Relative deficiency of acidic isoforms of osteopontin from stone former urine.

We have tested the relative electrophoretic mobility of osteopontin (OPN) isolated from urine obtained from normal individuals (NU) against similar samples derived from the urine of stone formers (SFU) using high-resolution isoelectric focusing (isoelectric point, pI range 3.5-4.5) in 2D electrophoresis, with Western blot detection. We also report the results from competitive ELISA analyses of these samples. We demonstrated that human urinary OPN has a discrete four band separation pattern that conforms to four previously documented OPN isoforms. The lower two M(r) isoforms migrate to a greater degree toward the acidic end of the gel than do the higher two M(r) isoforms. Densitometry of the signal reveals significant difference in the migration pattern of OPN from SFU as compared to that from NU based on an analysis of the spot intensities grouped in 0.1 pI unit increments. A novel method for the calculation of a weight-averaged pI based on the relative signal strength in an OPN 2D Western blot was developed. The analysis revealed a significantly increased weight-averaged pI values for the higher M(r) forms of OPN in the stone former compared to normal population. Additionally, alkaline phosphatase-treated NU samples resulted in a significant average pI shift of 0.05 units in the alkaline direction, suggesting that a decrease in the average degree of phosphorylation could be responsible for the difference between NU and SFU pI.

Regulation of pH in rat papillary tubule cells in primary culture.

To investigate the mechanisms responsible for urinary acidification in the terminal nephron, primary cultures of cells isolated from the renal papilla were grown as monolayers in a defined medium. Morphologically, cultured cells were epithelial in type, and similar to collecting duct principal cells. Cell pH measured fluorometrically in monolayers grown on glass slides showed recovery from acid loads in Na+-free media. Recovery was inhibited by cyanide, oligomycin A, and N-ethylmaleimide. Cyanide and oligomycin inhibited recovery less in the presence than in the absence of glucose. When cells were first acid loaded in a Na+-free medium and then exposed to external Na+, pH recovery also took place. This recovery exhibited first-order dependence on Na+ concentration and was inhibited by 5-(N-ethyl-N-isopropyl)amiloride. These studies demonstrate that in culture, collecting duct principal cells possess at least two mechanisms for acid extrusion: a proton ATP-ase and an Na+-H+ exchanger. The former may be responsible for some component of the urinary acidification observed in the papillary collecting duct in vivo; the role of the latter in acid-base transport remains uncertain.

Guaifenesin stone matrix proteomics: a protocol for identifying proteins critical to stone formation.

Drug-related kidney stones are a diagnostic problem, since they contain a large matrix (protein) fraction and are frequently incorrectly identified as matrix stones. A urine proteomics study patient produced a guaifenesin stone during her participation, allowing us to both correctly diagnose her disease and identify proteins critical to this drug stone-forming process. The patient provided three random midday urine samples for proteomics studies; one of which contained stone-like sediment with two distinct fractions. These solids were characterized with optical microscopy and Fourier transform infrared spectroscopy. Immunoblotting and quantitative mass spectrometry were used to quantitatively identify the proteins in urine and stone matrix. Infrared spectroscopy showed that the sediment was 60 % protein and 40 % guaifenesin and its metabolite guaiacol. Of the 156 distinct proteins identified in the proteomic studies, 49 were identified in the two stone-components with approximately 50 % of those proteins also found in this patient's urine. Many proteins observed in this drug-related stone have also been reported in proteomic matrix studies of uric acid and calcium containing stones. More importantly, nine proteins were highly enriched and highly abundant in the stone matrix and 8 were reciprocally depleted in urine, suggesting a critical role for these proteins in guaifenesin stone formation. Accurate stone analysis is critical to proper diagnosis and treatment of kidney stones. Many matrix proteins were common to all stone types, but likely not related to disease mechanism. This protocol defined a small set of proteins that were likely critical to guaifenesin stone formation based on their high enrichment and high abundance in stone matrix, and it should be applied to all stone types.

Anion transport regulates intracellular pH in renal cortical tissue.

