Hemodynamic basis for glomerular injury in
rats with desoxycorticosterone-salt
hypertension.
L D Dworkin, … , H G Rennke, B M Brenner
J Clin Invest.
1984;
73(5)
:1448-1461.
https://doi.org/10.1172/JCI111349
.
Micropuncture and/or morphologic studies were performed in seven groups of
uninephrectomized (UNX) adult male Munich-Wistar rats. Control groups 1, 3, and 6
received standard (24% protein) chow and tap water. Groups 2, 4, and 5 received weekly
injections of desoxycorticosterone pivilate (DOC) and 1% saline for drinking, groups 2 and 4
were fed standard chow, and Group 5 a diet containing 6% protein. Group 7 received DOC,
salt, and standard chow for 3 wk followed by withdrawal of DOC and salt for an additional 6
wk. 10-14 d after UNX, groups 1 and 2 exhibited similar single nephron glomerular filtration
rates (SNGFR) and initial glomerular plasma flow rates (QA). Group 2 had higher mean
arterial pressure (AP) and glomerular capillary hydraulic pressure (PGC) than group 1. 3-4
wk after UNX, group 4 exhibited further elevations in AP and PGC as compared with groups
2 and 3. SNGFR and QA were similar in groups 3 and 4, but these average values were
greater than typical for normal rats. Group 4 also demonstrated increased urinary protein
excretion. Morphologic evaluation of glomeruli in groups 2 and 4 revealed mesangial
expansion and focal intraglomerular hemorrhage whereas glomeruli of groups 1 and 3 were
essentially normal. Values for AP and PGC in group 5 were not different than group 3 but
significantly lower than group […]
Research Article
Hemodynamic
Basis for
Glomerular Injury in Rats
with
Desoxycorticosterone-Salt Hypertension
Lance D. Dworkin, Thomas H. Hostetter, Helmut G. Rennke, and Barry M. Brenner Laboratory ofKidneyandElectrolyte Physiology and
DepartmentsofMedicine andPathology, Brigham and Women's Hospital and Harvard Medical School, Boston,Massachusetts02115
Abstract. Micropuncture
and/or
morphologic
studies
wereperformed
in
sevengroups of
uninephrec-tomized
(UNX) adult male
Munich-Wistar rats. Control
groups 1, 3, and 6 received standard (24% protein) chow
and tap water. Groups 2, 4, and 5 received weekly
in-jections of desoxycorticosterone pivilate (DOC) and 1%
saline
for drinking, groups 2 and
4
were
fed standard
chow,
and
Group 5 a diet
containing 6% protein. Group
7
received DOC, salt, and standard chow for 3
wk
followed
by withdrawal of
DOC and salt for an additional 6 wk.
10-14 d
after
UNX,
groups 1 and 2 exhibited similar
single
nephron
glomerular
filtration rates (SNGFR) and
initial glomerular plasma
flow
rates (QA). Group 2 had
higher
mean
arterial pressure (AP) and glomerular
cap-illary hydraulic pressure
(PGc)
than group 1. 3-4
wk
after
UNX, group
4
exhibited further
elevations
in AP and
PGcx
as
compared
with
groups
2 and
3.
SNGFR and
QA
were
similar in groups 3 and 4, but these average values
were greater than
typical
for normal rats. Group
4
also
demonstrated increased
urinary protein
excretion.
Mor-Portions ofthesestudieswerepresentedatthe 14th AnnualMeetingof the American SocietyofNephrology,Washington, DC,22 November
1981,andpublishedinabstractformin Am. Soc.Nephrol. 14:102A.
Duringthesestudies,Dr.DworkinwastherecipientofanIndividual
ResearchService AwardoftheNationalInstitutesofHealth(HL-06190).
Dr.Hostetter was therecipientofaClinicalInvestigatorAward from theNationalInstitutes ofHealth
(AM.00767).
Dr. Rennkeis therecipient ofaResearch CareerDevelopmentAward from the National InstitutesofHealth(HL-00646)and U.S.Public Health Service grant HL22602. Address reprintrequeststo Dr. Brenner, Laboratory of
Kidney
andElectrolyte Physiology, BrighamandWomen'sHospital, Boston,MA 02115.
phologic evaluation of glomeruli in groups 2 and 4
re-vealed mesangial expansion and focal
intraglomerular
hemorrhage whereas glomeruli of groups 1 and 3 were
essentially normal. Values for AP and
Poc
in
group 5
were not different than group 3 but significantly lower
than group 4. QA and SNGFR were lower in group 5
(low protein) than in groups 3 and 4. Furthermore,
pro-teinuria and glomerular structural lesions were abolished
in
group 5. Morphologic studies performed in groups 6
and 7
showed that early DOC-SALT lesions progress to
focal glomerular sclerosis. These studies suggest that
con-tinued elevations in glomerular capillary flows and
pres-sures
predispose to glomerular injury in this model of
systemic arterial hypertension.
Introduction
Fiftyyearshave passed since the initial observation that pro-gressive azotemia and glomerular sclerosis follow extensive ablation of renal mass (1, 2). More recent studies have revealed that 1 wk after ablation,remnantkidneysdemonstrateincreased glomerular capillary hydraulic pressures and plasmaflow rates
(3). It has been suggested that these increased pressures and
flows may cause glomerular damage,eventuatinginmesangial sclerosis andproteinuria. Micropuncturestudies inhypertensive, salt-fed Holtzman rats (4) and 2-kidney, one clip Goldblatt hypertension(5) have demonstratedanaugmented pattern of glomerular capillary perfusion similar to that observed after reductionin renal mass.Furthermore,in both salt-fedHoltzman rats(4) and2-kidney,oneclipGoldblatthypertension (6), glo-merular sclerosiseventually develops.These observationssuggest that increased glomerular capillary pressures and flows may play a pathogenicrole inthe glomerular injurywhich occurs
inexperimental hypertension.
Hypertension has also been produced in the ratby
unine-phrectomy and administration ofdesoxycorticosterone and a
high saltintake(7).This model ofhypertensionis characterized
byincreasedplasmavolume,which is most markedduring the
J. Clin. Invest.
© The AmericanSocietyforClinical
Investigation,
Inc.initial6 wk of DOC-SALTtreatment(8).As bothplasma volume expansion (9) and uninephrectomy (10) induce renal vasodi-lation, it seemed likely that glomerular capillary perfusion would besignificantly increasedin rats with DOC-SALThypertension. Therefore, to specifically examine the hypothesisthatglomerular damage results from sustained elevationinglomerular perfusion, wecorrelated thestructural andhemodynamic alterations that
occurinthe glomeruli ofratswith DOC-SALT hypertension.
