Principles in the X-ray diagnosis of early stages of renal failure

The study was undertaken to impart better functional capacities to a urographic study and to convert its results to quantitative characteristics in order to realize its new capacities, namely, to detect early and latent renal functions. Three hundred and fifty-eight patients (165 males and 193 females) aged 3 to 74 years underwent excretory urography using the contrast agent Urografin. In 173 patients, X-ray planimetry determined the index of the renal parenchymatous area and estimated its size in relation to the individual normal value, i.e. the area of the body of the first lumbar vertebra. During urographic studies, 185 patients had a X-ray functional test that was used to determine the glomerular filtration by X-ray contrast agent clearance. A high correlation was established between the area of the parenchyma of the unaffected kidney and the X-ray planimetric area of the body of the first lumbar vertebra (a ratio of 3:1), which offered possibilities of estimating the normal value of parenchymatous tissue for each specific person. A procedure was developed to determine the individual normal glomerular filtration rate by contrast agent clearance. There was evidence for the fact that there was a close relationship of the anatomic parameters of the normal kidneys to their functional ones, which suggests that the filtrability of the glomerular apparatus corresponds to the mass of the intact parenchyma. This has allowed the authors to discover a basic principle of the X-ray diagnosis of renal failure, which consists in recording the parenchymatous tissue size-filtrability imbalance occurring in this condition; this fact may suggest the death of acting nephrons or a temporary reduction in their physiological potential.     

Computed tomographic anatomy of the kidneys and the retroperitoneal space

The authors described the anatomy of the kidneys and retroperitoneal space in health on the basis of CT of 90 patients. Five typical levels in CT (ensuring all necessary data on roentgenomorphological traits of the kidneys and retroperitoneal space in the kidney area) were singled out. Some roentgenometric data on kidney cross-sections as well as the quantitative densitometric characterization of the parenchyma of the kidneys, renal sinus and adjacent tissues were presented. X-ray anatomy of the renal fascia, pararenal space and perirenal fatty space of the kidney with different parts of the retroperitoneal space was described.     

Selecting the optimal cell for kidney regeneration: fetal, adult or reprogrammed stem cells

Chronic kidney disease (CKD) is a progressive loss in renal function over a period of months or years. End-stage renal disease (ESRD) or stage 5 CKD ensues when renal function deteriorates to under 15% of the normal range. ESRD requires either dialysis or, preferentially, a kidney organ allograft, which is severely limited due to organ shortage for transplantation. To combat this situation, one needs to either increase supply of organs or decrease their demand. Two strategies therefore exist: for those that have completely lost their kidney function (ESRD), we will need to supply new kidneys. Taking into account the kidneys' extremely complex structure, this may prove to be impossible in the near future. In contrast, for those patients that are in the slow progression route from CKD to ESRD but still have functional kidneys, we might be able to halt progression by introducing stem cell therapy to diseased kidneys to rejuvenate or regenerate individual cell types. Multiple cell compartments that fall into three categories are likely to be worthy targets for cell repair: vessels, stroma (interstitium) and nephron epithelia. Different stem/progenitor cells can be linked to regeneration of specific cell types; hematopoietic progenitors and hemangioblastic cell types have specific effects on the vascular niche (vasculogenesis and angiogenesis). Multipotent stromal cells (MSC), whether derived from the bone marrow or isolated from the kidney's non-tubular compartment, may, in turn, heal nephron epithelia via paracrine mechanisms. Nevertheless, as we now know that all of the above lack nephrogenic potential, we should continue our quest to derive genuine nephron (epithelial) progenitors from differentiated pluripotent stem cells, from fetal and adult kidneys and from directly reprogrammed somatic cells.     

