Nitric oxide in the developing kidney

Although nitric oxide (NO) has a well-established role in regulating renal function in the adult, recent studies point to perhaps an even more critical role for NO in maintaining basal renal blood flow (RBF) and glomerular filtration rate (GFR) in the developing kidney. The immature kidney has enhanced renal hemodynamic and functional responses to stimulation and inhibition of NO synthesis when compared with the adult, and these increased responses are not mediated by prostaglandins. Increased intrarenal activity of NO in the developing kidney counter-regulates the highly activated renin angiotensin system by modulating the angiotensin II-mediated vasoconstriction of the developing renal vasculature, the angiotensin II effects on GFR, as well as renin release. Localization studies demonstrate that NO acts on neonatal RBF and stabilization of GFR through an intrarenal distribution of the synthesizing enzyme, nitric oxide synthase, that is different from that of the adult. The developing kidney is dependent on NO to maintain RBF and GFR during periods of hypoxemia, protecting against renal injury, such as acute renal failure. In summary, NO is vital in the developing kidney to maintain normal physiological function and to protect the immature kidney during pathophysiological stress. Received February 12, 1996; received in revised form and accepted February 28, 1996     

Nitric oxide and vascular remodeling: spotlight on the kidney

Extracellular matrix (ECM) remodeling with successive tissue fibrosis is a key feature of chronic cardiovascular diseases, including atherosclerosis and restenosis. The atherogenic changes underlying these pathologies result from chronification of an acute repair response towards injurious and inflammatory stimuli. Thereby functional tissue is replaced by excessive ECM deposition. In the kidney, impaired remodeling is a major cause of perivascular, interstitial, and glomerular fibrosis but also a common complication of chronic hypertension. Experimental evidence points to the matrix metalloproteases (MMPs) and their intrinsic inhibitors, the tissue inhibitors of MMPs as key mediators of atherogenic and fibrotic pathologies. Mechanistically, a deregulation in ECM turnover tightly correlates with an increased production and release of proinflammatory and profibrotic factors including interleukin-1beta, transforming growth factor beta, angiotensin II, and reactive oxygen species. Unlike these factors the pleiotropic messenger molecule nitric oxide (NO) by acting as the major physiological vasodilator has emerged as one of the most atheroprotective factors. However, under inflammatory conditions NO does acquire proatherogenic and profibrotic properties thereby exacerbating tissue fibrosis. In this review, the mechanisms underlying both opposing properties of NO on perivascular ECM remodeling will exemplarily be discussed for renal fibrosis with a particular focus on the MMPs and intrinsic protease inhibitors.     

Nitric oxide and active oxygen species in severe sepsis and surgically stressed patients

To clarify how the kinetics of nitric oxide (NO) and active oxygen species are correlated with the occurrence of organ dysfunction in sepsis, the levels of monocyte-associated NO₂, NO₃, and active oxygen species were examined in severely septic patients with multiple organ dysfunction syndrome (group M; n=5), and the results compared with those of postoperative patients who had undergone gastrointestinal surgery (group S; n=5) and healthy volunteers (group C; n=10). The production of NO₂ and NO₃ by monocytes was significantly higher in group M than in the other two groups, while the production of active oxygen species by monocytes was significantly higher in groups M and S, than in group C. A significant correlation between the production of NO₂ and that of active oxygen species by monocytes was noted only in group M. These findings indicate that the simultaneous activation of NO and active oxygen species production by monocytes is a prerequisite for the onset of multiple organ dysfunction in severe sepsis.This paper was originally presented at the 22nd meeting of the Japanese Society for Abdominal Emergency Medicine held in Takarazuka in 1994.     

Nitric oxide enhances paracellular permeability of opossum kidney cells.

BACKGROUND: Nitric oxide (NO) has been shown to be a paracrine/autocrine regulator of proximal tubular transport. In this study, we investigated the effect of NO on the paracellular permeability of opossum kidney (OK) cells, a proximal tubule cell line that possesses a leaky paracellular pathway resembling that of the in vivo proximal tubule. METHODS: Paracellular permeability of OK cells cultured on permeable supports was measured as the apparent paracellular permeability coefficient (Papp) for 3[H]-D-mannitol. Changes in cell viability, cellular adenosine triphosphate (ATP) content, cGMP levels, and lipid peroxidation were assessed. RESULTS: Incubation with 2 mM sodium nitroprusside (SNP), an NO donor, for 24 hours significantly enhanced the Papp of OK cell sheets by 30.6 +/- 7.0% (N = 8, P < 0.05). This effect was largely blunted by hemoglobin, a NO scavenger. Cell viability was not compromised. This effect of SNP was concomitant with a moderate reduction of cellular ATP content, an increase in lipid peroxidation, and an increase in cellular cGMP levels. The antioxidant superoxide dismutase (SOD) significantly attenuated the effect of SNP on cellular ATP content and blunted the increase in Papp caused by SNP. A soluble guanylate cyclase inhibitor did not affect the effect of SNP on the Papp. CONCLUSIONS: NO enhances the paracellular permeability of OK cells possibly via mechanisms involving decreases in cellular ATP content.     