Glossary
AP mean femoral arterial pressure, mmHg C proteinconcentration,g/100 ml DOC desoxycorticosterone pivilate
GFR glomerularfiltrationrate(wholekidney),ml/min Hct bloodhematocrit in femoral artery, vol/100ml Kf glomerularcapillaryultrafiltration coefficient,
nl/(s.mmHg)
AP glomerulartranscapillary hydraulic pressure difference,
PGC- PT,
mmHg
Ir colloidosmotic pressure, mmHg
Air glomerulartranscapillary oncotic pressure difference,
7rGC-WT, mmHg
P hydraulic pressure, mmHg Q plasmaflowrate
R resistancetobloodflow,dyne-s cm-5
SNFF singlenephron filtration fraction
SNGFR single nephronglomerular filtration rate,nl/min
UNX unilateral nephrectomy
VG
glomerular volumeSubscripts
A afferentarteriole E efferentarteriole GC glomerularcapillary
T proximal tubule
Methods
Sixtyadult male Munich-Wistarratsweighing200-300gwereemployed
in these experiments. Onegroupofnormal ratsand seven groupsof
uninephrectomizedratswerestudied.Assummarized inTableI,group
0rats(n=3)werenormalcontrolsandgroup 1(n=9)ratswerefed
standardchow consisting of24%protein by weight(WayneLab-Blox,
AlliedMills, Inc., Chicago, IL) andwater.Group 2rats(n= 11)were
fedstandard chow,butreceivedweeklysubcutaneous injections of 10
mgof desoxycorticosteronepivilate (CIBA PharmaceuticalCo.,Summit,
NJ)insesameoilandweregiven 1%salinefordrinking.Micropuncture andmorphologic studieswereperformedon groups 1and2rats at 10 to 14dafteruninephrectomy. Group 3 (n= 12) andgroup4 (n= 10)
ratsweretreatedidenticallytogroup 1 andgroup2rats, respectively,
butwerestudiedat3to4wkafter uninephrectomy.Group 5 (n=7)
ratsalsoreceivedDOCand saline, butwerefedadiet containingonly
6%protein by weight thatwasrepletewith electrolytes,traceminerals, andvitamins. Ratsingroup 5werealsostudiedat3-4 wk after
uni-nephrectomy. Ratsingroups6 (n = 3)and 7 (n= 5)werestudied9
wkafteruninephrectomy. Group 6 ratsingested standard chow and waterand served ascontrols. Group 7 ratswere treated with DOC,
TableI. Experimental Protocols
Protein Time of
UNX DOC Salt diet study
Group0
(n=3) - - - 24% 3-4 wk
Group 1
(n=9) + - - 24% 10-14 d
Group2
(n= II) + + + 24% 10-14d
Group 3
(n= 12) + - - 24% 3-4 wk
Group 4
(n= 10) + + + 24% 3-4 wk
Group 5
(n=7) + + + 6% 3-4 wk
Group 6
(n=3) + - - 24% 9wk
Group 7*
(n=
5)
+ + + 24% 9wk* DOC and saline administered onlyduringinitial 3 wk.
saline, and standard chow for 3wk,but thereafter received only standard chow andwater.
Animals in groups 1-5 underwent both micropuncture and
mor-phologic study. Mormor-phologic studies alonewereperformedon ratsin groups 0, 6, and 7. On the day priorto study, rats were placed in metabolic cages and 24-h urine collectionsweremade for determination of protein and electrolyte excretion rates. On the morning of micro-puncture study, rats were anesthetized with Inactin (100 mg/kg body weightintraperitoneal) and prepared in the standard fashion for micro-puncture(11). To compensate for the loss of plasma associated with anesthesia and surgery, allratsreceived intravenous infusions ofavolume ofheparinized isoncotic rat plasma equal to 10 ml/kg body weight over 30 min, followed by sustaining infusions of plasma at -0.5 ml/h, adjusted to maintain hematocrit stableat base-line values. All
ratsalsoreceived a 0.5 ml intravenous bolus of inulin (7 g/100 ml) in normal saline followed by asustaining infusion of inulin ata rateof
1.2 ml/h.
Samples of proximal tubule fluidwereobtained by micropuncture for determination of flowrateandinulinconcentration, the latter by themethod of Vurek and Pegram (12). Efferent arteriolar blood samples were obtained for measurement of total protein concentration (13). Hydraulic pressure measurements were made in cortical tubules and vesselsby using the servo-null micropipette technique(1 1). The details of thecalculations employed have been given previously (1 1). Urinary protein concentration was measured by precipitation with 3% sulfosal-icylic acid. Turbidity was then determined by measuring absorbance at
awavelengthof 595 mytusingaColemanJuniorIIspectrophotometer. Urinaryandplasmasodium and potassium concentrations were deter-mined by standard flame photometry. Urinary phosphate concentration wasdetermined by the Fiske-Subbarow method ( 14). Statistical analysis wasperformed by Student's t test for comparisons between the means oftwogroups(1 vs. 2) or by one-way analysis of variance (groups 3, 4, and5) followed by computation of modified t values and multiple pairwise comparisons according to the method of Bonferroni (15). Statistical
Table II. Summary ofRenalCortical MicrocirculationStudies
Body
wt Hct AP PCC PT PE AP CA CE TA
g vol/100ml mmHg mmHg mmHg mmHg mmHg g/100ml g/IOOml mmHg
Group I
n =9 256±6 44±0.3 112±3 51±1 16±1 19±1 35±1 6.3±0.2 8.9±0.4
22±0.2
Group 2
n= 11 251±7 45±1 132±6 55±1 15±1 19±1 40±2 6.0±0.1 8.8±0.3
20±1
Group 3
n= 12 265±6 45±1 115±3 53±1 15±1 17±1 38±1 6.0±0.1 8.2±0.3 20±1
Group 4
n = 10 262±8 46±1 155±6 59±2 16±1 22±1 44±1 5.9±0.6 8.5±0.3
20±3
Group 5
n=7 201±3 40±1 124±6 50±1 14±1 16±1 37±1 5.2±0.1 7.3±0.2
17±1
P 1 vs. 2 NS NS <0.02 <0.0005 NS NS <0.025 NS NS NS
P3vs. 4 NS NS <0.05 <0.05 NS <0.05 <0.05 NS NS NS
P3 vs. 5 <0.05 <0.05 NS NS NS NS NS <0.05 <0.05 <0.05 P 4vs. 5 <0.05 <0.05 <0.05 <0.05 <0.05 <0.05 <0.05 <0.05 <0.05 <0.05
Mean±SEM
Following micropuncture studies, the kidneys of six animals each from groups 1-5 were fixedbyperfusion for 5 min at the measured
arterialpressurewith 1.25%glutaraldehydein0.1 Mcacodylate buffer
(pH 7.4).Additionalmorphologic data was obtained from three intact
animals (group 0), three uninephrectomyratsfollowed for9 wk (group
6),andfive uninephrectomy animals whichreceived DOC and saline
asdrinkingwaterfor thefirst3 wk and then were allowed to recover onnormaldiet anddrinkingwaterforanadditional 6 wk(group 7). Following perfusion-fixation,oneor two3-4 mmthickcoronalsections through the mid portion ofthekidneywere postfixedin4g/100ml
bufferedformaldehyde solution andprocessedroutinely forlight mi-croscopythroughparaffin embedding. Sections3Mminthicknesswere
stained withhematoxylin/eosinandbytheperiodic-acidSchifftechnique.
