Renal Function in Analgesic Nephropathy

Comprehensive one-day renal function tests in 20 patients with a history of analgesic abuse showed varying degrees of chronic renal failure in all. There was no evidence of a selective defect in proximal tubular function, while a defective concentrating mechanism, usually considered necessary for the diagnosis of analgesic-induced renal damage, could be demonstrated in only 16 patients. A urinary acidification defect associated with a concentrating defect was found in nine cases and was thought to reflect specific collecting duct dysfunction. Urinary ammonium excretion was reduced in 13 subjects, owing to a reduced number of functioning nephrons or inadequate acidification, or both. Low citrate excretion was frequently encountered, and this, as well as defective urinary acidification, may play some part in predisposing patients with analgesic nephropathy to intrarenal calcification and progressive renal failure.     

Differential Renal Function Studies in the Diagnosis of Renal Hypertension

Over a 10-year period, positive criteria of the Howard test and the Rapoport Index have shown consistently good correlation with sustained relief or marked improvement in hypertension, in patients with main renal artery lesions. Similar correlation was obtained with ischemic criteria from histopathologic studies.Differential function studies did not reveal positive ischemic criteria in any patient operated upon for unilateral parenchymal disease. Histopathologic criteria of ischemia were also infrequent in this group. Nevertheless, marked improvement or cure of hypertension occurred in 62% of the latter. No factor can be used to predict improvement in this type of renal hypertension. Differential renal function criteria may occasionally appear to indicate renal artery ischemia in the more normal kidney in patients with unilateral parenchymal renal disease; wrong interpretation is avoided by taking differential creatinine clearance into account. Until vasopressor substances can be easily measured and accurately interpreted, aortography is indicated in selected patients.     

Renal Function and Hematology in Rats with Congenital Renal Hypoplasia

Renal hypoplasia due to a congenitally reduced number of nephrons progresses to chronic kidney disease and may cause renal anemia, given that the kidneys are a major source of erythropoietin in adults. Hypoplastic kidney (HPK) rats have only about 20% of the normal number of nephrons and develop CKD. This study assessed the renal function and hematologic changes in HPK rats from 70 to 210 d of age. HPK rats demonstrated deterioration of renal excretory function, slightly macrocytic erythropenia at all days examined, age-related increases in splenic hemosiderosis accompanied by a tendency toward increased hemolysis, normal plasma erythropoietin levels associated with increased hepatic and decreased renal erythropoietin production, and maintenance of the response for erythropoietin production to hypoxic conditions, with increased interstitial fibrosis at 140 d of age. These results indicate that increases in splenic hemosiderosis and the membrane fragility of RBC might be associated with erythropenia and that hepatic production of erythropoietin might contribute to maintaining the blood Hgb concentration in HPK rats.Abbreviations: CKD, chronic kidney disease; HGN, hypogonadism; HPK, hypoplastic kidneyApproximately 10% to 13% of the general population has chronic kidney disease (CKD), including an estimated 13.3 million people in Japan.^13,15,20 Moreover, more than 1.1 million patients worldwide require maintenance dialysis, and that number continues to increase.²⁴ Determining the pathogenesis of CKD, identifying clinical makers of early stages of CKD, and developing effective methods to treat CKD are required, especially given that CKD has been reported to be a risk factor for cardiovascular disease, with high mortality rates.^11,13,15 Patients with CKD are frequently anemic, due to a low level of erythropoietin and inhibition of erythropoiesis.^12,27 The decreased production of erythropoietin may result from the transdifferentiation of interstitial fibroblasts to myofibroblasts, resulting in increased production of extracellular matrix in the kidneys.^4,29 The number of nephrons in the kidneys at birth varies greatly,^5,19 and a congenital reduction in number of nephrons is thought to be related to the occurrence and prognosis of CKD.^9,17,18,21 Therefore, a CKD animal model with a reduced number of nephrons is useful for studying the pathophysiology of and treatments for CKD.Affected rats in the hypogonadism (HGN) inbred strain are characterized by male sterility due to hypogonadism,^37,41 reduced female fertility due to ovarian hypoplasia,^30,31 and progressive renal dysfunction due to bilateral hypoplastic kidneys (HPK).^32,33 These defects are controlled by a single autosomal recessive gene, hgn.^38,40 Linkage analysis and sequencing of candidate genes revealed a 25-bp duplicated insertion mutation in exon 7 of Astrin/Spag5, which encodes a microtubule-associated protein.³⁹ Because this mutation causes a premature terminal codon resulting in a truncated Astrin protein that lacks the primary spindle-targeting domain, the cause of the phenotype is considered to be a loss-of-function type mutation of the Astrin gene.^38,39 The recovery of normal fertility and renal function in homozygous mutant rats by a transgene comprising normal Astrin cDNA indicates that Astrin is required for normal testicular and renal development.²²The HGN strain was isolated from the sixth filial generation of a polygenic hydronephrotic rat strain derived from the original stock of the Wistar–Imamichi rat closed colony.⁴¹ Because the occurrence of hydronephrosis would influence renal development and function, we established another hypogonadism strain (HGN II) that was directly derived from the original closed colony.³⁶ The HGN II strain has been maintained by inbreeding between carriers, and the mutated gene responsible for the phenotype in the HGN II strain is identical to that in the HGN strain.³⁹ The affected rats of the HGN II strain show a similar phenotype as that of the HGN strain with regard to hypogonadism and HPK.^35,36Although male HPK rats in the HGN and HGN II strains have only about 20% of the nephrons present in normal kidney, the total glomerular filtration rate per kidney is compensated by hyperfiltration of individual glomeruli.^32,36 However, continuous glomerular hyperfiltration and functional overload of individual nephrons can result in a deterioration in renal excretion. Histologically, HPK rats demonstrate glomerular hypertrophy and dilation of the renal tubules.^32,36 As these rats age, cast formation in tubular lumen, glomerular sclerosis, and cellular infiltration into interstitial tissue occur.^33,35 In addition, age-related features of renal deterioration, including polyposia, polyuria, azotemia, albuminuria, and hypertension, follow,³⁵ and secondary hyperparathyroidism, osteodystrophy, and anemia emerge at advanced age in HPK rats.³³ Therefore HPK rats are a model for studying how a congenitally reduced nephron mass may induce CKD and secondary renal diseases, and HPK rats might be useful for identifying biomarkers related to these diseases. Because our previous studies in HPK rats^33,35 provided only limited information about the progression of CKD and renal anemia, the current study was designed to analyze multiple parameters related to renal function and hematology and to characterize the anemic tendencies in 70- to 210-d-old HPK rats. We found that the hematologic condition of HPK rats is characterized by reduced renal excretive function, erythropenia, increased hemolysis in the spleen, progressive renal fibrosis, and maintenance of normal plasma erythropoietin concentrations.