Laboratory Investigation

Kidney International (1994) 46, 396–404; doi:10.1038/ki.1994.287

Modulation of glomerular hypertension defines susceptibility to progressive glomerular injury

Jacob L Simons, Abraham P Provoost, Sharon Anderson, Helmut G Rennke, Julia L Troy and Barry M Brenner

Renal Division and Department of Pathology, Brigham and Women's Hospital, The Harvard Center for The Study of Kidney Diseases, Harvard Medical School, Boston, Massachusetts, USA and Department of Pediatric Surgery, Erasmus University, Rotterdam, The Netherlands

Correspondence: Abraham P Provoost PhD, Department of Pediatric Surgery, Laboratory for Surgery, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.

Received 11 October 1993; Revised 17 February 1994; Accepted 22 February 1994.

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Abstract

Modulation of glomerular hypertension defines susceptibility to progressive glomerular injury. The fawn-hooded rat constitutes a spontaneous model for chronic renal failure with early systemic and glomerular hypertension, proteinuria (UpV) and high susceptibility to development of focal and segmental glomerular sclerosis (FGS). It has been argued that uninephrectomy (UNX) accelerates the development of glomerular injury by aggravation of glomerular hypertension and by an independent effect to promote glomerular enlargement. The present study was performed to further delineate the importance of these parameters for the development of FGS. At the age of eight weeks male rats were UNX and randomly assigned to either control (CON), enalapril (ENA) or Nw-nitro L-arginine methyl ester (NAME) treatment. In all groups glomerular hemodynamic studies were performed four weeks post-UNX. Systemic blood pressure and UpV were monitored for 4 to 12 weeks post-UNX. Kidneys were then prepared for morphologic study. ENA treatment achieved control of both systemic and glomerular hypertension, maintenance of glomerular hyperfiltration and hyperperfusion, increased ultrafiltration coefficient(Kf), and long-term protection against UpV and FGS. NAME rats showed aggravation of both systemic and glomerular hypertension, decreased renal perfusion and filtration with reduced Kf, and high filtration fraction. The incidence of FGS in NAME and CON groups was similar at 8 and 12 weeks post-UNX, respectively. Glomerular enlargement was present in CON and ENA rats, but did not correlate with injury, while glomerular tuft size was lowest in NAME rats, which displayed prominent glomerular injury. Systemic blood pressure correlated strongly with glomerular capillary pressure. We conclude that systemic and glomerular hypertension govern the development of UpV and FGS. Renal protection with converting enzyme inhibition is achieved by controlling glomerular hypertension in this highly susceptible model.

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