop cystinuria, but they do not form stones. The specific aim of this study was to characterize bladder function in cystinuria mice. METHODS Eight control (4 male, 4 female) and 16 Slc3a1 knockout (9 male, 7 female) mice of mixed strain background (C57B/129, age 4-5 months) were evaluated. Each mouse was anesthetized and the bladder dome catheterized for cystometry. Immediately following cystometry, the bladder was excised, weighed, and separated into three full thickness strips for contractile studies. RESULTS Bladders from cystinuria male mice had significantly increased weight, all of them had stones, decreased compliance, and decreased contractile responses to field stimulation, ATP, carbachol, and KCl. Compared with controls, female knockout mice showed normal bladder weight, decreased voiding pressure, slightly decreased compliance, and slightly decreased contractile responses. CONCLUSIONS These studies clearly demonstrate that the bladder stones that developed in the male cystinuria mice resulted in a partial outlet obstruction. Although the female cystinuria mice did not have bladder stones, bladder function was mildly impaired; presumably by the presence of cystine crystals.
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Affiliation(s)
- Mathew Ercolani
- Department of Surgery, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ, USA
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Hashem RM, Soliman HM, Shaapan SF. Turmeric-based diet can delay apoptosis without modulating NF-kappaB in unilateral ureteral obstruction in rats. J Pharm Pharmacol 2008; 60:83-9. [PMID: 18088509 DOI: 10.1211/jpp.60.1.0011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The unilateral ureteral obstruction (UUO) model of renal injury in rat is characterized by nuclear factor kappaB (NF-kappaB) activation and tumour necrosis factor alpha (TNF-alpha) production, which induces apoptosis via activation of caspase 8 resulting in cell death. Curcumin, the major component found in turmeric spice, has been reported to provide protection against fibrosis and apoptosis elicited by UUO. This study examined the effects of a turmeric-based diet (5% w/w) on the apoptotic pathway induced by UUO in rats after 30 days of ligation. Administration of a turmeric-based diet demonstrated a significant decrease (P<0.05) in mRNA expression of TNF-alpha and caspase 8, but not NF-kappaB, expression, which may contribute to the protective role of the turmeric-based diet. We conclude that a turmeric-based diet can delay apoptosis without modulating NF-kappaB, so as not to sensitize the mesangial cells to the apoptotic stimuli.
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Affiliation(s)
- Reem M Hashem
- Department of Biochemistry, Faculty of Pharmacy, Beni-suief University, Egypt.
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Nemett DR, Fivush BA, Mathews R, Camirand N, Eldridge MA, Finney K, Gerson AC. A randomized controlled trial of the effectiveness of osteopathy-based manual physical therapy in treating pediatric dysfunctional voiding. J Pediatr Urol 2008; 4:100-6. [PMID: 18631903 DOI: 10.1016/j.jpurol.2007.11.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2007] [Accepted: 11/02/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Pediatric dysfunctional voiding (DV) presents physical and emotional challenges as well as risk of progression to renal disease. Manual physical therapy and osteopathic treatment have been successfully used to treat DV in adult women; a pediatric trial of manual physical therapy based on an osteopathic approach (MPT-OA) has not been reported. The aim of this study was to determine whether MPT-OA added to standard treatment (ST) improves DV more effectively than ST alone. METHODS Twenty-one children (aged 4-11 years) with DV were randomly assigned to receive MPT-OA plus standard treatment (treatment group) or standard treatment alone (control group). Pre-treatment and post-treatment evaluations of DV symptoms, MPT-OA evaluations and inter-rater reliability of DV symptom resolution were completed. RESULTS The treatment group exhibited greater improvement in DV symptoms than did the control group (Z=-2.63, p=0.008, Mann-Whitney U-test). Improved or resolution of vesicoureteral reflux and elimination of post-void urine residuals were more prominent in the treatment group. CONCLUSIONS Results suggest that MPT-OA treatment can improve short-term outcomes in children with DV, beyond improvements observed with standard treatments, and is well liked by children and parents. Based on these results, a multi-center randomized clinical trial of MPT-OA in children with vesicoureteral reflux and/or post-void urinary retention is warranted.
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Affiliation(s)
- Diane R Nemett
- Kennedy Krieger Institute, Physical Therapy Department, 707 North Broadway, Baltimore, MD, USA.
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Henderson NC, Mackinnon AC, Farnworth SL, Kipari T, Haslett C, Iredale JP, Liu FT, Hughes J, Sethi T. Galectin-3 expression and secretion links macrophages to the promotion of renal fibrosis. THE AMERICAN JOURNAL OF PATHOLOGY 2008; 172:288-98. [PMID: 18202187 DOI: 10.2353/ajpath.2008.070726] [Citation(s) in RCA: 413] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Macrophages have been proposed as a key cell type in the pathogenesis of renal fibrosis; however, the mechanism by which macrophages drive fibrosis is still unclear. We show that expression of galectin-3, a beta-galactoside-binding lectin, is up-regulated in a mouse model of progressive renal fibrosis (unilateral ureteric obstruction, UUO), and absence of galectin-3 protects against renal myofibroblast accumulation/activation and fibrosis. Furthermore, specific depletion of macrophages using CD11b-DTR mice reduces fibrosis severity after UUO demonstrating that macrophages are key cells in the pathogenesis of renal fibrosis. Disruption of the galectin-3 gene does not affect macrophage recruitment after UUO, or macrophage proinflammatory cytokine profiles in response to interferon-gamma/lipopolysaccharide. In addition, absence of galectin-3 does not affect transforming growth factor-beta expression or Smad 2/3 phosphorylation in obstructed kidneys. Adoptive transfer of wild-type but not galectin-3(-/-) macrophages did, however, restore the fibrotic phenotype in galectin-3(-/-) mice. Cross-over experiments using wild-type and galectin-3(-/-) macrophage supernatants and renal fibroblasts confirmed that secretion of galectin-3 by macrophages is critical in the activation of renal fibroblasts to a profibrotic phenotype. Therefore, we demonstrate for the first time that galectin-3 expression and secretion by macrophages is a major mechanism linking macrophages to the promotion of renal fibrosis.