Theglomerular tuftvolume (VG)foreach animal was determined
fol-lowingthe proceduredescribedby Weibel (16). Forthis purpose, the meanglomerularrandomcross-sectionalarea
(AG)
wasdeterminedon100systematicallysampledglomerular tuftprofilesbypoint counting
at afinalmagnificationof200Xutilizinga361-pointoculargrid covering
a 369664 um2 microscopic field. The
VG
was then calculated as:VG=-
(AG)3/2,
whereft
= 1.38is theshape
coefficientforspheres (the
idealized shapeofglomeruli)andK =1.1isasizedistributioncoefficient (16, 17).The mean valueforeach group
(VG)
and standarddeviationwerecalculated.Significance of differencesbetween all groupswas de-terminedbyone-wayanalysisofvariance;twelvepredetermined
pairwise
comparisonswereassessedforsignificance bymodifiedtstatistics;and
criticalvalues werecalculatedbythe methods of
Bonferroni, Tukey,
andScheffe (15). Statistical significancewasdefinedasP<0.05. The
frequencyof focal andsegmentalglomerularlesionswasdeterminedfor each group of animalsbyexaminingallglomerular
profiles
contained inone coronal section from each animal. The number ofdamaged
glomeruliand the total number ofexaminedglomeruliin each group
as awhole were recorded and expressed as a frequency per 10,000 glomeruli; anaverage of 223 glomeruli/animal (range, 164 to 274) were
examined.Otherglomerularchanges, such as expansion of the mesangial areas andabnormalities of arteries and arterioles, were assessed
non-quantitativelybylightmicroscopy. Small, randomly selected fragments of cortex were also processed for electron microscopy by osmium
post-fixationandepoxy-resin embedding. Ultrathin sections of selected glo-merulifromeach groupstained withleadcitrateand uranyl acetate on thegridwerethenexamined for ultrastructuralabnormalitiesin a Philips 201 electronmicroscopeat60kV.Two tothreeglomeruli fromat least threeanimals in each group (groups 1-5) wereexamined by electron
microscopy. Nonquantitative evaluation ofthe light microscopic ap-pearance ofcortical sections takenfromrats ingroups 0-7 wereperformed
in a blinded fashion by a single observer. Quantitative morphologic measurements wereperformed by the sameinvestigatorin a standard
fashionasdescribed above but were notblinded.
Results
Micropuncture studies. Meanvaluesforbody weight; Hct; plasma sodium and
potassium concentration;
whole kidney GFR; AP;SNGFR; and thepressures,flows,
and resistancesgoverning
glomerular ultrafiltration for animals in groups 1-5 are
sum-marized in Table II. After uninephrectomy and 10-14 d of
DOC-SALT treatment, mean arterial pressure
(AP)
averaged 132±6 (SE) mmHg in group 2 rats, significantly greater (P<0.02)than themeanvalue of112±3mmHgmeasured in group 1 rats.Meanglomerular capillary hydraulicpressure(PGC) and themeanglomerular transcapillary hydraulicpressurePIsma
TE SNFF SNGFR GFR QA RA X 10'0 REX 1010 RT X10'0 [Na] [K]
mmHg nil/min mi/min nil/min dyne-s* cm-5 dyne s *cm'5 dvne-s*cm'5 meqiliter meqiliter
38±3 0.29±0.02 57.8±4.5 1.70±0.08 208±31 1.52±0.22 0.97±0.15 2.49±0.36 143±1 4.1±0.2
37±2 0.32±0.02 62.1±3.0 1.60±0.08 206±19 1.86±0.24 1.04±0.11 2.90±0.34 148±2 3.6±0.3
33±2 0.27±0.02 65.3±2.7 1.54±0.13 236±16 1.21±0.19 0.81±0.05 2.02±0.20 142±2 4.3±0.1
35±2 0.30±0.04 68.0±4.6 1.55±0.17 220±18 1.97±0.17 0.92±0.07 2.86±0.21 143±3 3.4±0.3
27±1 0.29±0.02 39.8±3.8 1.04±0.08 142±26 3.03±0.60 1.68±0.29 4.72±0.89 143±1 3.6±0.2
NS NS NS NS NS NS NS NS NS NS
NS NS NS NS NS NS NS NS NS <0.05
<0.05 NS <0.05 <0.05 <0.05 <0.05 <0.05 <0.05 NS =0.05
<0.05 NS <0.05 <0.05 <0.05 <0.05 <0.05 <0.05 NS NS
and 40±2 mmHg, respectively; both values weresignificantly greaterthan the corresponding averagevalues of 51±+1and 35±1
mmHgmeasured in group 1 rats. A selective increase in AP would bepredicted to increase SNGFR; however, values for wholekidney GFR and SNGFR were similarin groups I and 2, averaging 1.70±0.08 ml/min and 57.8±4.5
nl/min,
respec-tively,
forgroup 1 and 1.60±0.08ml/min
and62.1±3.0 nl/min forgroup 2.Average valuesfor initial glomerular plasmaflow rate(QA) andsystemic plasmaproteinconcentration(CA)were also not significantly different between groups 1 and 2. The only remaining explanation forthe similarity ofSNGFR in groups 1 and2,despite the increase inAPobserved ingroup 2,isthattheglomerularcapillaryultrafiltrationcoefficient (Kf) musthave been lowerin group 2 rats. Filtration pressure equi-librium (where rE= AP)obtained infive ofeight rats in group 1. The mean of the minimum Kf values calculated for animalsat
equilibrium
taken together with the unique Kf values cal-culated for animals atdisequilibrium
was 0.122±0.021 nl/(s.
mmHg)in this group. In group 2, all rats except one wereat filtration pressure disequilibrium. The unique values of Kf averaged 0.082±0.011
nl/(s.
mmHg) among these rats.' As shown in Table II, average values for afferent (RA), efferent (RE), and total (RT) arteriolar resistances were not statistically different in group 1 and 2 rats.1. With the inclusion oftheminimum value ofKfcalculated for the
one rat in group 2 at filtration pressure equilibrium, Kf averages
0.087±0.008
nl/(s.
