Modulating biochemical perturbations during 72-hour machine perfusion of kidneys: role of preservation solution

This study documents renal biochemistry during hypothermic machine perfusion of kidneys. It is intended to demonstrate that a comprehensive evaluation of organ viability during ex-vivo preservation is needed to increase the number of organs available for transplantation and to reduce the current renal discard rate. Porcine kidneys were hypothermically machine perfused for 72 h with either Unisol-UHK or Belzer-Machine Perfusion Solution, (Belzer-MPS). Renal perfusate samples were periodically collected and biochemically analyzed. Significant differences were measured in the renal metabolic activity between the two experimental groups while similar values for traditional parameters such as renal flow rate and vascular resistance values were recorded. The effluent of UHK perfused kidneys showed strong metabolites and NH(4)(+) dynamics (P<0.05 vs. baseline), while the Belzer-MPS kidneys metabolic activity led to little or no change of the effluent biochemistry relative to baseline.     

Iron chelation or anti-oxidants prevent renal cell damage in the rewarming phase after normoxic, but not hypoxic cold incubation

It has now been firmly established that, not only ischemia/reperfusion, but also cold itself causes damage during kidney transplantation. Iron chelators or anti-oxidants applied during the cold plus rewarming phase are able to prevent this damage. At present, it is unknown if these measures act only during the cold, or whether application during the rewarming phase also prevents damage. We aimed to study this after cold normoxic and hypoxic conditions. LLC-PK1 cells were incubated at 4 degrees C in Krebs-Henseleit buffer for 6 or 24h, followed by 18 or 6h rewarming, respectively. Cold preservation was performed under both normoxic (95% air/5% CO2) and hypoxic (95% N2/5% CO2) conditions. The iron chelator 2,2'-DPD (100 microM), anti-oxidants BHT (20 microM) or sibilinin (200 microM), and xanthine oxidase inhibitor allopurinol (100 microM) were added during either cold preservation plus rewarming, or rewarming alone. Cell damage was assessed by LDH release (n=3-9). Addition of 2,2'-DPD and BHT during cold hypoxia plus rewarming did, but during rewarming alone did not prevent cell damage. When added during rewarming after 6h cold normoxic incubation, BHT and 2,2'-DPD inhibited rewarming injury compared to control (p<0.05). Allopurinol did not prevent cell damage in any experimental set-up. Our data show that application of iron chelators or anti-oxidants during the rewarming phase protects cells after normoxic but not hypoxic incubation. Allopurinol had no effect. Since kidneys are hypoxic during transplantation, measures aimed at preventing cold-induced and rewarming injury should be taken during the cold.     

Legumain/asparaginyl endopeptidase controls extracellular matrix remodeling through the degradation of fibronectin in mouse renal proximal tubular cells

Legumain/asparaginyl endopeptidase (EC 3.4.22.34) is a novel cysteine protease that is abundantly expressed in the late endosomes and lysosomes of renal proximal tubular cells. Recently, emerging evidence has indicated that legumain might play an important role in control of extracellular matrix turnover in various pathological conditions such as tumor growth/metastasis and progression of atherosclerosis. We initially found that purified legumain can directly degrade fibronectin, one of the main components of the extracellular matrix, in vitro. Therefore, we examined the effect of legumain on fibronectin degradation in cultured mouse renal proximal tubular cells. Fibronectin processing can be inhibited by chloroquine, an inhibitor of lysosomal degradation, and can be enhanced by the overexpression of legumain, indicating that fibronectin degradation occurs in the presence of legumain in lysosomes from renal proximal tubular cells. Furthermore, in legumain-deficient mice, unilateral ureteral obstruction (UUO)-induced renal interstitial protein accumulation of fibronectin and renal interstitial fibrosis were markedly enhanced. These findings indicate that legumain might have an important role in extracellular matrix remodeling via the degradation of fibronectin in renal proximal tubular cells.     

酸性成纤维细胞生长因子对庆大霉素和顺铂所致肾小管上皮细胞损伤的保护作用

目的:研究酸性成纤维细胞生长因子(aFGF)对庆大霉素(GM)和顺铂(DDP)引起的体外培养肾小管上皮细胞损害的保护作用。方法:大鼠肾皮质经研磨、过网、胰蛋白酶消化,进行肾小管上皮细胞的体外培养。经Cytokeratin 18抗体进行鉴定后,用GM、DDP建立损伤模型,观察aFGF对损伤的肾小管上皮细胞的保护作用。结果:①经形态学观察、GM或DDP组与对照组比较,CAT、SOD、GSH-Px、Na~ -K~ -ATP酶活性下降,而NAG活性和NO、MDA升高(P<0.01或P<0.05),提示肾小管上皮细胞的培养和GM、DDP损伤的建模成功。②aFGF GM或DDP组与GM组或DDP组比较,大多数生化和酶学指标有显著或非常显著性差异(P<0.05或P<0.01);而aFGF GM或DDP组与对照组比较,CAT、NAG、GSH-Px、Na~ -K~ -ATP酶活性无显著性差异,但SOD活性下降、NO、MDA升高尚有显著性差异(P<0.05)。结论:aFGF对GM、DDP损伤的肾小管上皮细胞有明显的保护作用。     

