Assessment of Perfusion and Oxygenation of the Human Renal Cortex and Medulla by Quantitative MRI during Handgrip Exercise.

BACKGROUND: Renal flow abnormalities are believed to play a central role in the pathogenesis of nephropathy and in primary and secondary hypertension, but are difficult to measure in humans. Handgrip exercise is known to reduce renal arterial flow (RAF) by means of increased renal sympathetic nerve activity. METHODS: To monitor medullary and cortical oxygenation under handgrip exercise-reduced perfusion, we used contrast- and radiation-free magnetic resonance imaging (MRI) to measure regional changes in renal perfusion and blood oxygenation in ten healthy normotensive individuals during handgrip exercise. We used phase-contrast MRI to measure RAF, arterial spin labeling to measure perfusion, and both changes in transverse relaxation time (T2*) and dynamic blood oxygenation level-dependent imaging to measure blood oxygenation. RESULTS: Handgrip exercise induced a significant decrease in RAF. In the renal medulla, this was accompanied by an increase of oxygenation (reflected by an increase in T2*) despite a significant drop in medullary perfusion; the renal cortex showed a significant decrease in both perfusion and oxygenation. We also found a significant correlation (R2=0.8) between resting systolic BP and the decrease in RAF during handgrip exercise. CONCLUSIONS: Renal MRI measurements in response to handgrip exercise were consistent with a sympathetically mediated decrease in RAF. In the renal medulla, oxygenation increased despite a reduction in perfusion, which we interpreted as the result of decreased GFR and a subsequently reduced reabsorptive workload. Our results further indicate that the renal flow response's sensitivity to sympathetic activation is correlated with resting BP, even within a normotensive range.

Do distinct populations of dorsal root ganglion neurons account for the sensory peptidergic innervation of the kidney?

Peptidergic afferent renal nerves (PARN) have been linked to kidney damage in hypertension and nephritis. Neither the receptors nor the signals controlling local release of neurokinines [calcitonin gene-related peptide (CGRP) and substance P (SP)] and signal transmission to the brain are well-understood. We tested the hypothesis that PARN, compared with nonrenal afferents (Non-RN), are more sensitive to acidic stimulation via transient receptor potential vanilloid type 1 (TRPV1) channels and exhibit a distinctive firing pattern. PARN were distinguished from Non-RN by fluorescent labeling (DiI) and studied by in vitro patch-clamp techniques in dorsal root ganglion neurons (DRG; T11-L2). Acid-induced currents or firing due to current injection or acidic superfusion were studied in 252 neurons, harvested from 12 Sprague-Dawley rats. PARN showed higher acid-induced currents than Non-RN (transient: 15.9 +/- 5.1 vs. 0.4 +/- 0.2* pA/pF at pH 6; sustained: 20.0 +/- 4.5 vs. 6.2 +/- 1.2* pA/pF at pH 5; *P < 0.05). The TRPV1 antagonist capsazepine inhibited sustained, amiloride-transient currents. Forty-eight percent of PARN were classified as tonic neurons (TN = sustained firing during current injection), and 52% were phasic (PN = transient firing). Non-RN were rarely tonic (15%), but more frequently phasic (85%), than PARN (P < 0.001). TN were more frequently acid-sensitive than PN (50-70 vs. 2-20%, P < 0.01). Furthermore, renal PN were more frequently acid-sensitive than nonrenal PN (20 vs. 2%, P < 0.01). Confocal microscopy revealed innervation of renal vessels, tubules, and glomeruli by CGRP- and partly SP-positive fibers coexpressing TRPV1. Our data show that PARN are represented by a very distinct population of small-to-medium sized DRG neurons exhibiting more frequently tonic firing and TRPV1-mediated acid sensitivity. These very distinct DRG neurons might play a pivotal role in renal physiology and disease.

Temporal relationship between renal cyst development, hypertension and cardiac hypertrophy in a new rat model of autosomal recessive polycystic kidney disease.