mmHg)in thisgroup.Rats studied 3-4 wk after uninephrectomy and adminis-tration of DOC and salt (group 4) demonstrated even greater hemodynamic alterations as compared with UNX controls. AP averaged 155±6 mmHg in group 4 rats, a valuemarkedly greater(P<0.05) than that observed in control group 3 animals (Table II). As was the case in group 2 rats, this increase in systemic blood pressure was transmitted to the glomerular cir-culation,asaverage values forPGC and AP were also increased in group 4 rats, to 59±2 and 44±1 mmHg, respectively, vs. a
mean value forPGC of 53±1 mmHg andAP of 38±1 mmHg in group 3 rats. As shown in Table II, average values forGFR, SNGFR, QA, CA, and PTweresimilar in thesetwogroups.Once again, SNGFR failed to rise with the increase in AP seen in
group4rats because Kf tended tobe lower in these animals. All buttworatsingroup 3were atfiltrationpressure disequi-librium. The average of the minimum and unique Kf values calculated for all rats in group 3 was .0.119±0.014 nl/(s * mmHg). Group 4 containedtwo rats atfiltrationpressure
equilibrium for which only minimum values forKfcould be calculated. However, amongthe seven group 4 ratsfor which unique values for Kfwerecalculated,Kfaveraged0.071±0.014 nl/(s. mmHg),avaluesignificantlylessthan that seen ingroup
3 rats.2 Although numerically greater in group 4 rats, the average
2. When the minimum Kfvalues calculated for the two rats in group 4in which filtration pressure equilibrium obtained are included in the
determination of the mean, Kf averages 0.078±0.011 nl/(s -mmHg),
stillsignificantlyless (P < 0.05) than the corresponding valueobserved
values of the afferent, efferent, and total arteriolar resistances were not significantly different in group 3 and 4 rats.
Despiteidentical treatmentwithDOCand salt, group 5 rats maintained on a low protein diet exhibited strikingly different glomerular hemodynamic patterns from those fed standard chow (group 4). The mean values for GFR (1.04±0.08 ml/min) and SNGFR (39.8±3.8 nl/min) observed in group 5 rats were sig-nificantly lower (P < 0.05) than those found in both groups 3 and 4.This lower SNGFR resulted, in part, from lower average valuesof AP (124±6 mmHg), and therefore,
PGC
(50±1 mmHg) and AP(37±1 mmHg) in group 5 rats compared with those observed in group 4. In fact, these values for AP,PGC,
and AP in group 5 were not significantly different from corresponding values measured in UNX rats not receiving DOC and salt (group 3). Inaddition, the average valuesofQA (142±26 nl/min) and CA(5.2±0.1 g/100 ml) were significantly lower in group 5 rats than in groups 3 and 4. All animals in group 5 were at filtration pressure disequilibrium and, on average, Kf was reduced in these rats to 0.051±0.011nl/(s.
mmHg), a value significantly lower (P < 0.05) than in group 3. Thus, low protein feeding markedly altered the hemodynamic pattern in DOC-SALT rats, causing reductions in the mean values of AP,PGc,
AP,GFR,SNGFR,
QA,and
Kf.Asshown inTable III, ratsdrinking water (group 3) excreted
anaverageof 0.95±0.19 meqof sodium/24h.DOC-SALT rats drinking 1% saline (groups 4 and 5) excreted 7.35±1.78 and 8.28±0.75 meq of sodium/24 h, respectively; these values are significantly greater(P<0.05) than that observed in group 3. Potassium excretion rates were similar in all three groups of ratsmeasured3 wkafter uninephrectomy, averaging2.34±1.36 in group 3, 1.76±0.78 in group 4, and2.20±0.50 meq/24 hin group 5. Mean phosphate excretion rates werealso similar in group3 (0.46±0.12mM/24 h) and group4(0.56±0.15); how-ever,rats onthe lowprotein diet(group5)excretednearly twice
asmuchphosphate(0.93±0.13)as ratsin groups 3 and 4. Phos-phate contentwassimilar in the standard(0.99%)and lowprotein diets(0.70%), andratsappearedtoingest
approximately
equal amountsofthetwofeeds.Itispossiblethatincreased phosphate excretion in group 5 resulted from increasedgastrointestinal
Table III. UrinarySodium, Potassium, andPhosphateExcretion
UN.V UKV ubv
meq/24 h meq/24h mM/24 h
Group3
n= 10 0.95±0.19 2.34±1.36 0.46±0.12
Group4
n=7 7.35±1.78* 1.76±0.78 0.56±0.15
Group5
n=8 8.28±0.75* 2.20±0.50 0.93±0.13*
Values aregivenasmean±SEM.
*P<0.05 vs.group 3.
60-50
-UPROTV t
(mg/24h)
30-20
-10
GROUP GROUP GROUP GROUP GROUP
1 2 3 4 5
(n=8) (n=11) (n=8) (n=9) (n=8)
Figure1. 24-h urinary protein excretion ratesmeasuredontheday priortosacrifice in rats in groups 1-5. Bars representmeans±SEM.
Groupsaredefined in Table I. *, P< 0.05 vs. group 3; **, P <0.05
vs.group4.
absorption of phosphate; this isaconsequenceofthe fact that, in the low protein diet, most phosphate was supplied as inorganic sodium and potassium salts. Alternatively, urinary phosphate excretionmay have been increased in group 5 in the absence
ofdifferencesinphosphate absorption. If so, then serum phos-phate levels might have been lower in group 5 rats. As serum phosphate levels were not determined in these studies, we are unable to distinguish between these two hypotheses. Neverthe-less, it is apparent that the different hemodynamic and mor-phologic (see below) patterns observed in DOC-SALT rats fed
a6% (group 5)vs. a 24% (group 4) protein diet didnot result from reductions in the amounts of sodium, potassium, or phos-phateingestedby lowprotein rats.
