Filtration failure induced by p-aminophenol in rats is due to raised intratubular pressure and not changes in glomerular function.

1. The p-aminophenol (pAP) model of tubular necrosis displays elevated tubular pressures equivalent to 'stop-flow', with low glomerular filtration rate (GFR) but maintained blood flow and urine output. Renal function, micropuncture, and morphological studies were performed in anaesthetized rats to examine the causes of filtration failure. 2. At the height of pAP-induced renal failure proximal tubular fluid reabsorption (Jv(a] was markedly reduced while proximal and distal free-flow rates measured by tubular fluid collections during venting of the nephron were not significantly different from saline-injected controls. Renal blood flow was maintained over the 4 h observation period despite extensive and selective proximal tubular necrosis. There was no temporal relationship between increased tubular pressure and cast formation. 3. Maintained blood and tubular fluid flow rates indicate that activation of tubuloglomerular feedback plays little or no part in pAP-induced renal failure, which is apparently due to high fluid flow resistance in the region of the connecting tubule, late distal convolution or collecting ducts. Morphological appearances were consistent with compression of these segments.

Spontaneous papillary necrosis in the heterozygous Gunn rat.

Spontaneous papillary necrosis develops in aging heterozygous non-jaundiced Gunn rats. The lesion is situated in the subapical or mid papilla and in its earliest stages is manifest by the appearance of amorphous material in the interstitial space. This is seen in plastic-embedded sections taken from rats 6 months old. In its later stages, the accumulation of amorphous material is accompanied by loss of interstitial cells and cyst formation, but there is no associated inflammatory reaction. The largest lesions are found in the oldest rats, but even in these animals the macroscopic appearance of the papilla is normal. Similar papillary changes were not found in albino or homozygous Gunn rats, but in aging albino rats there was loss of papillary interstitial cells without accumulation of amorphous material.

Erythrocytes alter the pattern of renal hypoxic injury: predominance of proximal tubular injury with moderate hypoxia.

1. The distribution of morphological injury was assessed qualitatively and quantitatively in the perfused rat kidney in vitro at controlled rates of oxygen delivery in the presence of low concentrations of erythrocytes. 2. In control kidneys (total oxygen delivery approximately 32 mumol/min per kidney) no injury was seen in the medullary thick ascending limb of Henle's loop (MTAL) whilst 11 +/- 5(SD)% of proximal tubules sustained damage. 3. Mild hypoxia (total oxygen delivery approximately 28 mumol/min per kidney) produced little or no injury to MTAL, namely 6 +/- 4(SD)% and 3 +/- 3% of tubules damaged, respectively. In contrast, both groups sustained extensive damage to proximal tubules, averaging 46 +/- 13% (P less than 0.01 vs control) and 84 +/- 14% (P less than 0.001 vs control), respectively. This damage was equally distributed between the superficial and deep cortex. 4. Comparison with morphometric data obtained previously from cell-free-perfused rat kidneys [P.J. Ratcliffe, Z. H. Endre, S. J. Scheinman, J. D. Tange, J. G. G. Ledingham & G. K. Radda (1988) Clinical Science 74, 437-448] showed that (a) erythrocytes prevent hypoxic damage to the MTAL at mild and moderate levels of hypoxia; (b) when oxygen delivery rates are matched between cell-free- and erythrocyte-perfused kidneys, proximal tubular injury is greater in the presence of erythrocytes; (c) when arterial partial pressure of oxygen is matched between cell-free- and erythrocyte-perfused kidneys, the degree of proximal tubular injury is similar. 5. The data suggest that the proximal tubule and not the MTAL is the nephron segment most at risk of hypoxic injury in vitro.

Papillary necrosis in experimental renal transplantation in the rat.