BACKGROUND/METHODS: We have examined the hypothesis that cyst formation is key in the pathogenesis of cardiovascular disease in a Lewis polycystic kidney (LPK) model of autosomal-recessive polycystic kidney disease (ARPKD), by determining the relationship between cyst development and indices of renal function and cardiovascular disease. RESULTS: In the LPK (n = 35), cysts appear at week 3 (1.1 +/- 0.1 mm) increasing to week 24 (2.8 +/- 2 mm). Immunostaining for nephron-specific segments indicate cysts develop predominantly from the collecting duct. Cyst formation preceded hypertension (160 +/- 22 vs. Lewis control 105 +/- 20 mm Hg systolic blood pressure (BP), n = 12) at week 6, elevated creatinine (109 +/- 63 vs. 59 +/- 6 micromol/l, n = 16) and cardiac mass (0.7 vs. 0.4% bodyweight, n = 15) at week 12, and left ventricular hypertrophy (2,898 +/- 207 vs. 1,808 +/- 192 mum, n = 14) at week 24 (all p < or = 0.05). Plasma-renin activity and angiotensin II were reduced in 10- to 12-week LPK (2.2 +/- 2.9 vs. Lewis 11.9 +/- 4.9 ng/ml/h, and 25.0 +/- 19.1 vs. 94.9 +/- 64.4 pg/ml, respectively, n = 26, p < or = 0.05). Ganglionic blockade (hexamethonium 3.3 mg/kg) significantly reduced mean BP in the LPK (52 vs. Lewis 4%, n = 9, p < or = 0.05). CONCLUSION: Cyst formation is a key event in the genesis of hypertension while the sympathetic nervous system is important in the maintenance of hypertension in this model of ARPKD.

Catecholamines in kidneys of normotensive and genetically hypertensive rats. Effects of salt load.

The tissue content of norepinephrine, dopamine, and epinephrine was determined in different zones of the kidney in normotensive Sprague-Dawley and Otago Wistar rats and in genetically hypertensive Otago Wistar rats. One kidney in each animal was chronically denervated to allow estimation of the neuronal contribution to renal catecholamine content. In all strains, the renal cortex contained negligible amounts of nonneuronal norepinephrine and dopamine, while outer and inner medullary layers contained progressively larger amounts. Nonneuronal epinephrine was distributed fairly evenly through cortex and medulla. Neuronal norepinephrine content was similar in inner and outer cortex, substantially less in outer medulla, and not discernible in inner medulla. The amounts of neuronal dopamine were consistent with its localization predominantly in noradrenergic nerves. The renal cortices of normotensive Wistar rats contained more neuronal norepinephrine and less neuronal dopamine than those of Sprague-Dawley rats, and the cortices of hypertensive Wistar rats contained slightly more norepinephrine than those of normotensive Wistar rats. In both normotensive strains, long-term salt loading decreased selectively the neuronal norepinephrine in renal cortex. By contrast, in hypertensive animals, cortical norepinephrine was not reduced by salt loading. These results indicate that the genetically hypertensive rat may have an abnormal sympathetic reflex response to increased blood volume.

Exaggerated natriuresis in transgenic (mRen2)27 rats.

BACKGROUND: Hypertension features an exaggerated natriuresis after acute volume expansion. In humans, the degree of exaggerated natriuresis appears to be correlated inversely to the level of angiotensin (Ang) II. OBJECTIVE: To test the hypothesis that the degree of exaggerated natruresis is correlated to the level of Ang II by studying two rat models, transgenic rats (TGR) with and extra renin gene (TGR mRen2)27 and desoxycorticosterone acetate (DOCA)-salt rats, in comparison with Sprague-Dawley Hannover (SDH) rat controls. METHODS: All of the rats were uninephrectomized for 1 month. DOCA-salt rats were implanted with a DOCA pallet and drank 1% saline. Rats were anesthetized and their left kidneys were instrumented with renal sympathetic nerve activity (RSNA) electrodes and laser-Doppler cortical and medullary flow probes. The glomerular filtration rate, diuresis, and natriuresis were measured for 120 min after sodium loading (5% body weight 0.9% saline administered during 3 min). Kidneys were examined histologically. RESULTS: The blood pressure in TGR and DOCA-salt rats was 40-50 mmHg higher than that in SDH rats, and decreased briefly after volume expansion for all groups. The diuresis and natriuresis of TGR and DOCA-salt rats were greater than those of SDH rats. The medullary blood flow increased and the cortical blood flow in SDH decreased, whereas the cortical blood flow in TGR and DOCA-salt rats remained high. The RSNA in rats of all groups decreased; however, this decrease was greater in SDH than it was in TGR and DOCA-salt rats. The histology was affected most severely for the DOCA-salt rats. CONCLUSIONS: Exaggerated natriuresis occurred in hypertensive rats regardless of their Ang II status. Both strains were characterized by a smaller decrease in RSNA and a preserved cortical blood flow in the face of volume expansion. These data do not support the notion that exaggerated natriuresis is a function of renin-level suppression for rats.