10-14 d afteruninephrectomy, DOC-SALT ratsin group
2excreted, on average, 23.2±5.2 mgofproteinin 24h,a value
numerically but not significantly greaterthanthatmeasuredin group 1 rats(14.4±1.5). However, asshown in Fig. 1, by 3-4 wkafteruninephrectomy, DOC-SALT rats(group 4) had
sub-stantial proteinuria, excreting an average of 48.1±12.7 vs. 8.0±1.8 mgofprotein/24 h excretedby normo-tensivegroup
3 rats (P < 0.05). This increase in urinary protein in DOC-SALT rats wasessentially reversed bylow proteinfeeding, as rats ingroup 5 excreted onaverage only 15.2±7.5 mg/24 h;a
valuesignificantly less(P< 0.05)than that excretedbygroup
4 animals,butnotdifferent that that observed inratsin group 3.Interestingly,ratsallowedtorecoverfrom DOC-SALT treat-mentfor 6wk(group7)still had
proteinuria, excreting
23.0±4.7 mg ofprotein/24hvs.11.9±2.0 inuninephrectomizedcontrols.Morphologic studies. All nephrectomized animals showed an increase in mean glomerular capillary tuft volume (Table
TableIV. Quantitative Morphological Data
Segmental Segmental lesions/ 10,000 Group n V 1*X 10-6 lesionst glomeruli
Mm3
0 3 0.690±0.024 0/670 0
1 6 0.730±0.121 0/1,381 0
2 6 1.025±0.112 12/1,484 81
3 6 1.018±0.046 1/1,258 7.9
4 6 1.625±0.139 54/1,303 414
5 6 0.783±0.123 1/1,299 7.7
6 3 1.204±0.194 1/644 15.5
7 5 1.414±0.251 35/1,090 321.1
*Mean±SD.
fNumeratorequalsdamagedglomeruli; denominator equalstotal
no.of glomeruli examined.
(0.690 X 10-6 gm3, group 0); the difference attained statistical
significance (Table V) in all but groups 1 and 5. Therate of compensatory volumechange in nephrectomized animals ap-pearsminimal duringthe first 10-14 d(from 0.690 X 10-6to
0.730X 10-6Mm3), is maximalbetweendays 10 and21 (from 0.730 X 10-6 to 1.018 X 10-6 Mm3), and levels offby 9 wk
(1.204 X 10-6 Mm3),which is the last observation made in this series ofexperiments.As aresultofDOC-SALTadministration,
there was a significant increase in glomerular volume in
ne-phrectomizedanimals bothat 10-14d (1.025 X 10-6 ingroup
2 vs. 0.730 X 10-6 tim3 in group 1) as well as 3-4 wk (1.625
X 10-6 in group 4 vs. 1.018 X 10-6
Im3
ingroup3).Lowprotein diet in group 5 animals receiving DOC-SALTwaseffective inreducing the glomerular volume to 0.783 X 10-6
1Am3,
which is a value significantly lower when compared with that observed in animals given DOC-SALT only for 3 wk (group 4, 1.625X 10-6 MAm3)and intermediate between the figures calculated fornephrectomy animalsat3 wk (group 3, 1.018 X 10-6Mm3) and the intact animals (group 0, 0.690 X 10-6 MUm3), but not
significantly different from either. The effect of DOC-SALT
treatment for 3 wk on mean glomerular volume is partially reversed when animals are allowed to recover for anadditional 6wkonstandarddiet(group 7) resultingin a meanglomerular volume of 1.414 X 10-6 Am3, avalue numerically higherbut notstatistically different fromthat calculatedforanimals at9 wkpostnephrectomy (group 6, 1.204 X 10-6 um3).
Nephrectomized animals (group 1) showed virtually no
morphologic changesat days 10-14 (Fig. 2 a)with onlyvery occasional areasof segmental glomerularsclerosis (1 of 1,258 glomeruliin group 3 and 1 of644 glomeruli in group6)and minimal increase in mesangial areas at 3-4 wk(Fig. 2 c)and 9 wk postsurgery (Fig. 2 g). Thefrequency of segmental lesions increasedmarkedly whenDOC-SALTwasadministered(Table IV). Animalsingroups 2 and4developed
partially
thrombosed segmental microaneurysms of the glomerular tuft, segmental sclerosis, focal microthrombiinglomerular capillaries, andex-pansion ofthemesangium (Figs. 2
b, d,
ande). Thefrequency
Table V.Analysis ofVariance DataforMeanGlomerular Volume
Source ofvariation Degrees of freedom Sumof squares Mean squares Fratio
Between groups 7 4.14x 1012 5.92 x 10" (TSS) 30.19
Within groups 33 6.47x 10" 1.96 x 10'0(ESS) (FO.01(7,33) =3.23)
Resultsof Relevant PairwiseCompansons
Bonferronim= 12 Tukeycritical Scheffecriticalvalue Compared groups Modifiedtvalue criticalt* = 3.12 value = 3.24 = 4.02
0-1 0.41 NS NS NS
0-2 3.38 * * NS
0-3 3.31 * * NS
0-4 9.45 * * *
0-5 0.94 NS NS NS
0-6 4.49 * * *
0-7 7.08 * * *
1-2 3.65 * * NS
3-4 7.51 * * *
4-5 -10.42 * * *
3-7 -2.91 NS NS NS
,-}f,/
bts~~~~~~~l
$ ,,,%mi
Or
ofsegmental lesions(microaneurysmsandsegmental sclerosis) increased in DOC-SALT animals from 0.8% of glomeruli at
day 10to 14to>4%at the endof3-4 wk of mineralocorticoid and salt treatment(Table IV). When animalsweremaintained ona6%protein diet(group5), the effects of DOC-SALT
treat-ment on glomerular morphology were completely prevented (Fig. 2
f
Tables IVand V).Animals allowed to recover on astandard chow for 6 wk following a 3-wk treatment with DOC-SALT (group 7) only showed areasofsegmental glomerular sclerosis (Fig. 2h)with a frequency (3.2% of glomeruli) similar to that observed for microaneurysms at the end ofthe active treatment phase in group 4(4.1%). Nephrectomized animalsnottreated with DOC-SALT and followed for 9 wk (group 6) showed a 20-fold
re-duction intherateof segmentalglomerularlesions(TableIV). Smallarteriesandarteriolesin
hypertensive
animalsreceiving DOC-SALTfor3-4 wkrevealed occasional segmentalthickening of the vessel wall, perivascular edema, and infiltration ofthe vessel wall by amorphous,eosinophilic material ("fibrinoid ne-crosis"). The above described fibrinoid necrosis was only very rarely observed inarteries and arterioles in the vicinity of glo-meruli with microaneurysmal lesions. Therefore, a direct as-sociationof both glomerularand vascularlesionswas notevident from our observations.Attheultrastructural level,animalsin group4showed ad-ditional alterations ofthe glomerular capillary wall (Fig. 3). Epithelial cells showed focal obliteration of footprocesses, at-tenuations ofthecytoplasmwithblebformation,andincreases in the number ofcytoplasmic vacuoles and lysosomes (Fig. 3 b). The endothelial cell layer showed thickened expanses of cytoplasm devoid ofthe characteristic fenestrae and focal de-tachment fromthe underlyingbasementmembrane (Fig. 3b). Occasional capillaries contained platelets, fibrin, and inflam-matory cells (Fig. 3 b). Glomeruli from animals in group 2 showedsimilarchanges, although lower infrequency. In contrast, ultrastructuralanalysis of kidneys fromgroups 1,3, and4failed
todisclosechanges asdescribed above.