PPAR-gamma agonist ameliorates kidney and liver disease in an orthologous rat model of human autosomal recessive polycystic kidney disease

In autosomal recessive polycystic kidney disease (ARPKD), progressive enlargement of fluid-filled cysts is due to aberrant proliferation of tubule epithelial cells and transepithelial fluid secretion leading to extensive nephron loss and interstitial fibrosis. Congenital hepatic fibrosis associated with biliary cysts/dilatations is the most common extrarenal manifestation in ARPKD and can lead to massive liver enlargement. Peroxisome proliferator-activated receptor γ (PPAR-γ), a member of the ligand-dependent nuclear receptor superfamily, is expressed in a variety of tissues, including the kidneys and liver, and plays important roles in cell proliferation, fibrosis, and inflammation. In the current study, we determined that pioglitazone (PIO), a PPAR-γ agonist, decreases polycystic kidney and liver disease progression in the polycystic kidney rat, an orthologous model of human ARPKD. Daily treatment with 10 mg/kg PIO for 16 wk decreased kidney weight (% of body weight), renal cystic area, serum urea nitrogen, and the number of Ki67-, pERK1/2-, and pS6-positive cells in the kidney. There was also a decrease in liver weight (% of body weight), liver cystic area, fibrotic index, and the number of Ki67-, pERK1/2-, pERK5-, and TGF-β-positive cells in the liver. Taken together, these data suggest that PIO inhibits the progression of polycystic kidney and liver disease in a model of human ARPKD by inhibiting cell proliferation and fibrosis. These findings suggest that PPAR-γ agonists may have therapeutic value in the treatment of the renal and hepatic manifestations of ARPKD.     

Effects of chronic exercise on the kidneys at different ages

In order to determine the effects of chronic exercise on the kidneys at different ages, young, adult, and old rats swam 1 hour either daily or twice a week for 10 weeks and then were killed along with unexercised controls. The kidneys were removed and sections were prepared for histometric analysis including planimetric measurements on camera lucida drawings of renal components and line sampling. With both degrees of exercise young rats showed lower kidney weight, fewer glomeruli and less medullary tissue than unexercised controls. In the adult group no significant differences were noted between exercised and unexercised rats. In old rats both degrees of exercise resulted in a loss of kidney weight and medullary and cortical mass, and a decrease in size of glomeruli while total number of glomeruli remained unchanged. Thus the effects of chronic exercise on the kidneys varied with age. Retarded kidney development occurred in young animals; a loss of renal tissue in old animals; and no change in adult animals.     

Mechanisms of the early and late response of the kidney to contralateral nephrectomy.

The immediate (1 day, D1) and late (90 days, D90) effects of unilateral nephrectomy on contralateral renal hemodynamics, and the renal handling of electrolytes and water were investigated in the whole animal. The immediate and late ability of the remnant kidney to autoregulate perfusate flow and glomerular filtration rate (GFR) was studied in the isolated perfused kidney of the rat. In the whole animal, in D1 rats as compared to controls, GFR calculated for a single kidney increased from 0.85 +/- 0.3 to 1.1 +/- 0.2 ml/min (p less than 0.05). In D90 rats GFR increased further and was similar to prenephrectomy GFR (1.4 +/- 0.5 vs. 1.7 +/- 0.5 ml/min, p NS). Urinary prostanoid excretion in 24 h, calculated for one kidney, increased by 50-500% in D1 rats, but returned to prenephrectomy values in D90 rats. In the isolated perfused kidney, decreasing perfusion pressure (PP) from 100 to 70 mmHg did not change the renal vascular resistance (RVR) in control and D90 kidneys, but in D1 kidneys RVR decreased from 8.6 +/- 1.3 to 7 +/- 1.3 mm Hg/ml/min (p less than 0.05). In D90 kidneys RVR was significantly lower as compared to control and D1 kidneys at all perfusion pressures. Decreasing PP from 100 to 70 mm Hg resulted in a significant decrease in perfusion flow in control, D1 and D90 kidneys, while with the increase in PP from 100 to 130 mm Hg the perfusion flow increased significantly in all three kidney groups.(ABSTRACT TRUNCATED AT 250 WORDS)     