Renal papillary necrosis is a frequent complication of unsuccessful renal transplantation in rats, occurring in both isografts and allografts. Papillary necrosis does not occur alone, but only and inevitably in association with severe cortical damage. The pattern of the lesion is different from other forms of papillary necrosis in that the least severe lesions occur in the outer medulla and the more severe lesions involve both medulla and papilla. The incidence of papillary necrosis is increased in isografts, but not in allografts, by longer preservation times. It is suggested that the principal underlying cause may be damage to medullary capillaries, occurring either during preservation or as a consequence of rejection and leading to medullary ischemia.

31P nuclear magnetic resonance study of steady-state adenosine 5'-triphosphate levels during graded hypoxia in the isolated perfused rat kidney.

1. A model of controlled hypoxia in the isolated perfused rat kidney has been used to compare the extent of reduction in the steady-state level of adenosine 5'-triphosphate (ATP) from that initially observed with alterations in renal function and with the development of tubular cell injury. 2. ATP depletion was observed in response to decreased total oxygen delivery even when delivery greatly exceeded consumption and the venous oxygen tension remained in excess of 150 mmHg. 3. Increases in the fractional excretion of sodium occurred progressively below an apparent threshold value of whole kidney ATP of approximately 80% of the baseline. 4. With modestly decreased oxygen delivery, cellular injury was confined to deep proximal tubule and medullary thick ascending limb of Henle's loop. Severely decreased oxygen delivery rates were associated with cellular damage spreading throughout the cortex. 5. Even the smallest reductions in whole kidney ATP were associated with morphological damage to tubular cells. The extent of reduction in whole kidney ATP was closely correlated and approximately equivalent to the calculated volume of injured cells. 6. Our results indicate that reduction in whole kidney ATP during decreased oxygen delivery is a valid marker of the extent of injurious cellular hypoxia and are consistent with the view that cellular ATP concentrations in hypoxia are markedly inhomogeneous. They support the hypothesis that specific regions of the perfused kidney become critically hypoxic and develop cellular injury while overall oxygen delivery remains high. Areas at risk include deep proximal tubule as well as the medullary thick ascending limb of Henle's loop.

Experimental folic acid nephropathy.

In rats, single intravenous doses of folic acid induce damage to renal tubular epithelium, deposition of folic acid in tubular lumens, increase in wet kidney weight, oliguria and interstitial connective tissue proliferation. Separation of the nephrotoxic and obstructive effects of folic acid was attempted by pretreatment with NH4Cl or NaHCO3. These effects of folic acid were unaltered by pretreatment with NH4Cl and there was, in addition, accumulation of eosinophilic droplets in papillary collecting duct epithelium. After pretreatment with NaHCO3, folic acid deposition is decreased or absent; there is a smaller increase in wet kidney weight; the rats are polyuric rather than oliguric; interstitial connective tissue proliferation is reduced; and no droplets form in papillary collecting ducts, but lesions are still present in proximal convoluted tubule epithelial cells. These findings indicate that folic acid has direct nephrotoxic effects independent of intraluminal folic acid deposition, and that damage to renal epithelium, unlike that induced by many nephrotoxins, occurs at several levels of the nephron.

Lesions of the renal papilla induced by paracetamol.

The acute nephrotoxic effects of paracetamol in the uninephrectomized homozygous Gunn rat are different from those of aspirin. Both compounds induce renal papillary necrosis but paracetamol produces accumulation of non-cellular material in the interstitial space, less damage to interstitial cells, more damage to tubular epithelium, and more severe necrosis of proximal convoluted tubules. In both cortex and papilla only a small fraction of the cells at risk are affected. It is concluded that the findings are consistent with a synergistic nephrotoxic effect between the two compounds, but that the lesions are not sufficiently severe for the natural history of analgesic nephropathy to be wholly explicable by such synergism.

Glomerular permeability in the isolated perfused rat kidney.

Increased glomerular permeability to protein occurs during isolated rat kidney perfusion in the absence of ultrastructural changes in the glomerular capillary wall. The increase is greater with age, varies with strain and is reduced by amino acid supplementation of the perfusate. Glomerular permeability to protein is thus perceptibly influenced by non-pathogenic stimuli. Such phenomena, in turn, may influence glomerular function in disease or after experimental damage.