A direct projection from the kidney to the brainstem.

The double-labeling, fluorescent dye technique was used in order to demonstrate the extent to which the central processes of renal afferent neurons directly project to the brainstem. One injection of a fluorescent dye was placed in the cortex of the left kidney of male rats, and a second injection of a different dye was placed into the lower medulla. The results demonstrate that some of the renal afferents directly project to the medulla but not to higher regions of the brain. A total of approximately 8% of renal afferents were typically shown to have direct projections.

Neuropeptide Y (NPY)-like immunoreactive nerve fibers in the human and monkey (Macaca fascicularis) kidney.

Nerve fibers immunoreactive for neuropeptide Y (NPY) are demonstrated for the first time by the indirect immunofluorescence technique in the human and monkey kidney. NPY-like immunoactivity (NPY-LI) is shown in a bundle of nerve fibers in the surrounding connective tissue of arteries and to a lesser extent, veins, mainly at the juxtamedullary region. Varicose nerve terminals are shown associated with blood vessels and passing between tubules in the mid and lower cortex. NPY-LI nerve fibers are also seen surrounding afferent and occasionally efferent arterioles at the vascular pole of the glomeruli. The distribution of NPY-LI nerve fibers in the monkey and human kidneys is similar to that of other species, only the quantity of the nerve fibers varies.

Vasoactive intestinal polypeptide-immunoreactive nerves in the kidney.

Nerve fibers immunoreactive for vasoactive intestinal polypeptide (VIP) were demonstrated by immunocytochemistry in the dog and rat kidney. They were seen in association with the renal artery and its branches. In the dog, VIP-immunoreactive fibers were rarely seen close to small blood vessels suggestive of arterioles. The possible existence of neuroeffector junctions between VIP-positive fibers and renin-secreting juxtaglomerular cells requires further investigation. VIP-positive renal nerves, however, might have a vasodilatatory role.

Importance of the renal nerves for basal and stimulated renin mRNA levels in fetal and adult ovine kidneys.

OBJECTIVE: To investigate the effect of renal denervation on renin mRNA levels in fetal and nonpregnant adult ovine renocortical tissue and in isolated juxtaglomerular cells under basal conditions and after stimulation. METHODS: The left kidney was denervated and the right kidney subjected to a sham procedure in nine ovine fetuses (136-141 days' gestation) and 20 nonpregnant ewes. After 5-7 days the denervated and intact kidneys were obtained, and renin-containing renal cortical cells were isolated and cultured overnight. Then cells were treated with isoproterenol, forskolin, or isomethylbutyl xanthine (IBMX) for 4 hours. Total RNA was isolated and renin mRNA measured by RNase protection assay. Cyclic adenosine monophosphate (cAMP) levels were measured in the incubation medium with a competitive enzyme immunoassay. RESULTS: In adults, basal renin mRNA levels were significantly lower in denervated than in sham-operated kidneys. No difference was noted between denervated and intact fetal kidneys. Renin mRNA levels were significantly higher in fetal than in adult kidney tissue, and cells from fetuses had greater increases in renin mRNA after stimulation than did cells from adults. Fetal cells also released more cAMP into the incubation medium, and there was a correlation between cAMP and renin mRNA levels. CONCLUSIONS: The data indicate the effects of renal denervation on renin mRNA expression in the kidney are age dependent and that the fetus in late gestation has a mechanism for maintaining renin mRNA levels after denervation, which is absent or nonfunctional in the adult.

[Effect of disconnection of various types of autonomic mediation on the adenyl system of the cortex of a solitary kidney]. / Vliianie vykliuchenii razlichnyjh vidov vegetativnoi mediatsii na sostoianie adenilovoi sistemy kory edinstvennoi pochki.