Protein synthesis in kidneys of merino sheep in postnatal ontogenesis

By evaluating parameters of activity of the nucleolar organizers (AgNORs), patterns of protein synthesis in cells of the right and left kidneys of merino sheep were examined in dependence of their age, sex, and the organ position. Depending on these parameters, the number of AgNORs in the kidney of merino sheep varies from 2 to 7. The total area of AgNORs in cells was within 0.50 +/- 0.03-2.22 +/- 0.05 mcm2. In different structure of nephrons, regions of nuclear organizers differ in both the quantity and total area. The obtained data testify that in kidney of 3 month old males and females of merino sheep the synthesis of 18S- and 28S-classes of ribosomal RNA and, accordingly, proteins occurs most actively.     

西藏小型猪肾脏应用组织学特点

目的研究西藏小型猪肾脏的组织结构,为其在生物医药领域中的应用提供形态学依据。方法取西藏小型猪肾脏标本投入10%中性福尔马林溶液固定24 h以上,修块,冲洗,脱水,透明,包埋,常规石蜡切片,HE染色,光镜观察拍照。结果西藏小型猪的肾与人肾一样呈长而扁的菜豆形,是表面光滑的多乳头肾,肾的表面有致密的结缔组织构成的被膜,肾实质可分为皮质和髓质,由数百万个肾单位和泌尿小管组成,其间由少量结缔组织、血管和神经等构成肾间质。结论西藏小型猪的肾脏结构比犬和猴更接近于人类,在异种器官移植、药物临床前安全性评价等生物医药领域中具有重要应用前景。     

Production of a heparin-binding angiogenesis factor by the embryonic kidney

Embryonic mouse kidneys induce angiogenesis when transplanted on the quail chorioallantoic membrane (Ekblom, P., H. Sariola, M. Karkinen, and L. Saxén, 1982, Cell Differ., 11:35-39). In these experiments all blood vessels were derived from the quail host, suggesting that kidney endothelium is derived from outside blood vessels. We have now analyzed whether kidney angiogenesis is regulated by kidney-derived soluble factors that stimulate the growth of new blood vessels. In the rabbit cornea, 11-d embryonic kidneys induced angiogenesis, whereas uninduced 11-d kidney mesenchymes did not. To characterize and purify this activity from an embryonic organ, we dissected between 600 and 1,000 14-17-d-old embryonic mouse kidneys for each purification experiment. Growth factor activity for capillary endothelial cells was found to bind to heparin-Sepharose and eluted at 0.9-1.1 M sodium chloride. Gel filtration revealed a molecular weight of 16,000-20,000 of this factor. A major 18,000-mol-wt band was seen after gel electrophoresis and silver staining of partially purified growth factor material. The chromatographed factor is mitogenic for endothelial cells but not for smooth muscle cells and stimulates angiogenesis in vivo in the rabbit cornea. Adult kidneys contained two heparin-binding endothelial cell growth factors. The differentiation-dependent production of an angiogenesis factor by the embryonic kidney suggests an important role of angiogenesis in organogenesis.     

The role of the kidney in the biosynthesis of carnitine in the rat.

Intravenous administration of L-[methyl-3H]-labeled trimethyllysine to rats results in a very rapid accumulation of radioactivity by the kidneys, while the incorporation of the label into the liver occurs at approximately 1% of this rate when calculated per g of wet tissue. The kidneys convert a substantial portion of the trimethyllysine taken up to butyrobetaine and to beta-hydroxytrimethyllysine, a precursor of butyrobetaine, but fail to synthesize carnitine. Significant amounts of radioactivity are recovered in both carnitine and butyrobetaine of hepatic tissue after longer time periods, while the level of labeled trimethyllysine in this organ remains very low. Bilateral nephrectomy results in a marked decrease in the incorporation of label into the liver. These results indicate that in rats, the initial conversion of trimethyllysine to butyrobetaine occurs predominantly in kidney and that the liver capacity for this transformation is considerably smaller than its capacity to synthesize carnitine from butyrobetaine.     