The regulation of cell pH by anion transport was examined in suspensions of rabbit renal proximal tubules. Values for cell pH were derived from 14C-labeled 5,5-dimethyloxazolidine-2,4-dione distribution. In buffer with 10 mM/l HCO3-- and gassed with 95% O2/5% CO2, the anion transport inhibitors, 4-acetamido-4'-isothiocyano-2,2'-disulfonic stilbene and furosemide, raised the cell-to-extracellular pH gradient from 0.23 +/- 0.02 to 0.31 +/- 0.02 and 0.31 +/- 0.03, respectively, but in combination their effects were not additive. Replacement of extracellular Cl-- by NO3-- raised the pH gradient from 0.24 +/- 0.04 to 0.37 +/- 0.05. Neither inhibitor raised the pH gradient in Cl-- -free media. Incubation of suspensions in HCO3-- and CO2-free media raised the pH gradient from 0.18 +/- 0.02 to 0.29 +/- 0.03. Removal of Cl-- in addition to HCO3-- and CO2 raised the pH gradient still further, to 0.36 +/- 0.02. The results demonstrate that two different anion transport inhibitors raise cell pH and the cell-to-extracellular pH gradient in proximal tubules and are consistent with the idea that the mechanism for this effect is inhibition of alkali anion exit from the tubule cell. This process appears to depend on extracellular Cl-- and probably occurs primarily by HCO3-- transport. The results support the concept that alkali anion transport, most probably HCO3-- exit from the peritubular cell border, is an important regulator of cell pH in renal proximal tubule.

Sodium-proton exchange in human ileal brush-border membrane vesicles.

This study examines the characteristics of Na+ and H+ transport as well as Na+-H+ exchange in human ileal brush-border membrane vesicles from organ donor intestine. 22Na+ uptake into vesicles and the fluorescence quenching of Acridine orange were employed to measure Na+ and H+ transport, respectively. Concentrative uptake of 22Na+ (4-fold overshoot above equilibrium) was observed under conditions of an outward proton gradient (pHi 5.5; pHo 7.5). Voltage-clamping (Ki+ = Ko+ + valinomycin) reduced the uptake of 22Na+ by 40-50% indicating the presence of Na+ conductance. Dissipation of the Acridine orange fluorescence quench in ileal vesicles with a preformed pH gradient (pHi 5.5; pHo 7.5) was accelerated by either external Na+ or voltage-clamping in the absence of Na+. The effects of Na+ and voltage-clamping were additive under the above conditions. In the absence of a pH gradient, Acridine orange quenching was induced by intravesicular Na+ as well as an interior negative K+ diffusion potential. In voltage-clamped BBMV, pH-driven Na+ uptake was inhibited by amiloride (Ki = 140 microM). The initial rate of pH-driven Na+ uptake was saturable and conformed to Michaelis-Menten kinetics with apparent Km and Vmax values of 27 +/- 1 mM and 47 +/- 1 nmol.(mg protein)-1.(3 s)-1, respectively. Li+ and NH4+, but not Cs+, K+, Rb+ or choline+ inhibited pH gradient-driven 22Na+ uptake. The results demonstrate in human ileal brush-border membrane vesicles the presence of an Na+/H+ exchanger and conductive transport pathways for Na+ and H+.

Evidence that stimulation of 1,25(OH)2D3 production in primary cultures of mouse kidney cells by cyclic AMP requires new protein synthesis.

