(Hypertension. 1999;33:102-107.)
© 1999 American Heart Association, Inc.
Scientific Contributions |
Presented in part at the 30th Annual Meeting of the American Society of Nephrology in San Antonio, Tex, 1997. J Am Soc Nephrol. 1997;8:296A.
From the Department of Physiology, Tulane University School of Medicine, New Orleans, La.
Correspondence to Dr L. Gabriel Navar, Tulane University School of Medicine, Department of Physiology SL39, 1430 Tulane Ave, New Orleans, LA 70112. E-mail navar{at}mailhost.tcs.tulane.edu
| Abstract |
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Key Words: renin-angiotensin system hypertension, renal angiotensin antagonist receptors, angiotensin glomerular filtration rate renal blood flow
| Introduction |
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The functional responses of the nonclipped kidneys of 2K1C hypertensive rats to pharmacological blockade of RAS have not yielded consistent results. Indeed, the glomerular filtration rate (GFR) has been reported to be increased4 or unchanged;8 however, systemic receptor blockade also causes profound decreases in mean arterial pressure (MAP).8 Thus, it is possible that the compensatory mechanisms activated by systemic administration of angiotensin-converting enzyme inhibitors (ACEIs) or AT1 receptor antagonists could exert indirect effects to decrease renal function. Differences in responses to systemic and direct intrarenal blockade have been reported before. Siragy et al12 observed increases in renal plasma flow (RPF), GFR, sodium excretion, and urine flow when a combination of a renin inhibitor, an ACEI, and an Ang II receptor antagonist was infused directly into the renal artery of dogs. Similarly, Peng and Knox13 showed that renal interstitial infusion of an AT1 receptor antagonist increased sodium excretion in normotensive rats. However, these changes did not occur when the antagonist was infused systemically, eliciting a substantial decrease in MAP. In a recent study, we observed that renal responses to systemic administration of an AT1 receptor blocker were actually greater with lower doses that did not markedly lower arterial pressure than with higher doses that caused hypotension.14 Thus, rapid acute decreases in arterial pressure caused by systemic AT1 receptor blockade may elicit various indirect effects, including activation of the sympathetic nervous system, to increase peripheral vascular resistance and renal vascular resistance.15 16 17
Previous studies attempting to evaluate the direct in vivo effects of intrarenal Ang II receptor blockade were compromised because the systemic infusion of receptor antagonists, even if given directly into the renal artery, leads to spillover into the systemic circulation and consequent reductions in systemic arterial pressure.18 Recent availability of highly potent, nonsurmountable AT1 receptor antagonists19 20 has enabled more complete characterization of the effects of direct intrarenal Ang II blockade on the nonclipped kidneys of 2K1C Goldblatt hypertensive rats in the absence of decreases in MAP. The nonsurmountable nature of candesartan is particularly advantageous since this allowed us to elicit almost complete intrarenal AT1 receptor blockade with a single bolus dose, thus obviating the need for continuous infusion that progressively increases the circulating concentration of the antagonist. Accordingly, the second major aim of this study was to delineate the magnitude of Ang IIdependent influences on renal hemodynamics and sodium excretory function under conditions in which the systemic arterial pressure was maintained.
| Methods |
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Preparation of 2K1C Goldblatt Hypertensive Rats
Male Sprague-Dawley rats (Harlan, Indianapolis, IN) weighing 60
to 80 g were anesthetized with sodium pentobarbital (40
mg/kg IP). The right renal artery of each animal was isolated through a
flank incision and, as described previously,4 5 a
silver clip (0.25-mm internal gap) was placed on the renal artery.
Sham-operated rats, which underwent the same surgical procedure except
for placement of the renal artery clip, served as controls. All animals
were fed standard rat chow and tap water ad libitum and were kept on a
12-hour light/dark cycle. The acute experiments were performed 3 weeks
after placement of the clip.