Cyclosporine and the ischemic rat kidney.

The effects of cyclosporine (CsA) on renal function and morphology have been studied in the rat after unilateral nephrectomy and warm renal ischemia. There is evidence of an enhanced CsA nephrotoxic effect after unilateral nephrectomy alone and of an additive or synergistic effect of CsA and renal ischemia upon renal function and morphology. These enhanced effects are most evident after longer periods of ischemia (60 min) and with higher doses of CsA (25 mg/kg/day). The findings may be relevant to clinical practice and suggest that the nephrotoxic effects of CsA upon the donor kidney may be greatest when there is coincident renal damage from other causes.

Experimental pyelonephritis and papillary necrosis in the Gunn rat.

Homozygous and heterozygous female Gunn rats show increased susceptibility to experimental urinary infection. The strain develops pyelonephritis after intravesical inoculation of Proteus mirabilis in numbers which fail to induce the lesion in albino rats, and severe pyelonephritis is frequently complicated by papillary necrosis. The basis for this enhanced susceptibility has not been defined, but the occurrence of the phenomenon in both homozygous and heterozygous rats indicates that it is not caused primarily by high plasma levels of unconjugated bilirubin or by the deposition of bilirubin in the tip of the renal papilla. The increased susceptibility of the homozygous Gunn rat to ascending urinary tract infection provides supporting evidence for the suggestion that infection may complicate the natural history of experimental analgesic nephropathy in this strain and is relevant to the clinical association of analgesic nephropathy and urinary infection.

Pattern of renal cortical scarring after experimental papillary necrosis.

Three types of renal cortical damage were found in rats 2 mth after papillary necrosis had been induced by ethylenimine: (1) Circumscribed areas of interstitial nephritis affecting either deep or superficial nephrons. (2) Wedge-shaped or conical scars, extending from capsule to inner medulla. (3) Widespread tubular dilatation and cyst formation with a diffuse increase in interstitial tissue, usually associated with dense fibrous repair of the papillary remnant. The extent and character of the cortical changes did not appear to be determined by the severity of the papillary necrosis, and even the more severe cortical lesions were not accompanied by any major reduction in kidney size. Although these chronic experimental cortical lesions are the products of a less complex and less protracted natural history than end stage cortical damage in analgesic nephropathy, some of the factors influencing their evolution, such as infection, may also determine the natural history of the clinical lesion.

Chronic renal lesions in the uninephrectomized Gunn rat after analgesic mixtures.

Chronic cortical and medullary damage have been produced in uninephrectomized homozygous Gunn rats by single doses of the analgesics aspirin, paracetamol and phenazone, and by analgesic mixtures. The lesions are more severe than those of other experimental models of analgesic nephropathy, and the appearances of the cortical lesions suggest that they are ultimately due to the effects of papillary necrosis rather than to acute tubular necrosis observed in acute experiments with this model. The presence of an acute inflammatory reaction in both cortex and medulla in a number of animals one month after administration of analgesics indicates the possibility that the observed chronic renal damage may result from the intervention of additional complicating factors rather than from a single direct effect of analgesics.

Early functional and morphological changes in renal tubular necrosis due to p-aminophenol.