When primary culture of C75BL6 mouse cortical kidney cells in serum-free medium were incubated with unlabeled 25(OH)D3, they produced a metabolite which co-migrated with authentic 1,25(OH)2D3 and which could be measured by competitive receptor assay. A metabolite co-migrating with authentic 10-oxo-19-nor-25-OH-D3 was also produced. However, when cultures were incubated with 25(OH)D3 for 1 hour or longer, 10-oxo-19-nor-25-OH-D accounted for less than 15% of the total 3H-1,25(OH)2D3 displacement activity. Production of 1,25(OH)2D3 increased with increasing content of the culture, with time of incubation, and with substrate concentration. The apparent Km was 1.4 +/- 0.6 microM and Vmax 2.6 +/- 0.4 pM/mg protein/hr. These cultures possessed a very high level of phosphodiesterase activity, as indicated by their high cyclic AMP (cAMP) response to IBMX. This high phosphodiesterase activity may have been responsible for the lack of stimulation of 1,25(OH)2D3 production by physiologic or near physiologic concentrations of parathyroid hormone (PTH) in the absence of IBMX. However, when IBMX 10(-6) M was present, bPTH 10(-9) M significantly increased production of both cAMP and 1,25(OH)2D3. There was a close correlation between 1,25(OH)2D3 production and cAMP content of the cultures (basal or stimulated). An incubation time of at least 4 hours was required for cAMP to increase 1,25(OH)2D3 production and was inhibited in the presence of cycloheximide and actinomycin D. This study further documents the regulation of renal 1,25(OH)2D3 synthesis by PTH in mammalian kidney and provides evidence for cAMP as a possibly important second messenger in this effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Histochemical carbonic anhydrase in rat inner medullary collecting duct.

Rat inner medullary collecting duct (IMCD) secretes substantial amounts of H+. However, carbonic anhydrase (CA), a concomitant of H+ secretion, has been generally reported absent in this segment. To reexamine this problem, we investigated CA and the morphological phenotypes of cells comprising the IMCD by CA histochemistry, using a modified Hansson technique with light and electron microscopy. Throughout the medulla, tubule cells exhibit histochemical CA activity. In the initial third of the inner medulla, a small proportion have features of intercalated cells and demonstrate some degree of CA activity. However, the majority population in the early portions of the IMCD appears to consist of principal cells. These also show CA staining of widely variable intensity, both among and within cells. A third cell type, previously called "IMCD cells", appears in the middle portion of the IMCD and is the only cell type present near the papilla tip. In contrast to previous reports, these "IMCD cells" have histochemical CA staining, also of highly variable intensity. These results demonstrate that stainable carbonic anhydrase to support acidification is present throughout the rat IMCD, both in intercalated cells and in some cells clearly not of this type. Therefore, the presence of CA is not specific for the intercalated cell type and suggests that other cell types may participate in acid secretion in IMCD.

Ameloblastoma of the maxilla with distant metastases and hypercalcemia.

A case of metastatic ameloblastoma of the maxilla with secondary hypercalcemia in a 54-year-old man is presented. After treatment with surgery, chemotherapy, and radiotherapy, the patient was found to have multiple metastases and severe hypercalcemia associated with high levels of parathormone-like substance in the peripheral blood. At autopsy he was found to have widespread metastases and nephrocalcinosis.

Natriuretic and phosphaturic response to diuretics after parathyroidectomy in dogs.

Intact and acutely parathyroidectomized (TPTX) dogs were studied during hydropenia, volume expansion (VE), volume expansion plus ethacrynic acid (EA), and volume expansion plus acetazolamide (AZ). In intact dogs, VE produced marked increases in both Na+ and phosphate (Pi) excretion; in TPTX dogs, Na+ excretion increased but phosphaturia was minimal. Addition of EA increased Na+ but not Pi excretion in both groups. Discontinuing EA and substituting AZ in intact dogs produced a marked increase in Pi excretion compared to both VE and VE + EA. In TPTX dogs, AZ failed to increase Pi excretion compared to VE alone. The results suggest that increased distal Pi absorption in acutely TPTX dogs is not associated with NaCl reabsorption in the thick ascending loop of Henle or may occur at an alternative nephron site. Furthermore, the increased distal Pi reabsorptive capacity revealed by TPTX can overcome the increased distal Pi delivery produced by the superimposition of AZ on VE.

Acute renal failure associated with acetaminophen ingestion: report of a case and review of the literature.

A 26-year-old man experienced acute hepatic and renal damage after ingestion of an acetaminophen-containing compound. The clinical course, laboratory data and kidney biopsy were consistent with acute renal failure due to tubular necrosis. The patient required dialysis but ultimately renal function returned to normal. The etiology of the renal lesion was most likely nephrotoxicity due to acetaminophen. The clinical and experimental literature on acute renal failure associated with acetaminophen overdosage is reviewed. It is suggested that other drugs may precondition the kidney to tubular damage from this agent.