Discussion
Deenetal.(10) assessed glomerular dynamics in rats 3 wk after unilateral nephrectomy. The renal corticalmicropuncture data obtained in that study isnotexactly comparable with our data in thatDeen et al. (10) studied rats under conditions of hydro-penia and plasma volume expansion whereas our experiments wereperformed under euvolemic conditions. Nevertheless, the glomerular hemodynamic patterns observed in UNX rats were similarly altered in both studies. Accordingly, although the uninephrectomized rats in groups 1 and 3 servedascontrols in ourstudy, the mean values for SNGFR andQAobservedwere
increasedby more than 50% when compared with values pre-viously reported in normal, euvolemic Munich-Wistar rats from thislaboratory (18).
Administration of DOC and a high salt intake produces systemic arterial hypertension inuninephrectomized rats and leads toadditional alterationsin the determinants ofglomerular ultrafiltration. After only 10 d of DOC-SALT treatment, mean systemic arterial and glomerular capillary hydraulic pressure
aresignificantly increased. By 3wk,these pressures have risen furtherandsignificant morphologic evidence ofglomerular in-jury isalready apparent.Muller-Suuret al.(19)measured whole kidney GFR in DOC-SALT rats 4 wk after uninephrectomy and foundit to be increased toa value comparable with that reported here. Thesameauthors alsoestimatedmeanglomerular capillary hydraulic pressureusingstop-flow techniques and, in contrast tothe presentstudy, found ittobe normal. However, thevalidity ofthe stop-flow methodofestimating
Pcc
hasre-cently been questioned (20, 21). Therefore, technical artifacts may account forthe differencesbetween that studyand ours, where
PGC
was found to be clearly elevated when measured directly.In the present study, SNGFR andGFR were comparable in uninephrectomized control and DOC-SALT hypertensive
rats despite the fact that AP was significantly greater in the hypertensive animals; hence, Kf tended to be lower in the
DOC-Figure 2.Light micrographs of renal cortex.Representative light mi-crographs of renalcortexfrom different experimental animals after
perfusionfixation. I umthickepoxy-resin sectionswerestainedwith 1%toluidine blue (260 X). (a) Group 1: 10 d postnephrectomy on
regulardiet.The glomerulus shows adelicatemesangial matrix with
few cellular elements.(b) Group 2: 10d postnephrectomy on
DOC-SALT regimen.The glomerulusis noticeably enlarged showing
segmentalareasof mesangial expansion and hypercellularity (arrow).
(c)Group3:3-4wk postnephrectomy. The glomerulus is moderately
enlarged,segmentallesionsare notevident. (d) Group 4: 3-4 wk
postnephrectomyonDOC-SALTregimen. The glomerular tuft is
markedlyenlarged. Notice prominentmesangial elements and
occa-sionaldense reabsorption droplets invisceral epithelial cells (center,
lowerhalf ofthe capillary tuft). (e) This micrograph illustrates a
typi-calsegmentallesionobserved in animals from group 4, 3-4 wk
post-nephrectomy onDOC-SALTtreatment. The lower part of the
capil-larytuft is occupiedby amassively dilatedcapillaryloop
(microaneu-rysm) showing partial occlusion by fibrin, platelets, and other cellular elements(arrows). Notice alsoanincrease inreabsorption droplets in glomerular epithelialcells anderythrocytefragments in the lumen of
adistalconvoluted tubule (lowerrightcorner). (f) Group5: 3-4wk
postnephrectomyon DOC-SALT and lowprotein diet. The volume of glomeruli from animals in thisgroupis statistically less than that
measuredingroup3(Fig.c), but notdifferent fromthatobtained in
the2-kidneycontrols (group 0, notillustrated).Noticealso the lack
of segmental lesionsand narrowmesangial areas.(g) Group6:9wk
postnephrectomy.The glomerulusillustratedshows anincreased
di-ameterand prominent mesangium. (h)Group 7: 9 wk
postnephrec-tomyandafteran initial 3 wk on DOC-SALTregimen. The enlarged
glomerulartuftshows an area of segmental sclerosis withadhesion of
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Figure3. Electronmicrographsof glomerularcapillariesfollowing perfusionfixation (EP, visceralepithelialcells;End, endothelium;
Mes,mesangium; US, urinaryspace;CL,capillarylumen;F, fibrin;
P. platelet). (a) Group 3. Thecapillaryluminaarepatent; the endo-thelial cells show regularly spacedfenestrae;and theepithelialcell
re-veals normal foot process architecture(4,000 X).(b) Group4.The
capillariesarepartly occluded byfibrin (F)andplatelets(F).The
en-dothelium shows extensive areas devoidofnormalfenestrae(single
SALT rats. The mechanism of this reduction inKfisuncertain, butseveralpossibilities should be considered. Theultrafiltration coefficient, Kf, is equal to the product of the hydraulic con-ductivityof the glomerular capillary wall (k), and the total cap-illarysurfaceareaavailable for filtration (S). Therefore, reduc-tionsin the value ofKfcan bebroughtabout bydeclines in k
orS. Inthe present study, alterations inkmight have resulted fromthe glomerular capillary wall damage which was evident in groups 2 and 4. However, although focal abnormalities of the glomerular capillary wall were noted in hypertensive rats by electron microscopy, mostof the availablefiltration surface appeared normal. Furthermore, neither permselective nor ul-trastructural alterations of the glomerular capillary wall have beendetected by us in several other experimental settings as-sociated with reductions in Kf (22, 23). Therefore, selective alterations in k may not fully account for the low
Kf
seen in DOC-SALT rats.Alternatively, Kf might have been reduced because declines occurred in the value of S. Segmental glomerular lesions and
arrows) and the epithelium shows focal obliteration of foot processes (double arrows), attenuation of cytoplasm and increase inlyzosomes
(reabsorption droplets) (3,600 X). (c) Group 5. Most of thechanges
observed in group 4 animals could be prevented by low protein feed-ing, as illustrated by this segment of the glomerular tuft taken froma
nephrectomized animal on low protein diet treated for 3 wk with DOC-SALT(3,450X).
focal microthrombosis as notedabove may have contributed
to areduction of the value of S ingroup4 animals.Recently, considerable evidence hasbeen amassed to suggest that avariety of vasoactiveagents may induce reductions in S by virtue of their actionstopromotemesangial cell contraction (24). Mes-angial cells in culture exhibit contractileresponses toangiotensin II,antidiuretichormone,and norepinephrineatconcentrations well within the physiologicrange(25). Furthermore, both cir-culatingantidiuretichormone (26)andcatecholamine (27) levels
areelevated in rats with DOC-SALT hypertension. Therefore, it is attractive to speculate that the low Kf observed in
DOC-SALT ratsmighthave resulted from hormonally induced,
mes-angial cell contraction tending to reduce glomerular capillary surfacearea in vivo.