Functional and morphological changes developed rapidly in rats after the intravenous administration of the organic nephrotoxin p-aminophenol. Proximal intratubular pressure remained close to its mean control value of 14.9 +/- 0.9 mm Hg up to 40 min after injection of the nephrotoxin then rose rapidly over the following 50 min to a maximum of 38.7 +/- 7.4 mm Hg. Distal tubular pressure also rose in the same manner. Renal blood flow remained constant, but GFR fell to 11% of control values while fractional excretion of sodium and water rose 12 and five times, respectively. Morphological changes developed in parallel with the functional changes. They were widespread, varied in intensity from cell to cell, were more severe in the distal third of the proximal convoluted tubule and consisted of cytoplasmic swelling, reduced organelle concentration, reduction or loss of basal infoldings, widening of lateral intercellular spaces, extrusion of bubbles of cell sap into the tubular lumen; brush borders were preserved. No casts were present up to 90 min. Similar results were seen when p-aminophenol was added to the perfusate of the isolated perfused kidney. It is proposed that metabolic and morphological damage leads rapidly to both impairment of proximal tubular sodium reabsorption and increased flow resistance in the cortical collecting system. Both effects contribute to a rise in tubular pressures which oppose glomerular filtration.

Technical note: a new method for preparing renal tissue for microdissection.

The rat kidney has been prepared for microdissection by in vivo perfusion with hyaluronidase and collagenase and subsequent fixation with glutaraldehyde. The procedure ensures preservation of cytoplasmic detail, and the principle of fixation after maceration should provide a foundation for developing a variety of staining and histochemical studies.

Origin of glomerular crescents in rabbit nephrotoxic nephritis.

The origin of glomerular crescents was investigated in an accelerated model of rabbit nephrotoxic nephritis. In rabbits immunised against sheep gamma-globulin, the administration of sheep nephrotoxic serum provoked cellular crescent formation affecting 30 to 90 per cent. of glomeruli at 6 days. The crescents were composed predominantly of cells with ultrastructural features of macrophages. In animals depleted of circulating leukocytes by whole body irradiation, with or without shielding of the kidney, crescent formation was inhibited despite severe glomerular damage and fibrin deposition in Bowman's space. These findings support the hypothesis that glomerular crescents develop principally from the emigration and accumulation of bone marrow-derived mononuclear cells.

A new reproducible experimental model of analgesic nephropathy.

The uninephrectomised homozygous Gunn rat is more sensitive than other experimental animals to the nephrotoxic effects of analgesics. Phenacetin derivatives produce severe necrosis of proximal convoluted tubules and aspirin and phenazone renal papillary necrosis. The observations suggest that the components of compound analgesic preparations have separate and complementary nephrotoxic effects, and this is a possible factor contributing to the association of analgesic nephropathy with abuse of such preparations.

Ultrastructural appearances of acute renal papillary lesions induced by aspirin.

Renal papillary necrosis develops 16 hr after intravenous administration of aspirin to the uninephrectomised homozygous Gunn rat. Ultrastructural studies show the papillary interstitial cells to be most severely affected, the first changes being visible at 1 hr. Changes in capillaries are late in onset, and this suggests that the lesions are due to a direct toxic effect rather than to ischaemia.

Macrophages and glomerular crescent formation. Studies with rat nephrotoxic nephritis.

A model of crescentic glomerulonephritis in the rat was developed, based upon an augmented form of nephrotoxic nephritis. The glomerular lesions were relatively mild, permitting an analysis of the morphologic events in crescent formation to an extent not possible in models in other species in which the sequence of changes is obscured by the severity of the inflammatory process. Monocytes and macrophages accumulated in glomerular capillary lumens and walls. Crescents were composed of cells with ultrastructural features indistinguishable from those of the intracapillary mononuclear cells. The findings support the view that the crescent cells are predominantly composed of macrophages derived from circulating monocytes.

The genesis and ultrastructural appearance of spontaneous renal lesions in the homozygous Gunn rat.

Deposition of bilirubin at the tip of the renal papilla has been studied in the infant homozygous Gunn rat. The deposits form during the 4th wk of life in ground substance along basement membranes of capillaries and tubules and along the borders of interstitial cells. Deposits also form in capillary lumens. The early ultrastructural appearances indicate that unconjugated bilirubin is not directly cytotoxic. This conclusion has important implications for the pathogenesis of enhanced nephrotoxicity in the homozygous Gunn rat and ultimately for the pathogenesis of analgesic nephropathy.