The authors studied the ATP, ADP, and AMP intratissue content and the energy charge of the kidney cortex in compensatory hypertrophy during a continuous blocking effect produced by daily guanethidine and atropine injections on the transsynaptic mechanisms of sympathetic and parasympathetic neuromediation. Chronic disorders of energy metabolism were noted in both groups, which were more marked in deparasympathization. Complex combinations of the constant functional load exerted on the organ with the metabolic effects of the mediatory block in the tissues and disorders of their blood supply are the causes of tissue energy deficiency. The disorders of energy metabolism in the late periods of the experiment (after 60 days) in both cases were caused by deterioration of the blood supply to the cortex due, probably, to the noted accumulation in the tissue of metabolites of macroergic compounds which are vasoconstrictors of the renal arterioles.

Autonomic innervation of the periglomerular arteries.

OBJECTIVE: To explore spatial and volume relations of the calcitonine gene-related peptide (CGRP)-positive and tyrosine hydroxylase (TH)-positive nerve fibers in the wall of cortical blood vessels. STUDY DESIGN: Kidney specimens from 10 rats were processed for confocal microscopy. Nerve fibers were stained with anti-CGRP and anti-TH antibodies and image stacks were collected. Three-dimensional reconstruction and quantification of labeled fibers were performed to reveal their distribution and spatial relations. RESULTS: CGRP- and TH-immunoreactive nerve fibers were distributed throughout the kidney cortex. TH-positive fibers were dominant in the small periglomerular arteries (up to 4.6-fold). Examined nerves were finely intertwined in the wall of small blood vessels of the kidney and ran in the same nerve bundle but without co-localization. Extensive, web-like branching and varicosities of the TH nerves were observed. Sensory fibers prevailed in the wall of the larger arteries "embedded" into tubules near the medullary rays, and their endings can be verified in the muscularis layer of the interlobular arteries. CONCLUSION: Characteristics of the investigated fibers emphasize their role in the regulation of kidney blood vessel diameter and their influence on hypertension onset.

The protective effects of DA-9801 (Dioscorea extract) on the peripheral nerves in streptozotocin-induced diabetic rats.

It has been reported that DA-9801, an extract mixture of Dioscorea japonica Thunb and Dioscorea nipponica Makino, produces a neurotrophic activity. Therefore, this study was conducted to examine the neuroprotective effects of DA-9801 in streptozotocin-induced diabetic rats. The experimental rats were divided into six groups: the control group, Group I (non-diabetic rats treated with DA-9801), Group II (diabetic, non-treated rats) and Groups III, IV, and V (diabetic rats treated with DA-9801 at doses of 10, 50 or 100 mg/kg/d). Following a 16-wk course of oral treatment with DA-9801, functional parameters (von Frey filament test, hot plate test), biochemical parameters (nerve growth factor (NGF), tumor necrosis factor (TNF)-α, interleukin (IL)-6) were measured. An immunohistochemical staining was done to assess the neuroprotective effects of DA-9081 in the skin, sciatic nerve, gastric mucosa and renal cortex. In Week 8, pain was evoked by either tactile or thermal stimuli, whose threshold was significantly higher in Group III, IV and V than Group II. Western blot analysis showed a more significant increase in NGF and decrease in TNF-α and IL-6 in Group III, IV and V than in Group II (p<0.05). Moreover, following the treatment with DA-9801, a loss of intraepidermal nerve fibers (IENFs) was inhibited to a significant level in the skin, myelinated axonal fibers of the sciatic nerve and small nerve fibers innervating the gastric mucosa or renal cortex (p<0.05). Our results demonstrated that DA-9801 is a beneficial agent that protects the peripheral nerves in diabetic rats.

Sulodexide prevents peripheral nerve damage in streptozotocin induced diabetic rats.

