Long-Term Responses to Loss of Renal Mass: Control Mechanisms: The Role of Renal “Work” in Compensatory Kidney Growth

In a series of studies designed to test the role of renal “work” in compensatory kidney growth we examined the relationship between absolute sodium reabsorption—which constitutes the bulk of renal energy expenditure, and growth of the remaining kidney at various intervals after contralateral nephrectomy.The increase in weight of the remaining kidney preceded the rise in sodium reabsorption and these two processes took place at different rates between 24 hours and 21 days after uninephrectomy.Absolute sodium reabsorption did not change during the first hours after contralateral nephrectomy, at a time when biochemical alterations are known to occur.The rate of [¹⁴C] choline incorporation into renal phospholipid, an early biochemical indicator of compensatory kidney growth, increased significantly one hour after contralateral nephrectomy but remained unchanged after sham-nephrectomy, regardless of the magnitude or direction of the concomitant change in absolute sodium reabsorption (“kidney work”).These results indicate that renal work expended in the reabsorption of glomerular filtrate is neither the initiating, nor the primary controlling factor, of the compensatory kidney growth that follows unilateral nephrectomy.     

Long-Term Responses to Loss of Renal Mass: Glomerular Changes: Compensatory Renal Hypertrophy in Dogs: Single Nephron Glomerular Filtration Rate

Kidney weight, length of superficial and juxtamedullary proximal tubules, glomerular diameter, kidney filtration rate and PAH clearance, sodium excretion and intrarenal distribution of filtration (with ¹⁴C-ferrocyanide) were measured in the remaining hypertrophic kidneys of dogs 10 days after unilateral nephrectomy. Whereas kidney weight increased to 75 percent of the original total renal mass, proximal tubule length and mean glomerular diameter remained unchanged. PAH and creatinine clearance, and absolute, but not fractional, sodium excretion, rose significantly. The ratio superficial/juxtamedullary filtration rate remained unchanged, indicating parallel increases of filtration in both cortical regions of hypertrophied kidneys.     

Biochemical and Molecular Responses to Loss of Renal Mass: Atpase and Cyclic Nucleotides: Evidence for Altered Cyclic Nucleotide Metabolism During Compensatory Renal Hypertrophy and Neonatal Kidney Growth

In adult male Sprague-Dawley rats contralateral nephrectomy was followed by an initial fall of the concentration of cGMP in renal cortical tissue followed by a rise to a peak level of 300 percent of the initial concentration within two hours. cGMP concentration in the remaining renal cortex remained at about 300 percent of the initial value during the subsequent 72 hours and slowly declined to 150-200 percent in the following two weeks. The changes in cGMP concentration were due to exactly parallel changes in the soluble fraction of renal cortical guanylate cyclase activity, while cGMP-phosphodiesterase activity remained unchanged. cAMP concentration after contralateral nephrectomy fell significantly by about 25 percent within two hours and remained below baseline level for up to eight hours. In the kidneys of newborn rats the concentration of cAMP was approximately one-half that found in adult kidneys: it slightly fell between the fourth and the seventh day after birth and subsequently continuously rose to reach adult values approximately two weeks after birth. The concentration of cGMP was significantly greater four days after birth than in adult rats, further rose between the fourth and the seventh day after birth and subsequently gradually declined to adult levels. The increased cGMP concentration appears to be due to an increase of guanylate cyclase activity in total kidney homogenates which, in turn, was mainly due to an increase of the particulate (membrane-bound) fraction of the enzyme. cGMP-phosphodiesterase activity, however, was also increased in respect to adult levels, one or three weeks after birth. Renal growth from the seventh day after birth to adulthood is accompanied by a continuous increase of the ratio cAMP/cGMP. Removal of one kidney four to seven days after birth resulted in a slower increase of this ratio. The data suggest that cGMP may trigger renal growth and that increases of cGMP concentration in the kidneys are the result of a primary increase in the activity of guanylate cyclase.     