Associatedwithincreased glomerular capillary pressures and flows, glomeruliinDOC-SALT hypertensive rats revealed
mor-phologic evidence of injury by 10 d after uninephrectomy. By
3 wk, adiffuse increase in mesangial matrix and cells as well
as focal areas ofintraglomerular thrombosis and hemorrhage
us A
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were noted. Electron microscopic examination revealed that in individualglomerularcapillary loops, endothelial cells had be-come focally detached from the basement membrane. These morphologic alterationsaresimilar to those described previously (28, 29,30)in kidneys of rats with thisform ofsteroid-induced hypertension.
To test thepossibilitythatfocalintraglomerular hemorrhage might result in permanent structural damage, we performed morphologic studies on another group ofuninephrectomized ratsinwhich DOC and saltadministration werediscontinued after3 wk (group 7).Interestingly, proteinuria persisted inthese animals despite cessation of DOC-SALTtreatment. Atthe time of sacrifice, light microscopic examination ofthe kidneys of these rats demonstrated asimilar frequency ofsegmentallesions as was seen at the end ofthe 3-4 wkDOC-SALT treatment. However, the lesions had evolved from thrombosed micro-aneurysms, as seeningroup 4animals,to"healed" segmental sclerosis with hyalinosis.
Hostetter andco-workers (3) have recently suggested that, after reduction in renal mass, alterations in glomerular he-modynamicslead to eventual glomerularinjury.Thepossibility that asimilar mechanism mightberesponsiblefor renalinjury which results fromsustained elevations in systemic arterial pres-surehas also been proposed (4,29).Inthe presentstudy, struc-turalalterations and substantial
proteinuria,
bothindicativeof widespread glomerular injury, were associated with increased glomerularcapillarypressures andflows in DOC-SALT hyper-tensive rats. To testwhetherthese changes in glomerular dy-namics per se might have beenresponsible
for the observed glomerularinjury, agroup ofuninephrectomized
DOC-SALT rats werefedalowprotein diet. Thismaneuverhas been shown tomarkedlyinfluence
intrarenalhemodynamics,
andtoblunt theincrease in SNGFR which develops aftersurgical
reduction in renal mass (3) or as a consequence of normalmatur-ation (31).
Aspredicted,
protein
restriction markedly affectedboth sys-temic andintrarenalhemodynamics. Interestingly, protein
re-stricted DOC-SALTratsexhibited
significantly
lowervalues for AP thanratsfedstandard chow.Morelandetal.(32)
have also foundblood pressure to belowered in DOC-SALT rats feda5%protein diet for4wk. The mechanism of the reduction in
systemic
arterial pressureinducedby
protein
restriction isun-certain. However, Moreland etal.
(32)
observed that vascularstrips
takenfromprotein
restrictedDOC-SALT
animals wereless sensitive tonorepinephrine than those taken from DOC-SALT ratsfed standard chow
(22.5%
protein).
This decreased reactivity wasassociated with decreased membrane stores of calcium so that less calcium was available for activationby
norepinephrine
in theserats.Atthe levelofthe renal
circulation,
wholekidney
andsingle
nephron GFR were lower in group 5 rats as
compared
with groups 3 and 4. Theselower filtrationrates were, in turn, the result ofreductionsinbothQA
and AP.Furthermore,the increase inVG,
segmentallesions,
andproteinuria
seen in DOC-SALTratsfed a standard diet was essentially abolished in rats ingesting thelow protein diet. Therefore, in our study, a maneuver which blunted the hemodynamic consequences of
DOC-SALT
hy-pertension also prevented structural glomerular injury. In ad-dition, glomerular hemodynamic alterations were present in DOC-SALT rats 10 d after uninephrectomy, prior to the ap-pearanceof marked proteinuria and widespread structural ab-normalities. These findings are consistent with the hypothesis thatsustained hemodynamic changes observed in hypertensive rats werethemselves responsible for the glomerular injury.It should be noted that, during the course of micropuncture study, blood pressure tended to decline in hypertensive rats. This fall occurred despite constant plasma infusion designed to maintainastable intravascular volume. Therefore, it is possible that the glomerular capillary pressures and flows we observed in anesthetized, hypertensive rats were not truly representative of those which prevailed in the awake state. It seems likely, however, that, as blood pressure fell only in the hypertensive groups, the values of AP and QA we observed in DOC-SALT animalsprobably represent lower limits for the true values ex-istingin theserats before micropuncture. Accordingly, it seems valid to makecorrelations between the patterns of glomerular perfusion we observed in anesthetized rats and the histologic alterations that developed in these same animals over a 2-3-wk period.
Otherstudies have also demonstrated an effect ofvarying dietary protein content on the progression of renal disease. For example, Blatherwick et al. (33) and later Lalich et al. (34) observed accelerated glomerular sclerosis when uninephrec-tomized ratswerefedahigh protein diet. Inotherstudies(35, 36), gradedreductions indietary proteincontent led to stepwise increasesin thelifespan ofratsundergoingextensive renal abla-tion. More recently, in studies ofrats after 90% ablation of renal mass,maintenance ofglomerularhemodynamics at nearly normal levels by protein restriction wasassociated with pres-ervationof glomerular architecture and absenceof proteinuria (3).Insubsequentexperiments, Meyer et al.(37) comparedthe effects of a 6% vs. a 40% protein diet on the incidence of glo-merular sclerosis and proteinuria in rats aftera 50% or 67% reduction in renal mass. 8 mo after surgical ablation, graded lossof renalmassledtoincreasesinproteinuriaandglomerular sclerosis. However,lowprotein feedingwasassociated with lower inulin clearance, reduced protein
excretion,
and less sclerosis after either 50or67%ablation. Thesefindings
arealso consistent with thehypothesis that the reduced GFRwhichaccompanies protein restriction may limit progressive glomerular damage followingloss ofrenalmass.(41).While careful hemodynamic measurements were not per-formed in thatstudy, it is attractiveto speculatethat the pro-tective effectof lowprotein feedingresulted from the prevention ofhyperperfusion insurviving nephronsin these patients.