We investigated whether sulodexide has additional protective effects against peripheral nerve damage caused by microvascular dysfunction in a rat model of diabetes. Female Sprague-Dawley (SD) rats were divided into the following 4 groups (n=7-9/group): Normal, Normal+Sulodexide (sulodexide 10mg/kg), diabetic group, and diabetic+Sulodexide (sulodexide 10mg/kg). We assessed current perception threshold, skin blood flow, superoxide dismutase, and proteinuria in experimental rats after oral administration of sulodexide for 20 weeks. We also performed morphometric analysis of sciatic nerves and intraepidermal nerve fibers of the foot. Superoxide dismutase activity in the blood and sciatic nerve were increased significantly after sulodexide treatment in the diabetic group. Current perception threshold was reduced at 2000 Hz (633.3 ± 24.15 vs 741.2 ± 23.5 µA, P<0.05) and skin blood flow was improved (10.90 ± 0.67 vs 8.85 ± 0.49 TPU, P<0.05) in the diabetic+Sulodexide group compared with the diabetic group. The mean myelinated axon area was significantly larger (56.6 ± 2.2 vs 49.8 ± 2.7 µm(2), P<0.05) and the intraepidermal nerve fiber density was significantly less reduced (6.27 ± 0.24 vs 5.40 ± 0.25/mm, P<0.05) in the diabetic+Sulodexide group compared to the diabetic group. Our results demonstrate that sulodexide exhibits protective effects against peripheral nerve damage in a rat experimental model of diabetes. Therefore, these findings suggest that sulodexide is a potential new therapeutic agent for diabetic peripheral neuropathy.

Comparison of peripheral nerve damages according to glucose control timing in experimental diabetes.

OBJECTIVE: In addition to tight glucose control, early intensive therapy has been reported to be more important for the prevention of diabetic micro- and macro-vascular complications. What is not known exactly is the quantitative difference according to timing delay in glucose control and whether early period control is really better than late control in terms of diabetic peripheral neuropathy. In this study, we investigated the effect of timing differences in glucose control on the peripheral nerves in an experimental diabetic model. METHODS: 5 groups (6-8 rats in each group) were comprised of normal glucose rats (designated control), rats with hyperglycemia (designated DM), rats with glucose control for the entire 28-week study period (designated DM + INS [W0-28]), rats with glucose control for the early 14-week period followed by hyperglycemia for the late 14-week period (designated DM + INS [W0-14]), and rats with hyperglycemia for the early 14-week period followed by glucose control in the late 14-week period (designated DM + INS [W15-28]). RESULTS: We found that the current perception threshold (CPT) was lower in the DM + INS (W0-28) and DM + INS (W15-28) groups than in the DM + INS (W0-14) or DM groups (P<0.05). The mean myelinated fiber area of the sciatic nerve was significantly greater in the DM + INS (W0-28) and DM + INS (W15-28) groups (63.5±2.32 and 60.1±2.14 um, respectively) than in the DM + INS (W0-14) or DM groups (55.5±2.81 or 51.5±2.64 um, respectively) (P<0.05), and the intraepidermal nerve fiber (IENF) density was significantly higher in the DM + INS (W0-28) and DM + INS (W15-28) groups (6.9±0.46 and 6.8±0.11, respectively) than in the DM + INS (W0-14) or DM groups (59.5±0.32 and 5.3±0.39/mm, respectively) (P<0.05). CONCLUSION: Our results indicate that continuous glucose control is necessary to alleviate peripheral nerve damage and that glycemic control during the later period may be more important than early period management. The importance of continuous glucose control, including the later period of diabetes, should therefore be emphasized in diabetic peripheral neuropathy.

Mechanosensitive N-methyl-D-aspartate receptors contribute to sensory activation in the rat renal pelvis.

The N-methyl-D-aspartate (NMDA) subtype of the ionotropic glutamate receptor is found in the periphery. The present study tested whether NMDA receptors (NMDARs) are present in the ends of afferent renal nerves in the renal pelvis, an area concerned mainly with transmitting sensation and the to reflex regulation of body fluid. The main NMDAR subunit, NMDAzeta1, was found to be more abundant in the renal pelvis than the renal cortex and medulla, and was mainly colocalized with the pan-neuronal marker PGP9.5 or the sensory nerve marker, the neurokinin-1 receptor. However, NMDAzeta1 mRNA was undetectable, suggesting that it might be synthesized outside the renal pelvis. Intrarenal arterial administration of the specific ion channel blocker (+)-MK-801, but not the inactive enantiomer (-)-MK-801, decreased urine output and sodium excretion. High doses of (+)-MK-801 also caused regional vasoconstriction in the renal cortex, as determined by laser-Doppler flowmetry. Intrapelvic administration of the NMDAR ligand D-serine caused a dose-dependent increase in substance P (SP) release and afferent renal nerve activity, but had no effect on arterial pressure. The D-serine-induced sensory activation and SP release were abrogated by (+)-MK-801, the SP receptor blocker L-703,606, or dorsal rhizotomy. Increasing intrapelvic pressure resulted in an increase in afferent renal nerve activity and a diuretic/natriuretic response. Interestingly, these effects were attenuated by prior administration of (+)-MK-801. These results indicate that NMDAR-positive sensory nerves are present in the renal pelvis and contribute to the renorenal reflex control of body fluid.