Biochemical and Molecular Responses to Loss of Renal Mass: Atpase and Cyclic Nucleotides: Cyclic Nucleotide Concentrations in Relation to Renal Growth and Hypertrophy

In rats no consistent change in the concentration of cyclic GMP or cyclic AMP concentration was found in the renal cortex between 2 hours and seven days after unilateral nephrectomy. In regenerating liver tissue, between 2 hours and seven days after removal of one-third of the liver, there were no consistent changes in cyclic GMP concentrations, but cyclic AMP concentrations were higher than in controls. During postnatal growth, no consistent changes occurred in the cyclic GMP concentration of the spleen, the testes, the kidney cortex, the renal papilla, the liver or the ventricle between two and sixty days after birth. Cyclic AMP concentration on the other hand, in all these tissues with the exception of the spleen, was depressed between the twenty-first and fortieth day after birth, i.e., at a period of rapid growth. In the spleen, the concentration of cyclic AMP increased continuously from the second to the fifth day after birth. During renal parenchymal hyperplasia induced by a large intravenous dose of folic acid two days before sacrifice, the concentration of cyclic GMP in renal cortical tissue increased consistently. A model is proposed to explain the different patterns of changes in the cyclic nucleotide concentrations found.     

The incorporation of glycerol into mitochondrial lipids during neonatal renal compensatory growth

[¹⁴C]glycerol incorporation into isolated inner and outer mitochondrial membrane is enhanced in the remaining kidney after unilateral nephrectomy. Serum from neonatal rabbits taken 24 hours after unilateral nephrectomy and added to tissue slice incubations appears to stimulate incorporation of [¹⁴C]glycerol into mitochondrial lipids of normal kidney cortex. Post-nephrectomy serum, however, depresses incorporation of [¹⁴C] glycerol and [³H]leucine into mitochondria when added to kidney cortex from animals in which uninephrectomy was performed 24 or 48 hours previously.     

Biochemical and Molecular Responses to Loss of Renal Mass: Atpase and Cyclic Nucleotides: Changes in Renal Cyclic Nucleotides as a Trigger to the Onset of Compensatory Renal Hypertrophy

In adult male Wistar rats contralateral nephrectomy was followed, within 10 minutes, by a nearly twofold rise of the content of cGMP in renal tissue. 20 and 40 minutes after contralateral nephrectomy cGMP fell to one half its control level to rise again to its normal level within 90 minutes. The initial rise of the concentration of cGMP was accompanied by a simultaneous fall of the concentration of cAMP by about 30 percent: the cAMP concentration remained 10-20 percent below control level for approximately two hours and rose again to its initial level after three hours. Cross-circulation of a nephrectomized rat with an intact animal led to a sharp increase of cGMP in the kidneys of the latter with a peak at 10 minutes after initiating cross-circulation and also to a fall of the cAMP concentration. When the same nephrectomized donor rat was subsequently cross-circulated with one, or even two, intact receiver animals, similar short-lasting changes of cyclic nucleotide concentrations were recorded in the kidneys of all the receivers. When a normal kidney was transplanted to the neck of a rat, subsequent removal of one of its own kidneys did not result in any change in cyclic nucleotide content in either the remaining or the transplanted kidney. The data are interpreted to indicate that renal tissue produces a factor inhibiting renal growth which counteracts a circulating humoral kidney growth stimulating factor of unknown origin. An initial rise of cGMP and a fall of cAMP may trigger the subsequent stimulation of protein synthesis responsible for hypertrophy.     

Biochemical and Molecular Responses to Loss of Renal Mass: Membranes and Protein Synthesis: Macromolecular Metabolism in Compensatory Renal Hypertrophy

1. The initial biochemical changes of compensatory hypertrophy occur well within 1 hour of unilateral nephrectomy and perhaps within the first few minutes.2. The initial increment in rRNA is from decreased metabolism rather than from increased synthesis.3. Changes in the processing of mRNA precursors are probably also important.4. Compensatory hypertrophy is regulated by a humoral stimulus or stimuli.5. The stimulus needs to be present virtually all of the time during the early phases of compensatory hypertrophy.6. The stimulus is related to loss of renal mass, not to loss of renal function.     

N-Acetyl-l-cysteine abolishes the bromoethylamine-induced choline incorporation into renal papillary tissue

The role of regenerative processes in the protective effect of N-acetyl-L-cysteine (NAC) against bromoethylamine-induced renal papillary necrosis was assessed in rats given bromoethylamine (BEA) (1.2 mmol/kg), N-acetylcysteine (6 mmol/kg), or N-acetylcysteine plus BEA. Renal papillary slices were dissected after 15 hours of treatment, and ¹⁴C-choline incorporation into total phospholipid, lysophosphatidylcholine, sphingomyelin, and phosphatidylcholine was measured. Bromoethylamine elicited an increase in the incorporation of ¹⁴C-choline into choline-containing phospholipid, an effect that was abolished when N-acetylcysteine was administered prior to bromoethylamine. These studies indicate that the defensive mechanism of N-acetylcysteine against bromoethylamine-induced renal papillary necrosis is not related to regenerative processes and that N-acetylcysteine abolishes the bromoethylamine-induced choline incorporation into papillary phospholipid. © 1996 John Wiley & Sons, Inc.     