Nevertheless,it ispossiblethat the lowproteindiet protected DOC-SALTratsfrom glomerular damage bysomeeffect other thanonerelatingtoglomerularhemodynamics.It isclear, how-ever,that thiseffectwas notthe result of differences in sodium orpotassium excretion or balance, as rats in groups 4 and 5 excreted similar amounts of these electrolytes in 24 h. Alter-natively, it mightbe suggested thatchangesindietaryphosphate accountedfor the different morphologyof groups 4 and 5. Alfrey andco-workers(42,43) have reported thatphosphorusrestriction protects ratswith renalinjury fromdeveloping
progressive
renal insufficiency.However,dietary phosphoruscontent wassimilar in the standard and lowprotein diets employed inthis study. Furthermore,ascan beseenfrom TableIII,rats onlow protein diet(group5)actuallyexcretedalmost twiceasmuchphosphate in24 h asdidrats onstandard chow.Therefore,itseemsunlikely that changes in dietary phosphate account for the difference between groups4and 5.Studies inseveral otherexperimentalmodels of hypertension are consistent with the notion that hemodynamic alterations predispose toglomerular injury in this setting. Azaret al. (4) performed micropunctureandmorphologic studiesin one-kid-ney"postsalt" hypertensive rats of the Holtzman strain. At 5 mo, obvious nephrosclerosis was present in thekidneys of all hypertensiverats.Furthermore, thesemorphologic abnormalities were associated with marked increases in the mean values of SNGFR, QA, and APin these animals.
Similarly,
Feld et al. (44, 45) suggested that the relative failure of juxtamedullary nephrons to autoregulateisresponsible for the glomerular injury that selectively affects this population ofnephrons in the spon-taneously hypertensiverat.Finally,ithas long been known that whenhypertension is produced by constricting one renal artery in the rat, glomerular lesions are produced in the opposite kidney butnotin theipsilateralclipped kidney (6, 29). Recent micro-puncture studies (5) indicate that, in rats with this form of experimentalhypertension,theunclipped kidney has augmented glomerular capillary pressures and flows and single nephron filtration rates, while, in contrast, these same parameters are reduced in theclipped"protected"kidney. Thus, the glomerular hemodynamicpattern observed inthe unclipped kidneys of rats with 2-kidney Goldblatt hypertension closely resembles that observed in DOC-SALT hypertensive rats. Taken together, these studies provide further evidence that altered dynamics per se contributetoglomerular injury in experimental hypertension.Itmight be argued that the increase in AP of 6 mmHg in group 4 vs.group 3 rats is ofsmall magnitude and, therefore,
unlikely
toaccountfor a dramatic difference in glomerular mor-phology. However, it should be noted that this increase in mean glomerular transcapillary hydraulic pressure difference is su-perimposed on glomerular capillary plasma flows which are alreadysubstantially elevated as a result of the uninephrectomy.QA averaged 236
nl/min
in euvolemic uninephrectomized rats in group 3, a value -50% greater than that which has been observed in normal 2-kidney Munich-Wistar rats in this lab-oratory(18). Of note, the glomeruli ofratsin this group dem-onstrated a diffuse increase in glomerular mesangium thatwaseasily distinguishable from normal. Eventually, these unine-phrectomized rats go on to develop obvious glomerular sclerosis intheremainingkidneys (37). The findings in the presentstudy suggest that when glomerular capillary hypertension is super-imposed onavasodilatedkidney, the progression toglomerular sclerosis ingreatly accelerated.
Consistent with thishypothesis, Raijet al.(46)have recently suggested the combination of systemic hypertension and pre-glomerular afferent arteriolar vasodilation may exacerbate fer-ritin-antiferritin immune complex glomerulonephritis. They studiedhypertensive rats of the spontaneously hypertensive rat and Dahl strains because it has been demonstrated that relative afferent arteriolar vasoconstriction protects the superficial glo-meruli ofspontaneously hypertensive rats but not Dahl rats from increases in perfusion pressure (47). As predicted, Dahl
rats developed more severe mesangial sclerosis than sponta-neouslyhypertensive rats in responsetointraperitoneal injections of ferritin.Thus, the presence of arterial hypertension amplified immune-mediated glomerular injury only in the presence of relative renal vasodilation. Similarly, Tikkanen et al. (48)
ex-amined the effects ofDOC-SALT treatment on the course of autologous immune complex nephritis (Heymann nephritis) in
rats.DOC-SALT nephritic rats developed hypertension and a
significant increase in GFR although these parameters were
un-affected by the induction ofnephritis alone. Associated with these hemodynamic alterations, DOC-SALT nephritic rats demonstratedincreasedproteinuriaandmore severerenal his-tologic lesionsthan nephriticrats notreceivingDOC and salt. It is attractive to speculate that, as in the study of Raij et al. (46), augmented glomerular capillary hydraulic pressures and plasma flow rates enhanced theimmune-mediatedglomerular
injury.
The mechanism whereby augmented glomerular capillary pressureandflowalterglomerular structure is not known. One possibility is that the increased glomerular transcapillary hy-draulic pressuredifference, AP, mayinjurethecapillarynetwork by some mechanism analogous to the effects of hypertension
ofmacromolecules through the wall, thereby contributing to the ultimate injury of hypertensive glomeruli (51, 52).
Clinically, chronic renal insufficiency often leads to end-stage renalfailureat apredictablerate(54, 55). It has also been observedthat uncontrolled systemic arterial hypertension com-plicating chronic renal insufficiency may hasten this progression to uremia (56). Furthermore, therapy with antihypertensive agents hasbeen reported to stabilize renal function at existing levels insome hypertensive patients with mild to moderate renal dysfunction(57). The finding in the present study that glomerular capillary hypertension accelerates glomerular injury after re-duction in renal mass provides an attractive explanation for these clinicalobservations, andprovides a rationale for the ag-gressive control ofblood pressure in the hypertensive patient with renaldisease.
In summary, rats made hypertensive by uninephrectomy and3 wkoftreatmentwith DOCandhigh saltintakeexhibit strikingstructuralabnormalities of their glomeruliand increased urinary protein excretion, bothin association withaugmented glomerular capillary plasma flow rates and transcapillary hy-draulic pressure gradients. A low protein diet prevents these increments in glomerular capillary pressures and flows, and protectsDOC-SALT rats from developing proteinuria and mor-phologicevidence ofglomerular injury. Thisprotective effect oflowproteinfeeding isnotexplained by differencesinsodium, potassium, orphosphate excretion orbalance. These findings, therefore,suggest thatglomerularcapillary hypertension inthe presence ofaugmented capillary perfusion predisposesto glo-merularinjury in thismodelof systemic arterial hypertension. Furthermore,they lendadditionalsupport to theviewthat ele-vations in glomerular pressuresand flows constituteageneral mechanism foreventualglomerular destructionin awide
variety
of renal diseases.
Acknowledgments
Ms. J. L.Troy,Ms. C. Lenherr, Ms. J. Noddin, and Ms.D.Sandstrom
provided expert technical assistance, and Ms. Vivian Patrikes and Ms. Lynne Leung gavesecretarialassistance.Desoxycorticosterone pivilate
wasgenerouslyprovided by CIBA Pharmaceutical Co., Summit, NJ. Thesestudies were supported by U. S. Public Health Service grants AM-19467 and AM-27853.
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