Effects of mitral regurgitation on the reflex diuresis to pulmonary lymphatic obstruction in rabbits.

Increasing the extravascular fluid of the airways acutely by obstructing pulmonary lymph drainage causes a reflex diuresis mediated by neuronal nitric oxide synthase in the renal medulla. The authors examined this reflex in rabbits with a chronic increase in extravascular fluid of the airways resulting from surgically induced mitral regurgitation. Intact rabbits served as controls. Renal neuronal (nNOS) and endothelial (eNOS) nitric oxide synthase expressions were also examined. The reflex was absent in rabbits with mitral regurgitation. There were significant increases in medullary and cortical nNOS mRNA compared to controls. The observed changes in mRNA levels correlated with nNOS protein levels. eNOS mRNA was unaffected.

Myelinated nerve fibers in the rat kidney. Light- and electron microscopic studies.

Thinly and richly myelinated nerve fibers in the rat kidney are demonstrated by light and electron microscopy. They run within the peripheral nerves in the periadventitia of the arteria rencularis and arteria arcuata and seem to end in the innermost renal cortex at the boundary to the renal medulla. Sporadically, a single myelinated fiber is found in this region, running near tubuli or in the neighbourhood of a glomerulus. No ganglion cells were seen within the renal parenchyma. The intrarenal medullated nerve fibers are assumed to be afferent. They sometimes showed reactive and degenerative changes in pathologically altered kidneys.

[Effect of reinnervation on the state of transplanted kidneys in dogs]. / Vliianie reinnervatsii na sostoianie transplantirovannoi pochki u sobak.

In the experiments lasted for 2 years, the effect of surgical reinnervation on the morphofunctional state of autotransplanted and denervated kidney was studied in 175 dogs. General morphological, impregnational, special neurohistological investigations and kidney scanning demonstrated that 2 months after surgical reinnervation of the autotransplantated and denervated kidneys, active sprouting of nerve fibers, adrenergic and cholinergic including, was started along the degenerated nerve trunks, and by the 4th month the nerve fibers reached the renal glomeruli, tubules and pelves. A rather complete restoration of the organic innervation resembling that of the intact organ provided stability of the general morphological structure in the reinnervated kidney, its functional ability and prevented atrophy, sclerosis and stable functional depression observed in cases of renal transplantation and denervation without surgical reinnervation. From this point of view, the problem of necessary active surgical reinnervation of the renal transplantation is discussed.

Innervation of the thick ascending limb of Henle.

The overlap of accumulations of autoradiographic grains (AAGs) on profiles of the thick ascending limb of Henle (TALH) was measured in autoradiograms of sections from rat kidneys with monoaminergic nerves labeled by means of tritiated norepinephrine. The amount of AAG overlap was used as an indirect means of quantifying innervation along the TALHs of superficial, mid-cortical, and juxtamedullary nephrons. The density of innervation along the TALH showed nephron heterogeneity; the juxtamedullary nephrons with a high pre- and postjuxtaglomerular apparatus (JGA) TALH density of innervation and the upper and midcortical nephrons with high TALH innervation densities at the level of the JGA. The pre-JGA TALH of the juxtamedullary nephrons had a significantly higher (P less than 0.001) density of innervation than the midcortical or superficial nephrons. The TALHs of juxtamedullary nephrons were found to have substantially more innervation than the TALHs of the other nephrons. For all three populations of nephrons, the pre-JGA TALH had the greatest amount of innervation. Neural regulation of TALH function would occur mainly along the pre-JGA and level of the JGA TALH. This regulation would increase TALH NaCl reabsorption (decrease luminal NaCl concentration) and therefore influence 1) the urinary concentrating mechanism, and 2) renin secretion via the macula densa mechanism. The innervation of the TALH was predominantly associated with the vasculature of the TALH's own nephron. However, innervation associated with medullary ray capillary beds from deeper nephrons was observed on pre-JGA TALHs from superficial and midcortical nephrons.