Studies on Possible Mechanisms of Early Functional Compensatory Adaptation in the Remaining Kidney

Two to 4 hours after unilateral renal exclusion in rats, urine flow rate from the remaining kidney had increased to twice the control level, whereas the filtration rate remained unchanged. After contralateral nephrectomy, NGFR was similar to that of controls, but fractional water reabsorption along proximal tubules decreased. Protein concentration in efferent arteriolar plasma, and hydrostatic pressure gradient between proximal tubules and peritubular capillaries were similar in experimental and control kidneys. Unilateral renal exclusion was followed by a rapid increase of blood pressure. Prevention of this rise depressed but did not abolish functional compensatory adaptation. The occurrence of compensatory adaptation was not affected by decreased renal perfusion pressure.     

Anti-epidermal growth factor antibody inhibits compensatory renal hyperplasia but not hypertrophy after unilateral nephrectomy in mice.

The effect of anti-epidermal growth factor (EGF) antibody on the compensatory renal growth including hyperplasia and hypertrophy was investigated. The antibody used in this study blocked the stimulatory effect of EGF on the DNA synthesis of cultured rat hepatocytes. When this antibody was injected into mice intravenously after unilateral nephrectomy, the labeling index of the renal cortical tubular cells decreased significantly at the second day after uninephrectomy, but the antibody caused no decrease in remaining kidney weight. Immunohistochemical study revealed that injected anti-mouse EGF rabbit IgG was positively stained at the renal cortical tubular cells. EGF would thus appear importantly essential to compensatory renal hyperplasia.     

Long-Term Responses to Loss of Renal Mass: Pathophysiological Aspects: Changes in Renal Function in Early Pregnancy in Women with One Kidney

In healthy women the 24-hour endogenous creatinine clearance is elevated by some 50 percent within 6 weeks of conception and an analogous increase of the 24-hour glucose excretion occurs. 24-hour glucose excretion later reverts to normal, reflecting a delayed onset of increased tubular reabsorption.Following unilateral nephrectomy there are marked increases in RPF and GFR in the contralateral kidney. Single hypertrophied kidneys apparently can adapt still further as in normal pregnancy. We have studied 5 women, in satisfactory general health prior to the pregnancy, each with only one kidney, before conception and during early pregnancy. Three had had unilateral nephrectomy for renal trauma 6-9 years earlier. two had received renal allografts 3 years earlier. In all cases the endogenous creatinine clearance began to rise in the second half of the menstrual cycle and when pregnancy supervened it rose rapidly to a peak value of 30-40 percent above the midcycle level within 7-10 weeks of the last menstrual period. That early peak was not always sustained and GFR subsequently fell to a level of 25-30 percent above the midcycle level. These changes in renal function were slower and smaller than in healthy women with 2 kidneys but were compatible with a successful outcome of pregnancy in these five cases.     

Biochemical and Molecular Responses to Loss of Renal Mass: Membranes and Protein Synthesis: Further Studies on a Renotropic System in Rats

Based upon many investigations, the existence of short-lived, specific, circulating substances which incite and/or regulate compensatory renal growth has been proposed. In our studies, we find that sera and plasma from unilaterally nephrectomized rats compared to sera and plasma from sham-operated rats stimulate the incorporation of ³H-thymidine monophosphate, ³H-thymidine and ¹⁴C-uridine into the DNA of incubating rat kidney fragments. While extracts from growing rat kidneys are not excitatory, they produce a relative enhancement to incorporation of isotope into DNA when combined with sera from uninephrectomized rats—more than the sera do alone. The above is found also for the incorporation of ¹⁴C-uridine into RNA of incubating rat kidney fragments. Sera from uninephrectomized rats fail to stimulate DNA synthesis in liver slices from rats but do so in the presence of extracts from growing kidneys. Renotropic factors in sera and extracts do not appear to work by diluting the isotopes, by enhancing transport, or by effecting overall metabolism of the renal cells. The above described serum and liver factors may play a role in compensatory renal growth.     