罗格列酮对果糖饲养SD大鼠肝肾功能、血脂、血常规的影响

目的:了解罗格列酮(Rosiglitazone)处理果糖饲养的SD大鼠后对肝、肾功能,血常规的影响。方法:将24只成年健康SD大鼠随机分为A、B两组。A组持续喂高果糖饲料1月后再随机分为:①高果糖饲养组;②果糖饲养同时用罗格列酮处理组。B组喂标准饲料1月后随机分为:①对照组;②罗格列酮处理组。采用氧化酶法、放免法等技术方法测定大鼠的空腹血糖、血脂、胰岛素水平,肝功能,肾功能,血常规等指标。结果:与对照组相比:果糖饲养组大鼠直接胆红素、总胆红素、间接胆红素、血糖、胰岛素、总胆固醇、甘油三酯等指标均升高;而总蛋白、钾、钠、氯、胰岛素敏感指数等指标均下降,差异均具有统计学意义(P＜0．05)。而罗格列酮处理组中总胆红素、间接胆红素、尿酸和尿素/肌酐等指标均升高;而总蛋白、球蛋白、钾、钠、氨水平、甘油三酯、血常规细胞数、血红蛋白均下降,差异具有统计学意义(P＜0．05)。与果糖饲养组相比,果糖饲养罗格列酮处理组的总胆红素、直接胆红素、谷草转氨酶、间接胆红素、谷丙转氨酶、总胆固醇均升高;而胰岛素、甘油三酯、钙离子水平均下降差异均具有统计学意义,且前面三个指标的差异更明显(P＜0．05)。结论:罗格列酮在治疗过程中虽改善了果糖饲养SD大鼠所引起的胰岛素抵抗,但会加重肝肾功能障碍;对机体有一定的毒副作用。     

尼可地尔联合冠状动脉心脏介入治疗冠心病合并肾功能不全的疗效及对NGAL、Cys-C的影响

摘要 目的：探析冠心病（CHD）合并肾功能不全（RI）应用冠状动脉心脏介入治疗（PCI）联合尼可地尔的临床疗效及对胱抑素C（Cys-C）、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）影响。方法：选择本院2019年6月~2021年6月就诊的86例CHD合并RI患者,随机数字表法分为两组各43例。 两组均实施PCI治疗,对照组实施常规静脉水化处理,观察组联合尼可地尔治疗。对比两组PCI治疗前后24 h肾功能指标（Cys-C、NGAL）、血清炎性因子指标（高敏C反应蛋白 (hs-CRP)、白细胞介素 6 (IL-6)）、心肌损伤指标（心肌肌钙蛋白I（cTnI）及肌酸激酶同工酶（CK-MB））、并发症发生率。结果：观察组CIN发生率（2.33%）、MACE率（2.33%）均明显低于对照组（16.28%、13.95%）,有统计学差异（P<0.05）。两组PCI治疗前Cys-C、NGAL、hs-CRP、IL-6、cTnI、CK- MB无统计学差异（P<0.05）。治疗后观察组Cys-C、NGAL、hs-CRP、IL-6升高幅度、组cTnI、CK- MB明显低于对照组（P<0.05）。结论：PCI 联合尼可地尔应用于CHD合并RI临床治疗效果显著,可有效改善患者肾功能,降低炎症反应、心肌损伤,预防CIN发生。     

氯沙坦联合螺内酯对预N-硝基-L-精氨酸甲酯诱导高血压模型大鼠肾脏纤维化及心室重塑的影响

摘要 目的：探讨氯沙坦联合螺内酯对预N-硝基-L-精氨酸甲酯（N''-nitro-L-arginine-methylesterhydrochloride,L-NAME）诱导高血压模型大鼠肾脏纤维化及心室重塑的影响。方法：选择8周龄Wistar大鼠为研究对象,通过给予0.1 %的L-NAME饮用水诱导高血压模型。将大鼠根据随机数字表法分为三组：对照组,诱导组和联合治疗组。通过超声心动图比较室间隔厚度和左心室后壁厚度。CODATM8无创血压系统监测大鼠心脏功能。通过蛋白印迹分析大鼠肾切片中I型胶原、III型胶原和CTGF的蛋白表达。Masson的三色染色评估肾脏组织胶原含量沉积。通过RT-PCR分析大鼠心脏肥大标志物和转录因子心房利钠肽（Atrial natriuretic peptide,ANP）和脑利钠肽（Brain natriuretic peptide,BNP）的表达。通过免疫组化和免疫比浊法分析大鼠肾小球硬化指数和白蛋白尿。结果：模型组较对照组大鼠室间隔厚度和左心室后壁厚度、MAP和心脏/体重比、I型胶原、III型胶原和CTGF的蛋白表达、ANP和BNP的mRNA表达、肾小球硬化指数和白蛋白尿以及SMA和TGF-β1的蛋白表达均显著增加,FS显著降低（P<0.05）,联合治疗组较模型组室间隔厚度和左心室后壁厚度、MAP和心脏/体重比、I型胶原、III型胶原和CTGF的蛋白表达、ANP和BNP的mRNA表达、肾小球硬化指数和白蛋白尿以及SMA和TGF-β1的蛋白表达均显著降低,FS显著增加（P<0.05）。结论：氯沙坦联合螺内酯可减轻L-NAME诱导的高血压大鼠模型中心脏重塑和肾脏纤维化的发生。     