Renal cortical intermediary metabolism in the recovery phase of postischemic acute renal failure in the dog.

Renal metabolism has been studied in eight dogs before and 48 hr after a 60-min period of renal ischemia induced by clamping the left renal artery with the simultaneous removal of the right kidney, and in 12 sham-operated animals. The study involved the measurement of renal uptake and production of lactate, glutamine, glutamate, alanine, ammonium, and oxygen, and the measurement of the tissue concentrations of ATP, glutamine, lactate, alpha-ketoglutarate, aspartate, and alanine in the renal cortex. Two days after a temporary renal ischemia, the remaining kidney showed a 22% decrease in glomerular filtration rate (GFR) and a 25% decrease in renal plasma flow. Fractional sodium and potassium excretions were similar to those of control dogs. Renal production or extraction of glutamine, glutamate, alanine, ammonium, and oxygen (all expressed by 100 ml of GFR) was not significantly different in basal conditions or 2 days after ischemia, but lactate extraction was reduced in postischemic kidneys (-101 +/- 29 vs -204 +/- 38 mumol/100 ml GFR in control dogs). The cortical concentrations of glutamine and glutamate were lower in postischemic than in control kidneys. No differences were found in cortical concentration of alpha-ketoglutarate, aspartate, lactate, pyruvate, or ATP, but total nucleotides and inorganic phosphate were decreased in postischemic kidneys. It is concluded that in the recovery phase of the ischemia, a decreased lactate uptake is the main metabolic change, and total ATP production is adapted to the decrease of GFR and sodium reabsorption.     

多层螺旋CT测量成年贵州小型猪活体肾参考数据

目的通过测量成年贵州小型猪肾脏各种径线值及体积,建立贵州小型猪肾脏数据。方法采用西门子双源CT对12头成年贵州小型猪(雄性6头,雌性6头)进行薄层容积扫描,原始数据经Aquarius iNtuition4.4软件进行MRP及VR重组,在横断位正中层面测量双肾前后径及左右径,在冠状位最大面测量双肾长径及短径,计算小型猪体积及双肾体积,双肾长径与短径比值,采用统计学软件对肾长径、长短径比值与肾脏体积,肾脏体积与小型猪体积及体重做相关性分析,P0.05为差异有统计学意义。结果左肾前后径及左右径分别为(40.40±1.67)mm及(27.47±1.40)mm,长径及短径分别为(80.36±2.74)mm及(31.79±1.99)mm,左肾体积为(52.78±2.25)cm3,左肾长径与短径比值为(2.42~2.71)∶1;右肾前后径及左右径分别为(40.95±1.43)mm及(26.90±0.65)mm,长径及短径分别为(79.03±2.38)mm及(32.04±2.34)mm,右肾体积为(51.91±2.25)cm3,右肾长径与短径比值为(2.33~2.77)∶1。双肾长径与肾脏体积呈高度正相关(r左=0.92,P0.05;r右=0.88,P0.05),肾脏体积与小型猪体积呈正相关(r左=0.90,P0.05;r右=0.81,P0.05),与体重也呈高度正相关(r左=0.96,P0.05;r右=0.98,P0.05),但肾脏长短径比值与体积呈负相关(r左=-0.51,P0.05;r右=-0.67,P0.05)。结论多层螺旋CT及其后处理软件可准确测量贵州小型猪活体肾脏的多项影像学数据,为人类肾脏疾病的动物模型研究提供参考。     

Strain energy density as a rupture criterion for the kidney: impact tests on porcine organs, finite element simulation, and a baseline comparison between human and porcine tissues