Endothelial dysfunction promotes the transition from compensatory renal hypertrophy to kidney injury after unilateral nephrectomy in mice

Loss of functional nephrons associated with chronic kidney disease induces glomerular hyperfiltration and compensatory renal hypertrophy. We hypothesized that the endothelial nitric oxide synthase (eNOS) [soluble guanylate cyclase (sGC)] protein kinase G (PKG) pathway plays an important role in compensatory renal hypertrophy after unilateral nephrectomy. Analysis of mice subjected to unilateral nephrectomy showed increases in kidney weight-to-body weight and total protein-to-DNA ratios in wild-type but not eNOS knockout (eNOSKO) mice. Serum creatinine and blood urea nitrogen increased after nephrectomy in eNOSKO but not in wild-type mice. Furthermore, Bay 41-2272, an sGC stimulator, induced compensatory renal hypertrophy in eNOSKO mice and rescued renal function. The NO donor S-nitrosoglutathione (GSNO) and Bay 41-2272 stimulated PKG activity and induced phosphorylation of Akt protein in human proximal tubular cells. GSNO also induced phosphorylation of eukaryotic initiation factor 4E-binding protein and ribosomal protein S6. Our results highlight the importance of the eNOS-NO-PKG pathway in compensatory renal hypertrophy and suggest that reduced eNOS-NO bioavailability due to endothelial dysfunction is the underlying mechanism of failure of compensatory hypertrophy and acceleration of progressive renal dysfunction.     

Epidermal growth factor binding to cortical basolateral membranes in compensatory renal hypertrophy.

We studied epidermal growth factor (EGF) binding to renal basolateral membranes before and following unilateral nephrectomy. After 48 h unilateral nephrectomy there was a small increase in kidney cortex weight but EGF binding was unchanged, suggesting that alterations in EGF binding do not play a role in early renal hypertrophy. In contrast, 3 week unilateral nephrectomy was associated with a significant decrease in the Bmax of the high affinity binding sites for EGF without a change in the affinity constant. The changes in EGF binding seemed specific since binding for insulin was not changed by 3 week unilateral nephrectomy. The changes in EGF binding were not correlated with changes in Na-H antiporter activity elicited by unilateral nephrectomy but seemed inversely correlated with changes in renal cortical weight. Our results demonstrate that unilateral nephrectomy is not associated with changes in EGF binding in early stages, but is associated with a decrease in the number of high affinity binding sites after 3 weeks. This suggests that in the steady state, compensatory renal hypertrophy is associated with 'down regulation' of the EGF receptor.     

Incorporation of 32P into phospholipids in vivo during compensatory renal growth

Incorporation of 32P into phospholipids, RNA and DNA was studied in adult male C57BL/GoZgb mice. Left nephrectomy was performed under diethyl ether anesthesia, and the remaining right kidney was excised 10 min to 28 days later. Sham-operated animals were used as controls. 2 h before killing, animals were injected intraperitoneally with 37 kBq (1 microCi) 32P (as sodium orthophosphate) per g of body weight. In the right kidney, incorporation of 32P into total phospholipids, and five phospholipid fractions (phosphatidylcholine, phosphatidylethanolamine, phosphatidylserine, diphosphatidylglycerol and sphingomyelin) was increased by 25-35% between 20 and 72 h after uninephrectomy. The incorporation of 32P into RNA showed a similar pattern. However, incorporation of 32P into phosphatidylinositol and phosphatidic acid was already increased 20 min after uninephrectomy, reached a peak about 110-120% above control values 4 h after uninephrectomy, and then slowly returned to the control value at about 84-96 h. These results indicate that an early alteration in phospholipid metabolism, particularly of inositol lipids, may play a role in initiation of compensatory renal growth.     

The relationship of protein and lipid synthesis during the biogenesis of mitochondrial membranes

Summary Rat liver mitochondria were fractionated into inner and outer membrane components at various times after the intravenous injection of¹⁴C-leucine or¹⁴C-glycerol. The time curves of protein and lecithin labeling were similar in the intact mitochondria, the outer membrane fraction, and the inner membrane fraction. In rat liver slices also, the kinetics of³H-phenylalanine incorporation into mitochondrial KCl-insoluble proteins was identical to that of¹⁴C-glycerol incorporation into mitochondrial lecithin. These results suggest a simultaneous assembly of protein and lecithin during membrane biogenesisThe proteins and lecithin of the outer membrane were maximally labeledin vivo within 5 min after injection of the radioactive precursors, whereas the insoluble proteins and lecithin of the inner membrane reached a maximum specific acitivity 10 min after injection.Phospholipid incorporation into mitochondria of rat liver slices was not affected when protein synthesis was blocked by cycloheximide, puromycin, or actinomycin D. The injection of cycloheximide 3 to 30 min prior to¹⁴C-choline did not affect thein vivo incorporation of lecithin into the mitochondrial inner or outer membranes; however treatment with the drug for 60 min prior to¹⁴C-choline resulted in a decrease in lecithin labeling. These results suggest that phospholipid incorporation into membranes may be regulated by the amount of newly synthesized protein available.When mitochondria and microsomes containing labeled phospholipids were incubated with the opposite unlabeled fractionin vitro, a rapid exchange of phospholipid between the microsomes and the outer membrane occurred. A slight exchange with the inner membrane was observed.     