Changes in smooth muscle cell pH during hypoxic pulmonary vasoconstriction: a possible role for ion transporters.

Hypoxic pulmonary vasoconstriction (HPV) occurs in smooth muscle cells (SMC) from small pulmonary arteries (SPA) and is accompanied by increases in free cytoplasmic calcium ([Ca2+]i) and cytoplasmic pH (pHi). SMC from large pulmonary arteries (LPA) relax during hypoxia, and [Ca2+]i and pHi decrease. Increases in pHi and [Ca2+]i in cat SPA SMC during hypoxia and the augmentation of hypoxic pulmonary vasoconstriction by alkalosis seen in isolated arteries and lungs suggest that cellular mechanisms, which regulate inward and outward movement of Ca2+ and H+, may participate in the generation of HPV. SMC transport systems that regulate pHi include the Na+ - H+ transporter which regulates intracellular Na+ and H+ and aids in recovery from acid loads, and the Na+ -dependent and Na+ -independent Cl-/HCO3- transporters which regulate intracellular chloride. The Na+ -dependent Cl-/HCO3- transporter also aids in recovery from acidosis in the presence of CO2 and HCO3-. The Na+ -independent Cl-/HCO3- transporter aids in recovery from cellular alkalosis. The Na+ - H+ transporter was present in SMC from SPA and LPA of the cat, but it seemed to have little if any role in regulating pHi in the presence of CO2 and HCO3-. Inhibiting the Cl-/HCO3- transporters reversed the normal direction of pHi change during hypoxia, suggesting a role for these transporters in the hypoxic response. Future studies to determine the interaction between pHi, [Ca2+]i and HPV should ascertain whether pHi and [Ca2+]i changes are linked and how they may interact to promote or inhibit SMC contraction.

Bariatric surgery, hyperoxaluria, and nephrolithiasis: a plea for close postoperative management of risk factors.

Hyperoxaluria contributes significant risk for kidney stone development. It can result from disordered metabolism, excessive intake of oxalate or other nutrients, or alterations of bowel flora and function. Sinha et al. show that individuals undergoing Roux-en-Y bypass have high rates of stone disease, both before and after their procedure. Whether or not the incidence of stone events is increased after surgery, hyperoxaluria should be addressed. After Roux-en-Y, it is important for patients to maintain high urine outputs, to limit fat intake, and to ingest adequate amounts of calcium.

Regulation by macromolecules of calcium oxalate crystal aggregation in stone formers.

Based on the structure of kidney stones, it is likely that they form as aggregations of preformed crystals, mostly calcium oxalate monohydrate (COM). In this study, we examined the ability of a macromolecular mixture isolated from the urine of normal individuals and stone formers to inhibit aggregation of preformed COM seed crystals in a simple ionic solution using measurements of changes in the particle size distribution (PSD) of preformed COM crystal aggregates. We also examined the effect in this assay of a number of synthetic homopolymers, naturally occurring urine macromolecules, and binary mixtures thereof. The macromolecular mixtures from urine of normals and most stone formers reduced the degree of aggregation of the seed crystals, whereas 22% of stone former urine macromolecules either did not disaggregate or actually promoted further aggregation. Stone formers within one family shared this property, but a non-stone forming sibling did not. Polyanions, either synthetic or naturally occurring, induced disaggregation to an extent similar to that exhibited by normal urine macromolecules, while polycations had no effect on the PSD. However, mixing a polyanion, either poly-aspartate or osteopontin, with the polycation poly-arginine, changed their behavior from disaggregation to aggregation promotion. The disaggregating behavior of normal urinary macromolecules provides a defense against aggregation, but a minority of stone forming individuals lacks this defense, which may contribute to stone formation.

Proton ATPases and urinary acidification.