Determinations of Plasma, Kidney, and Proximal Tubular Fluid Levels
of Ang II
Experiments were performed to determine the Ang II levels in
proximal tubular fluid, plasma, and kidneys of anesthetized
2K1C Goldblatt hypertensive rats (n=8). On the day of experiment, rats
were anesthetized with pentobarbital sodium (50 mg/kg IP),
placed on a thermoregulated table, and prepared for micropuncture
experiments as described previously.8 9 10 11 After
completion of surgery and a 60-minute equilibration period, two
30-minute clearance periods were performed to assess control renal
function. By use of procedures previously described to collect samples
of proximal tubular fluid,9 10 11 collection
micropipettes were inserted into mid-to-late segments of proximal
tubules, and complete free-flow tubular fluid samples were collected
for 10 to 20 minutes. It has previously been shown that there is not
significant in vitro generation of Ang II in the collection
pipette.10 Immediately after collection, the
tubular fluid sample volume was determined with a slide comparator
(Gaertner Scientific) and the sample was transferred to a tube
containing 1 mL of chilled methanol. Multiple free-flow proximal
tubular fluid samples were obtained from each rat, and the samples were
pooled. The pooled tubular fluid samples were stored in methanol at
-20°C until the day of radioimmunoassay. Approximately 1 µL of
pooled proximal tubular fluid was obtained from each animal. At the end
of the experiment, the kidneys were excised, drained, weighed, and
homogenized in chilled methanol. Immediately after removal
of the kidney, a 1-mL arterial blood sample was collected
into 9 mL of chilled methanol. Ang II levels in proximal tubular fluid,
plasma, and kidney tissue were assessed by radioimmunoassays as
described previously.9 10 11 21
Renal Function Studies
For the studies evaluating responses to the
AT1 receptor blockade, rats were prepared in a
manner similar to that described above. In addition, a tapered PE-10
catheter was inserted into the left renal artery via the left femoral
artery for selective intrarenal administration of agents by use of a
slight modification of the technique described previously for renal
blood flow (RBF) reactivity studies.22 The tip of
a laser Doppler flow probe (Med Pacific) was placed near the
surface of the kidney for measurement of relative changes in cortical
renal blood flow (CRBF). Laser Doppler flow technology allows
dynamic assessment of relative changes in RBF.14
During surgery, an isotonic saline solution containing albumin
(6%) was infused at a rate of 20 µL/min. After surgery, an isotonic
saline solution containing albumin (1%), p-aminohippurate
sodium (PAH) (1.5%), and polyfructosan (2%) was infused at the same
infusion rate. After a 60-minute equilibration period, the response in
CRBF to an intrarenal bolus of Ang II (2 ng) was tested. The
experimental protocol consisted of three 30-minute clearance periods to
assess control renal function. The rats then received a single
injection of candesartan (0.5 µg) directly into the renal artery,
which was followed by a 10-minute delay and three 30-minute
experimental clearance periods. Pilot studies indicated that this dose
of candesartan is sufficient to prevent the renal vasoconstrictor
effects of an intrarenal bolus injection of 2 ng of Ang II for up to 3
hours yet not spill over to the systemic circulation in sufficient
amounts to produce significant decreases in MAP or to attenuate
systemic blood pressure responses to intravenous injections
of 50 ng of Ang II. At the end of the experiment, the responses in CRBF
to an intrarenal bolus of Ang II (2 ng) were tested again. Two blood
samples were collected at the midpoint of the second and fifth
clearance periods to calculate GFR and PAH clearance. The following
experimental groups were examined: group 1 (n=6),
sham-operated+intrarenal vehicle control; group 2 (n=10),
sham-operated+intrarenal candesartan (0.5 µg); group 3 (n=8), 2K1C
rats+intrarenal vehicle control; group 4 (n=10), 2K1C rats+intrarenal
candesartan (0.5 µg).
Analytical Procedures, Calculations, and Statistical
Analyses
Urine volume was measured gravimetrically. Inulin and PAH
concentrations were measured
colorimetrically.23 Sodium and
potassium concentrations were determined by flame photometry. GFR,
fractional sodium, and potassium excretion were calculated using
standard formulas. PAH clearance was used as an index of RPF. RBF was
estimated from the PAH clearance and hematocrit values but without
correction for PAH extraction. Data are expressed as mean±SEM.
Statistical comparisons within groups were conducted by use of ANOVA
for repeated measures, followed by Newman-Keuls test. Student's
unpaired t test was used for comparisons between groups.
Values exceeding the 95% probability limits (P<0.05) were
considered statistically significant.
| Results |
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Plasma, Kidney, and Proximal Tubular Fluid Levels of Ang
II
As shown in Figure 1
, plasma Ang II
concentrations were 483±53 fmol/mL, the Ang II contents in the
nonclipped kidneys were 650±66 fmol/g, and proximal tubular fluid
concentrations of Ang II were 9.19±1.06 pmol/mL. The values obtained
from tubular fluid samples were, in all cases, substantially greater
than the plasma and kidney Ang II levels. For comparison, the plasma
and kidney tissue values are shown as pmol/mL and pmol/g of kidney
tissue on the same graph as the tubular fluid Ang II
concentrations.
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Effects of Intrarenal Candesartan on MAP and on Pressor Responses
to Intravenous Ang II
Administration of candesartan at a dose of 0.5 µg did not change
MAP significantly either in 2K1C rats or in sham-operated rats (152±3
to 148±3 and 125±1 to 123±3 mm Hg, respectively); similarly,
the saline vehicle alone did not elicit significant changes in
arterial pressure (157±3 to 153±2 and 125±3 to
124±5 mm Hg, respectively). Intravenous
administration of candesartan also did not alter the magnitude of
pressor responses to intravenous bolus injections of 50 ng
of Ang II in sham-operated rats (51±2 to 47±4 mm Hg, n=3) or in
2K1C rats (47±5 to 48±3 mm Hg, n=3). Collectively, these data
indicate that the dose of candesartan did not spill over into the
general circulation in amounts sufficient to elicit significant
blockade of extrarenal AT1 receptors.