High-velocity (up to 25 m/s) impact tests were performed on pig kidneys to characterize failure behavior at deformation rates associated with traumatic injury. Cylindrical tissue samples (n = 45) and whole perfused organs (n = 34) were impacted using both falling weights and a high-velocity pneumatic projectile impactor. Impact energy was incrementally increased until visible rupture occurred. The strain energy density failure threshold fell between 25 and 60 kJ/m3 for excised porcine tissue samples, and between 15 and 30 kJ/m3 for whole, perfused organs. The relationship between localized failure in whole organ impacts and tissue level failure thresholds observed in cylindrical tissue samples was explored using a detailed finite element model of the human kidney. The model showed good correlation between experimentally observed injury patterns and predicted strain energy density distributions within the renal parenchyma. Finally, to facilitate interpretation of the porcine renal impact results with regard to human trauma, quasi-static compression test results of freshly excised human kidney cortex samples (n = 30) were compared against similar tests on pig kidneys. Human tissues failed at Lagrange strain levels similar to porcine tissue (63+/-6.3%), but at 52% lower Lagrange stress (116+/-28 kPa), and 35% lower strain energy density (17.1+/-4.4 kJ/m3). Thus conservative interpretation of porcine test results is recommended.     

X-ray colonometry in the diagnosis of colonic dyskinesias and inflammatory diseases

Clinical and X-ray studies were made in 316 patients, which revealed intestinal dyskinesia, chronic colitis, and nonspecific ulcerative colitis in 105, 133, and 78 patients, respectively. Irrigoscopy (administration of a contrast enema, examination of the mucosal contour, and double contrasting) was performed in all the patients, by analyzing X-ray planimetric indices. X-ray colonoplanimetry makes it possible to objectify the interpretation of the X-ray pattern in chronic inflammatory diseases of the large bowel and colonic dyskinesia.     

Changes in glomerulotubular dimensions, single nephron glomerular filtration rates and the renin-angiotensin system in hypothyroid rats

Glomerular diameters (GD) and lengths of attached proximal convoluted tubules (TPL) were measured in nephrons dissected from the superficial (S), intermediate and juxtamedullary (JM) cortex (7-15 each) of acid-macerated kidneys of weight-matched (E) euthyroid and (H) hypothyroid (2-6 months after radioiodine treatment or thyroidectomy) male Sherman-Wistar rats. Incoordination of growth in H rats was evident in a more marked retardation in kidney than in total body growth. A similar incoordination of microstructural growth was evident in maintenance or GD within normal limits with respect to body weight while attached TPL fell 23% on the average below control values relative to body weight. These changes affected the total nephron population uniformly. As a result, GD/TPL in all nephrons increased significantly (p less than 0.01), by 27% in S and by 29% in JM nephrons. The glomerulotubular dimensional imbalance was associated with a marked and uniformly distributed reduction in single nephron glomerular filtration rate (ferrocyanide method), by 36% in S and JM nephrons. Plasma renin activity fell within normal limits while plasma renin substrate was decreased to 56% of control values. These findings are construed as evidence that growth retardation in hypothyroid rats affects the parenchyma of the kidney (and perhaps other viscera) more than the vasculature.     

Effects of hypothermic kidney preservation on the isolated perfused kidney: a comparison of reperfusion methods

Two isolated-perfused kidney methods were used to study the effects of hypothermic preservation on renal function in dog kidneys. The isolated-machine-perfused kidney (IMPK) used an in vitro perfusion technique--the perfusate was a Krebs-bicarbonate type delivered to the kidney at 37 degrees C by a mechanical pump at a constant pressure (100 mm Hg). The isolated-blood-perfused kidney (IBPK) utilized transplantation of the preserved kidney to the femoral vasculature. Renal function (urine analysis) was determined over a 1-hr reperfusion interval and included GFR (creatinine clearance), urine formation, and Na+ reabsorption. Kidneys preserved for only 24 hr by cold storage in either Collins'--C3 solution or in hypotonic citrate and kidneys hypothermically perfused for 24 hr demonstrated greater retention of renal function when reperfused by blood (IBPK) than with the in vitro perfusate (IMPK). The GFR was reduced by 38-58% when tested with the IBPK, but by 80-90% when tested with the IMPK. Na+ reabsorption was normal (97%) with blood reperfusion but was reduced to 36-50% in cold-stored kidneys and 82% in hypothermically perfused kidneys determined by machine reperfusion (IMPK). However, kidneys perfused for 72 hr demonstrated more similar renal functions when tested by either IMPK or IBPK. GFR was reduced to 20% (IBPK) and 11% (IMPK) and Na+ reabsorption averaged 76-85% (IBPK or IMPK). These results suggest that either reperfusion method is suitable for determining the effects of renal preservation on kidney function in kidneys preserved for 72 hr but, for short-term preserved kidneys (24 hr), the IBPK model may be preferred.     