Acidification of the urine is mediated by vectorial H+ transport from cells at a number of sites in the kidney. A proton ATPase has been described that appears to mediate a significant proportion of this H+ transport. In particular, in proximal tubule and collecting duct, there is evidence both for the presence of transporter protein and for H+ transport with features that have been identified with it. This review highlights some of the unresolved questions regarding this transporter, specifically, its distribution and relationship to the vacuolar pump present in endocytotic vesicles, how physiologic control is asserted, and its role in pathophysiology. The review discusses in greater detail the issue of whether the vacuolar H+ ATPase is responsible for all of the urinary acidification and concludes that it probably is not. Specifically, compelling evidence for acidification at sites in the kidney that appear to lack this transporter is presented. In addition, the evidence for the presence in the kidney of a gastric-type H(+)-K+ ATPase is also reviewed. The evidence appears to be strong for a K(+)-stimulated ATPase that is sensitive to omeprazole and SCH 28080, the prototypical H(+)-K+ ATPase inhibitors; however, uncertainties remain because of problems of transport inhibition specificity and discordant results of molecular biologic studies.

Effects of pent-4-enoic acid on renal free water, bicarbonate and phosphate excretion in the dog.

1. The effects of pent-4-enoic acid, an inhibitor of fatty acid oxidation, were studied in dogs undergoing water diuresis and acetazolamide diuresis. Free water excretion and distal solute delivery were increased when infusion of pent-4-enoic acid was superimposed on an increasing mannitol diuresis. 2. Bicarbonate excretion increased significantly when infusion of pent-4-enoic acid was superimposed on maximum acetazolamide diuresis. 3. Phosphate excretion exceeded 90% of filtered load when pent-4-enoic acid was administered under stable free water conditions and increased significantly when pent-4-enoic acid was superimposed on stable acetazolamide diuresis. 4. The results are interpreted as indicating inhibition of proximal tubular reabsorption by pent-4-enoic acid, emphasizing the importance of fatty acids as a major fuel for proximal tubular metabolism.

Cloning and preliminary characterization of a calcium-binding protein closely related to nucleolin on the apical surface of inner medullary collecting duct cells.

Calcium stone crystal attachment to the urinary epithelium plays an essential role in the development of kidney stones by allowing small crystals to be retained in the kidney until they become macroscopic. We among others have described attachment of stone crystals to cultured renal epithelia (Wiessner, J. H., Kleinman, J. G., Blumenthal, S. S., Garancis, J. C., and Mandel, G. S. (1987) J. Urol. 138, 640-643). To isolate protein(s) that may participate in crystal attachment, apical membranes of cultured renal inner medullary collecting duct were biotinylated, the cells were lysed with detergent, the lysate was subjected to hydroxyapatite chromatography, and fractions were incubated with calcium oxalate monohydrate. Electrophoresis of material solubilized from the crystals showed several selectively adsorbed protein bands. A 110-kDa band stained positively for biotin and for glycosides and bound (45)Ca. The amino acid sequence of this band was determined to be that of a protein closely related to rat nucleolin (nucleolin-related protein; NRP). NRP was cloned and sequenced and was 83% homologous with the previously sequenced nucleolar protein nucleolin. Using temperature-induced phase partitioning with Triton X-114, NRP was associated with both the insoluble membrane skeleton pellet and the soluble aqueous phase but not the soluble detergent phase. This association with the membrane skeleton was increased in the presence of calcium. Thus, NRP is associated with the apical membranes of cultured renal tubular cells and is bound to membrane skeletal elements in a calcium-dependent fashion. The physiological role of NRP remains to be determined; however, a pathophysiological role may be that of mediating the attachment to the renal tubular epithelium of calcium stone crystals.

Pyelonephritis complicating relapsing acute pancreatitis.

A case of right pyelonephritis with hydronephrosis complicating relapsing acute pancreatitis and right pararenal phlegmon formation is presented. Hydronephrosis is a reportedly rare complication of extrapancreatic inflammation; the only 6 previous cases involving the right side are reviewed. The present case report, to our knowledge, is the first to describe clinical and laboratory evidence of pyelonephritis secondary to partial obstruction of the right upper renal tract by an extrapancreatic phlegmon. The clinician caring for patients with acute pancreatitis should be aware of this important complication, since the presentation of pyelonephritis-flank pain and fever--could erroneously be attributable solely to the pancreatitis.