Effects of Intrarenal Candesartan on CRBF Responses to Intrarenal
Bolus Injections of Ang II
As shown in Figure 2
, decreases in
CRBF in response to intrarenal Ang II (2 ng) before candesartan
treatment averaged 39±5% in 2K1C rats and 28±6% in sham-operated
rats. Intrarenal administration of candesartan completely blocked CRBF
responses in both sham-operated and 2K1C rats. Interestingly, 2K1C rats
treated with candesartan exhibited slight increases in CRBF in response
to Ang II (7±4%), suggesting a slight renal vasodilatory effect of
Ang II under conditions of AT1 receptor
blockade.
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Effects of Intrarenal Candesartan on GFR and RBF
As shown in Figure 3
(top),
candesartan elicited significant increases in GFR in both 2K1C and
sham-operated rats (0.65±0.06 to 0.83±0.11 and 0.71±0.04 to
0.87±0.06 mL · min-1 ·
g-1, respectively; P<0.05 in both
cases). Despite the differences in arterial pressure, the
GFR responses to candesartan were similar in both groups. As shown in
Figure 3
(bottom), candesartan elicited significant increases in RBF in
2K1C and in sham-operated rats as well (6.32±0.74 to 7.29±0.87 and
5.71±0.37 to 6.52±0.67 mL · min-1
· g-1, respectively; P<0.05 in
both cases).
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Effects of Intrarenal Candesartan on Urine Flow and Sodium
Excretory Function
Intrarenal candesartan elicited significant increases in urine
flow in 2K1C and sham-operated rats (6.1±0.9 to 9.4±1.6 and 6.5±0.5
to 10.2±1.1 µL · min-1 ·
g-1, respectively; P<0.05 in both
cases). As shown in Figure 4
, candesartan
caused marked increases in sodium excretion in both 2K1C and
sham-operated rats with increases from 0.23±0.07 to 1.13±0.34 and
0.21±0.04 to 1.19±0.26 µmol ·
min-1 · g-1,
respectively; P<0.05 in both cases. Likewise, fractional
sodium excretion increased about 3-fold (0.38±0.1% to 1.22% and
0.35±0.08% to 1.07±0.18%, respectively; P<0.05 in both
cases). No significant changes in potassium excretion were found in any
of the groups.
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| Discussion |
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The present data indicate that the nonclipped kidney has an impaired ability to appropriately suppress intrarenal levels of Ang II in response to sustained elevations of arterial pressure and despite the renin depletion. In view of the evidence that Ang II receptors are located on the luminal as well as on the basolateral membrane of proximal tubule cells25 and that the reabsorptive status of the proximal tubule is critically influenced by Ang II concentrations,3 26 it is likely that such inappropriately high intraluminal and intrarenal Ang II levels observed in nonclipped kidneys of 2K1C hypertensive rats would stimulate proximal tubular reabsorption rate. This effect combined with an enhancement of TGF responsiveness8 may contribute to the development and maintenance of hypertension by maintaining an inappropriately high sodium reabsorption rate even at elevated arterial pressures. It has been shown that vascular AT1 receptor density is not decreased after 2 to 4 weeks of clipping27 and that tubular AT1 receptor density may actually be increased by elevated Ang II levels.28 Thus, the Ang II dependency would apparently not be counteracted by reciprocal decreases in AT1 receptor density.
The renal functional data provide further support for a high degree of Ang II dependency in the nonclipped kidney and show that selective intrarenal AT1 receptor blockade elicits substantial increases in RBF, GFR, and proportionally even greater increases in sodium excretion. When Ang II blockade was restricted to the kidneys, avoiding confounding consequences of decreases in arterial pressure, we observed increases in GFR and RBF. These results are consistent with those reported by Imamura et al29 who reported that chronic treatment with losartan resulted in increases in GFR and RBF in nonclipped kidneys of 2K1C hypertensive rats. Increases in GFR could be caused not only by the vasodilatory actions on the renal microvasculature but also by increases in the glomerular filtration coefficient due to blockade of endogenous Ang II at the glomerulus.30 31 The specific mechanisms underlying the renal hemodynamic responses to intrarenal AT1 receptor blockade require further investigation. The substantially greater increases in both absolute and fractional sodium excretion compared with RBF and GFR increases in response to intrarenal candesartan suggest that in addition to the natriuresis caused by renal hemodynamic changes, blockade of tubular AT1 receptors contributed to increases in urinary sodium excretion.3 26
In summary, the present data indicate that proximal tubular fluid of anesthetized 2K1C Goldblatt hypertensive rats contains nanomolar concentrations of Ang II. The maintained responsiveness of the nonclipped kidney to Ang II blockade and inappropriately high intraluminal and kidney tissue Ang II levels for hypertensive rats are consistent with the concept that functional derangements of the nonclipped kidneys of 2K1C Goldblatt hypertensive rats are strongly Ang II dependent and contribute to the development and maintenance of hypertension in this model. Further, when hypotension is prevented, renal responses in hypertensive rats as well as normal rats are consistently characterized by increases in RBF, GFR, and proportionally greater increases in sodium excretion.
| Acknowledgments |
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Received June 28, 1998; first decision July 2, 1998; accepted September 4, 1998.
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