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Affiliation(s)
- Neil C Henderson
- The Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK
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Thongboonkerd V. Urinary proteomics: towards biomarker discovery, diagnostics and prognostics. MOLECULAR BIOSYSTEMS 2008; 4:810-5. [DOI: 10.1039/b802534g] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Olivares Sánchez L, Pareja Grande J. Hidronefrosis aguda e insuficiencia renal obstructiva en adolescente sano. An Pediatr (Barc) 2006; 64:285-6. [PMID: 16527102 DOI: 10.1157/13085522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
Congenital obstructive nephropathy is the primary cause for end-stage renal disease (ESRD) in children. An increasingly used animal model of obstructive nephropathy is unilateral ureteral obstruction (UUO). This model mimics, in an accelerated manner, the different stages of obstructive nephropathy leading to tubulointerstitial fibrosis: cellular infiltration, tubular proliferation and apoptosis, epithelial-mesenchymal transition (EMT), (myo)fibroblast accumulation, increased extracellular matrix (ECM) deposition, and tubular atrophy. During the last decade genetically modified animals are increasingly used to study the development of obstructive nephropathy. Although the use of these animals (mainly knockouts) has highlighted some pitfalls of this approach (compensation by closely related gene products, absence of temporal knockouts) it has brought important information about the role of specific gene-products in the pathogenesis of obstructive nephropathy. Besides confirming the important pathologic role for angiotensin II (Ang II) and transforming growth factor-beta (TGF-beta) in obstructive nephropathy, these animals have shown the complexity of the development of tubulointerstitial fibrosis involving a large number of closely functionally related molecules. More interestingly, the use of these animals has led to the discovery of unexpected and contradictory roles (both potentially pro- and antifibrotic) for Ang II, for ECM degrading enzymes matrix metalloproteinase 9 (MMP-9) and tissue plasminogen activators (PAs), for plasminogen activator inhibitor 1 (PAI-1), and for the adhesion molecule osteopontin (OPN) in obstructive nephropathy. Further use of these animals, especially in combination with pharmacologic tools, should help to better identify potential antifibrotic strategies in obstructive nephropathy.
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Abstract
Routine second trimester ultrasound screening has resulted in more infants diagnosed with antenatal hydronephrosis. Current recommendations suggest postnatal evaluation of all infants with a renal pelvic diameter >5 mm with ultrasound and voiding cystourethrogram (VCUG.) There are many etiologies of obstructive uropathy including ureteropelvic junction (UPJ) obstruction, ureterovesical junction (UVJ) obstruction, posterior urethral valves (PUV), prune belly syndrome, and vesicoureteral reflux (VUR). Obstructive uropathy can result in tubular damage and decreased nephron number. Tubular damage can result in sodium wasting, hyperkalemic acidosis, and nephrogenic diabetes insipidus. Most patients do not require renal replacement therapy in the neonatal period; however, chronic renal insufficiency can occur if the neonate has a significant reduction in nephron number or progressive renal damage from obstruction or infection.
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Affiliation(s)
- Amy Becker
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, 5323 Harry Hines Blvd,. Texas 75390-9063, USA
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Chiou YY, Shieh CC, Cheng HL, Tang MJ. Intrinsic expression of Th2 cytokines in urothelium of congenital ureteropelvic junction obstruction. Kidney Int 2005; 67:638-46. [PMID: 15673311 DOI: 10.1111/j.1523-1755.2005.67120.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The cytokine-producing ability of urothelium, a urinary tract barrier between urine and underlying connective tissue, may exacerbate the pathogenesis of congenital ureteropelvic junction obstruction (UPJ-O) disease. A role for urothelium in human urinary tract obstruction has rarely been described. In this study, we investigated the immunopathologic characteristics of, and cytokine production by, urothelium in children with congenital UPJ-O. METHODS Twenty-four children with congenital UPJ-O who had received pyeloplasty were enrolled. Morphologic abnormalities and pathologic and inflammatory changes of UPJ-O segments were studied. Expression of cytokines and chemokines in urothelium was investigated and compared with control tissue by immunohistochemistry (IHC), in situ hybridization (ISH), and urinary enzyme-linked immunosorbent assay (ELISA). RESULTS Atypical or simple hyperplasia of the urothelium with evidence of Ki67 over-expression was found frequently in UPJ-O. There were variable degrees of inflammatory cell and eosinophil infiltration. Augmented expression of IL-5 and eotaxin detected by IHC and ISH, and enhanced degranulation of tissue mast cells were observed in the urothelium of UPJ-O segments. IL-4, IFN-gamma, and TNF-alpha were undetectable. Significantly higher levels of urinary IL-5, IFN-gamma, and eotaxin were detected in urine collected from the obstructed kidney. Among these, high urinary IL5 and/or IFN-gamma levels were associated with more severe obstructive uropathy (P < 0.05). CONCLUSION Urothelium, like intestinal and respiratory epithelia, plays an active role in immunoregulation and may contribute to exacerbation of the pathogenesis of congenital UPJ-O. Many eosinophil-associated disease cytokines, which can lead to the degranulation of mast cells, are predominant regulators in UPJ-O urothelium.
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Affiliation(s)
- Yuan-Yow Chiou
- Department of Pediatrics, National Cheng Kung University Medical Center, Tainan, Taiwan
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