Senescent Kidney Cells in Hypertensive Patients Release Urinary Extracellular Vesicles.

Background Hypertension may be associated with renal cellular injury. Cells in distress release extracellular vesicles (EVs), and their numbers in urine may reflect renal injury. Cellular senescence, an irreversible growth arrest in response to a noxious milieu, is characterized by release of proinflammatory cytokines. We hypothesized that EVs released by senescent nephron cells can be identified in urine of patients with hypertension. Methods and Results We recruited patients with essential hypertension (EH) or renovascular hypertension and healthy volunteers (n=14 each). Renal oxygenation was assessed using magnetic resonance imaging and blood samples collected from both renal veins for cytokine-level measurements. EVs isolated from urine samples were characterized by imaging flow cytometry based on specific markers, including p16 (senescence marker), calyxin (podocytes), urate transporter 1 (proximal tubules), uromodulin (ascending limb of Henle's loop), and prominin-2 (distal tubules). Overall percentage of urinary p16+ EVs was elevated in EH and renovascular hypertension patients compared with healthy volunteers and correlated inversely with renal function and directly with renal vein cytokine levels. Urinary levels of p16+/urate transporter 1+ were elevated in all hypertensive subjects compared with healthy volunteers, whereas p16+/prominin-2+ levels were elevated only in EH versus healthy volunteers and p16+/uromodulin+ in renovascular hypertension versus EH. Conclusions Levels of p16+ EVs are elevated in urine of hypertensive patients and may reflect increased proximal tubular cellular senescence. In EH, EVs originate also from distal tubules and in renovascular hypertension from Henle's loop. Hence, urinary EVs levels may be useful to identify intrarenal sites of cellular senescence.

Role of age-related decrease of renal organic cation transporter 2 in the effect of atenolol on renal excretion of metformin in rats.

Many diabetes patients, especially the elder ones, suffered from hypertension simultaneously. Therefore, it is very likely that a large number of diabetes patients receiving metformin hydrochloride may simultaneously be given beta-blockers. Knowing that both metformin and atenolol are eliminated by organic cation transporter 2 (OCT2/SLC22A2) expressed in the renal basolateral membrane, it is not clear whether there is a competitive effect on the renal excretion of metformin and/or atenolol when metformin and atenolol were co-administered, and whether age was involved in this drug-drug interaction. In this present study, both young rats (aged 3 months) and aged rats (aged 12 months) were used, rats were divided into metformin-treated group and metformin and atenolol co-administrated group, respectively. Either metformin (2.5 mg/kg) alone or metformin (2.5 mg/kg) in combination with atenolol (8 mg/kg) was administered to rats by tail vein injection. Then, urine was collected and the metformin concentration in urine was determined by HPLC. The localization and expression of rOCT2 in kidney were also investigated by Western blotting and immunohistochemistry. Significant differences of t 1/2, K e, CLtot and the accumulated metformin excretion in urine were founded in aged rats, but not in young rats, between metformin-treated group (2.002 ± 0.51 h, 0.346 ± 0.07/h, 57.161 ± 18.59 %, 4,287.087 ± 458.08 µg) and metformin plus atenolol-treated group (3.03 ± 0.67 h, 0.228 ± 0.05/h, 43.199 ± 10.28 %, 3,239.972 ± 446.61 µg). Moreover, a significant age-related decrease in rOCT2 protein expression was observed in the aged rats (P < 0.01), which may be responsible for the effect of atenolol on the renal excretion of metformin in the aged rats. In conclusion, there is a drug-drug interaction between atenolol and metformin, and more attention should be paid when atenolol and metformin were co-administered to the aged people inclinical.

[Prevention of contrast-induced nephropathy in the context of evidence-based medicine].

The paper considers the mechanisms of development of contrast-induced nephropathy in the use of iodinated radiopaque contrast agents (RCAs), as well as the criteria of their assessment. It gives different existing recommendations for prevention of the nephrotoxic effects of RCAs.

Non-urate transporter 1-related renal hypouricemia and acute renal failure in an Israeli-Arab family.

Idiopathic renal hypouricemia (IRHU) is a rare hereditary disease, predisposing the individual to exercise-induced acute renal failure (EIARF) and nephrolithiasis, and it is characterized by increased clearance of renal uric acid. Most of the described patients are Japanese, who have loss-of-function mutations in the SLC22A12 gene coding for the human urate transporter 1 (URAT1) gene. An 18-year-old youth, who was admitted for EIARF due to IRHU, and six consanguineous Israeli-Arab family members were included in the study. The family members were tested for fractional excretion of uric acid and molecular analysis of the URAT1 gene. Four family members, including the proband, had very low levels of blood uric acid and high rate of fractional excretion (FE urate> 100%) of uric acid. Genetic analysis of the affected family members did not reveal a mutation in the coding regions and intron-exon boundaries of SCL22A12. Haplotype analysis excluded SCL22A12 involvement in the pathogenesis, suggesting a different gene as a cause of the disease. We herein describe the first Israeli-Arab family with IRHU. A non-URAT1 genetic defect that causes decreased reabsorption or, more probably, increased secretion of uric acid, induces IRHU. Further studies are required in order to elucidate the genetic defect.