术前超声引导下腰方肌阻滞联合全身麻醉对肾移植患者术后血清应激反应和疼痛相关指标的影响

摘要 目的：探讨术前超声引导下腰方肌阻滞（QLB）联合全身麻醉对肾移植患者术后血清应激反应和疼痛相关指标的影响。方法：选择我院2019年9月~2021年8月期间收治的行肾移植手术的患者82例作为观察对象。根据随机数字表法分为A组和B组,分别为41例。A组给予全身麻醉,B组给予术前超声引导下QLB联合全身麻醉,对比两组静息视觉疼痛模拟（VAS）评分、自控静脉镇痛中的舒芬太尼使用量、有效按压次数,对比两组术后血清应激反应和疼痛相关指标变化,对比两组不良反应发生情况。结果：B组术后6 h、12 h、24 h、48 h静息VAS评分低于A组（P<0.05）。B组自控静脉镇痛中的舒芬太尼使用量少于A组,有效按压次数少于A组（P<0.05）。B组拔管后、术后24 h血糖（Glu）、皮质醇（Cor）低于A组（P<0.05）。两组术后24 h P物质（SP）、前列腺素E₂（PGE₂）及5-羟色胺（5-HT）均升高,但B组低于A组（P<0.05）。两组的不良反应发生率对比无差异（P<0.05）。结论：术前超声引导下QLB联合全身麻醉用于肾移植手术患者,可有效减轻疼痛和应激反应,减少自控静脉镇痛中的舒芬太尼使用量、有效按压次数,且不增加不良反应发生率。     

l-Arginine Effects on Na+ Transport in M-1 Mouse Cortical Collecting Duct Cells—A Cationic Amino Acid Absorbing Epithelium

The effect of l-arginine on transepithelial ion transport was examined in cultured M-1 mouse renal cortical collecting duct (CCD) cells using continuous short circuit current (I _SC ) measurements in HCO₃ ⁻/CO₂ buffered solution. Steady state I _SC averaged 73.8 ± 3.2 μA/cm² (n= 126) and was reduced by 94 ± 0.6% (n= 16) by the apical addition of 100 μm amiloride. This confirms that the predominant electrogenic ion transport in M-1 cells is Na⁺ absorption via the epithelial sodium channel (ENaC). Experiments using the cationic amino acid l-lysine (radiolabeled) as a stable arginine analogue show that the combined activity of an apical system y⁺ and a basal amino acid transport system y⁺L are responsible for most cationic amino acid transport across M-1 cells. Together they generate net absorptive cationic amino acid flux. Application of l-arginine (10 mm) either apically or basolaterally induced a transient peak increase in I _SC averaging 36.6 ± 5.4 μA/cm² (n= 19) and 32.0 ± 7.2 μA/cm² (n= 8), respectively. The response was preserved in the absence of bath Cl⁻ (n= 4), but was abolished either in the absence of apical Na⁺ (n= 4) or by apical addition of 100 μm amiloride (n= 6). l-lysine, which cannot serve as a precursor of NO, caused a response similar to that of l-arginine (n= 4); neither L-NMMA (100 μm; n= 3) nor L-NAME (1 mm; n= 4) (both NO-synthase inhibitors) affected the I _SC response to l-arginine. The effects of arginine or lysine were replicated by alkalinization that mimicked the transient alkalinization of the bath solution upon addition of these amino acids. We conclude that in M-1 cells l-arginine stimulates Na⁺ absorption via a pH-dependent, but NO-independent mechanism. The observed net cationic amino acid absorption will counteract passive cationic amino acid leak into the CCD in the presence of electrogenic Na⁺ transport, consistent with reports of stimulated expression of Na⁺ and cationic amino acid transporters by aldosterone. Received: 11 September 2000/Revised: 6 December 2000     

Kir1.1 expression in embryonic kidney epithelia

K(+) channels may regulate cell cycling, cell volume, and cell proliferation. We have recently shown a role for an inwardly rectifying K(+) channel, Kir6.1/SUR2(B), in the regulation of cell proliferation during early kidney development. Here, we show that the protein of a further K(+) channel, Kir1.1 (ROMK), is also developmentally expressed in prenatal rat kidney epithelia. In the embryonic stage, Kir1.1 protein was localized to the plasma membrane of ureteric buds and collecting ducts, and of nephron stages up to the comma-shaped body. Experimental increase in cAMP upregulated Kir1.1b (ROMK2) mRNA abundance in ureteric buds. Kir1.1 protein was restricted to the distal nephron during later postnatal development and adulthood, as has been reported. In conclusion, we demonstrate redundancy of Kir channel expression in early embryonic kidney which could suggest that Kir1.1 acts in a similar way as Kir6.1/SUR2(B) to promote cell proliferation or other developmental functions.