Compensatory changes in enzymes of arginine metabolism during renal hypertrophy in mice

The present study investigates enzyme activities of the urea cycle, transamidinase and ornithine–proline inter-conversion in the hypertrophied kidney after unilateral nephrectomy in mice. Surgical removal of the left kidney in mice led to compensatory enlargement of the right kidney after 1 and 14 days. This renal growth was associated with an increase in glomerular volume (but not number) and enlargement of the proximal convoluted tubules. The total renal protein content increased in proportion to the increase in kidney weight, but the protein per gram weight of kidney did not change. The specific activity of only ornithine aminotransferase (OAT), the rate-limiting enzyme in the conversion of ornithine to proline, increased in 2 weeks of hypertrophy. The specific activity of all other enzymes was unchanged. However, the total enzyme activity per kidney of all the enzymes, without exception, was elevated in the hypertrophied kidney. While the increase in total OAT activity was much more than the increase in kidney weight, all other enzymes increased more or less in proportion to the increase in renal mass. The results suggest that compensation in OAT activity to chronic reduction in renal mass was complete, but only partial in the case of other enzymes.     

Lipid metabolism of ripening apples

Little change was observed in the concentration of sitosterol, the principal free sterol of apple, during ripening of the fruit in air at 12°. Phospholipid increased by ca 10% during the first 15–18 days and thereafter showed little change. Phosphatidylcholine increased during ripening whilst phosphatidylethanolamine exhibited a transitory increase in the first 7–18 days. Incorporation of [¹⁴C]acetate into free sterol by apple cortical discs showed little change during ripening but incorporation into phospholipids increased substantially between days 1 and 15 with a 27-fold increase in incorporation into phosphatidylcholine and an 8-fold increase into phosphatidylethanolamine and phosphatidylinositol.     

Dynamics of Urinary Calprotectin after Renal Ischaemia

Background: Urinary calprotectin has been identified as a promising biomarker for acute kidney injury. To date, however, the time-dependent changes of this parameter during acute kidney injury remain elusive. The aim of the present work was to define the time-course of urinary calprotectin secretion after ischaemia/reperfusion-induced kidney injury in comparison to neutrophil gelatinase—associated lipocalin, thereby monitoring the extent of tubular damage in nephron sparing surgery for kidney tumours. Methods: The study population consisted of 42 patients. Thirty-two patients underwent either open or endoscopic nephron sparing surgery for kidney tumours. During the surgery, the renal arterial pedicle was clamped with a median ischaemic time of 13 minutes (interquartile range, 4.5–20.3 minutes) in 26 patients. Ten retro-peritoneoscopic living donor nephrectomy patients and 6 nephron sparing surgery patients in whom the renal artery was not clamped served as controls. Urinary calprotectin and neutrophil gelatinase—associated lipocalin concentrations were repeatedly measured by enzyme-linked immunosorbent assay and assessed according to renal function parameters. Results: Urinary concentrations of calprotectin and neutrophil gelatinase—associated lipocalin increased significantly after ischaemia/reperfusion injury, whereas concentrations remained unchanged after nephron sparing surgery without ischaemia/reperfusion injury and after kidney donation. Calprotectin and neutrophil gelatinase—associated lipocalin levels were significantly increased 2 and 8 hours, respectively, post-ischaemia. Both proteins reached maximal concentrations after 48 hours, followed by a subsequent persistent decrease. Maximal neutrophil gelatinase—associated lipocalin and calprotectin concentrations were 9-fold and 69-fold higher than their respective baseline values. The glomerular filtration rate was only transiently impaired at the first post-operative day after ischaemia/reperfusion injury (p = 0.049). Conclusion: Calprotectin and neutrophil gelatinase—associated lipocalin can be used to monitor clinical and sub-clinical tubular damage after nephron sparing surgery for kidney tumours. Urinary calprotectin concentrations start rising within 2 hours after ischaemia/reperfusion-induced kidney injury.