Increased Renal Iron Accumulation in Hypertensive Nephropathy of Salt-Loaded Hypertensive Rats

Although iron is reported to be associated with the pathogenesis of chronic kidney disease, it is unknown whether iron participates in the pathophysiology of nephrosclerosis. Here, we investigate whether iron is involved in the development of hypertensive nephropathy and the effects of iron restriction on nephrosclerosis in salt- loaded stroke-prone spontaneously hypertensive rats (SHRSP). SHRSP were given either a normal or high-salt diet for 8 weeks. Another subset of SHRSP were fed a high-salt with iron-restricted diet. SHRSP given a high-salt diet developed severe hypertension and nephrosclerosis. As a result, survival rate was decreased after 8 weeks diet. Importantly, massive iron accumulation and increased iron content were observed in the kidneys of salt-loaded SHRSP, along with increased superoxide production, urinary 8-Hydroxy-2′-deoxyguanosine excretion, and urinary iron excretion; however, these changes were markedly attenuated by iron restriction. Of interest, expression of cellular iron transport proteins, transferrin receptor 1 and divalent metal transporter 1, was increased in the tubules of salt-loaded SHRSP. Notably, iron restriction attenuated the development of severe hypertension and nephrosclerosis, thereby improving survival rate in salt-loaded SHRSP. Taken together, these results suggest a novel mechanism by which iron plays a role in the development of hypertensive nephropathy and establish the effects of iron restriction on salt-induced nephrosclerosis.     

Echotomography and excretory urography in the diagnosis of renal parenchymal "bridges"]

Sonographically detectable parenchymal 'bridges' in the median segment of the kidney may look atypical. The most incident parenchymal 'bridges' are asymmetric irregular ovoid incomplete connections, not reaching the parenchyma at the site of renal hilus; such 'bridges' may be compared to a 'humpbacked' overturned kidney. Besides that, double and Y-shaped connections were detected, occurring in different variants of fused kidneys. Clinical significance of atypical 'bridges' of the parenchyma consists in simulation by them of echomixed processes, of renal tumors first of all. Excretory urography should be the second stage of the diagnosis after initial ultrasonic examination of the kidneys; after it repeated pointed ultrasonography should be carried out, that will help rule out the diagnosis of a renal tumor.     

Tissue and subcellular distribution of bismuth radiotracer in the rat: considerations of cytotoxicity and microdosimetry for bismuth radiopharmaceuticals

The whole-body clearance, organ distribution, and subcellular distribution of no-carrier-added and carried-added intraperitoneally administered bismuth radiotracers (205Bi-206Bi) has been determined in Sprague-Dawley rats. Differences in clearance rate kinetics were observed for this study with the administration of neutral solutions of tracers in a carbonate buffer compared to other studies with other chemical forms. The final organ distribution was not strongly dependent on administered chemical form. We provide definitive evidence that bismuth does indeed enter subcellular organelles such as the nucleus and the mitochondria, which had 30-50% and 10-25%, respectively, of activity in kidney tissue. The kidneys were the main sink for radiotracer with uptake ranging from 20 to 50% of total body activity. The calculated energy deposition by recoil nuclei after alpha emission of potentially therapeutically useful 212Bi was found to equal or exceed the alpha energy deposition per organelle if the source is inside the cell nucleus or mitochondria.