一氧化氮在获得性肾囊肿癌变过程中的作用

目的　探讨一氧化氮 (NO)过多产生在获得性肾囊肿 (ACDK)发生肾癌过程中的作用。　方法　用高压液相自动分析方法测定 1 6例 1 8份ACDK和 1 2份单纯性肾囊肿囊内液体中NO的代谢产物亚硝酸盐 /硝酸盐 (NO-2 /NO-3 )的含量 ,同时测定 5份ACDK患者血浆NO-2 /NO-3 的含量。采用免疫组织化学方法 (LSAB法 )检测 1 7份ACDK和 2 0例非ACDK肾组织一氧化氮合酶 (iNOS)的表达。　结果　ACDK囊内液NO-2 /NO-3 的含量 (1 5 1 .6± 6 4.2 μmol/L)明显高于单纯性肾囊肿组(5 0 .1± 33.6 μmol/L) ,差异有极显著性 (P <0 .0 0 1 )。其中在相同的 5例ACDK患者中囊内液NO-2 /NO-3 的浓度明显的高于血浆中的浓度。在免疫组织化学染色 (LSAB法 )检测肾组织iNOS的表达中 ,1 7份ACDK中 1 4例 (82 % )为阳性。 1 3例正常肾组织和 7例非ACDK慢性肾衰的肾组织均无i NOS的表达。　结论　NO在ACDK囊内液中过多产生有可能是其囊上皮发生肾癌的原因之一。     

Nitric oxide, angiotensin II, and hypertension

Although initially adaptive, the changes that accompany hypertension, namely, cell growth, endothelial dysfunction, and extracellular matrix deposition, eventually can become maladaptive and lead to end-organ disease such as heart failure, coronary artery disease, and renal failure. A functional imbalance between angiotensin II (Ang II) and nitric oxide (NO) plays an important pathogenetic role in hypertensive end-organ injury. NO, an endogenous vasodilator, inhibitor of vascular smooth muscle and mesangial cell growth, and natriuretic agent, is synthesized in the endothelium by a constitutive NO synthase. NO antagonizes the effects of Ang II on vascular tone, cell growth, and renal sodium excretion, and also down-regulates the synthesis of angiotensin-converting enzyme (ACE) and Ang II type 1 receptors. On the other hand, Ang II decreases NO bioavailability by promoting oxidative stress. A better understanding of the pathophysiologic mechanisms involved in hypertensive end-organ damage may aid in identifying markers of cardiovascular susceptibility to injury and in developing therapeutic interventions. We propose that those antihypertensive agents that lower blood pressure and concomitantly restore the homeostatic balance of vasoactive agents such as Ang II and NO within the vessel wall would be more effective in preventing or arresting end-organ disease.     

Nitric oxide and glomerulonephritis

Glomerulonephritis is a common clinical condition that is caused by immune-mediated injury to the kidney and is characterized by dysfunction of the glomerular capillary filtration barrier. Nitric oxide (NO), a ubiquitous molecule with many biological functions throughout the body, has been evaluated as an inflammatory mediator in these circumstances. NO may induce glomerular injury directly or may act via stimulation of a host of other inflammatory mediators. A variety of experimental models of glomerulonephritis have been studied including those induced by infusion of antibodies to the Thy1.1 antigen or glomerular basement membrane, Heymann nephritis, and autoimmune nephritis. In virtually all of these cases there is evidence of increased NO production. Excessive production of NO by inducible nitric oxide synthase (iNOS), derived from infiltrating immune cells or resident glomerular cells, nearly always is associated with increased glomerular injury. Interventions that inhibit this enzyme result in less proteinuria and diminished glomerular damage. In contrast, NO derived from endothelial nitric oxide synthase (eNOS) may limit glomerular disease by preserving endothelial cell integrity. There are only a limited number of studies that have evaluated the impact of NO in patients with glomerulonephritis. Although the bulk of evidence supports a role of NO as a pro-inflammatory mediator in glomerulonephritis, additional work is needed to show an association between altered NO production and the severity and outcome of disease in patients with this disease. It is hoped that better understanding of the role of NO in glomerulonephritis will lead to the development of therapies to ameliorate the disease.     

Nitric oxide and glomerulonephritis

The normal glomerulus expresses constitutive nitric oxide (NO) synthesis. Increased NO from inducible nitric oxide synthase (iNOS) occurs in acute immune glomerulonephritis (GN), in which rapid induction probably depends on local cytokines and/or oxygen radical production. Although intrinsic glomerular cells possess iNOS, in acute GN, a leukocyte origin for iNOS activity is most evident. Although NO potentially could be toxic or protective, there is as yet no clear understanding of how it affects the pathogenesis of GN. This may depend on the amount present, which in turn depends on NOS gene regulation, simultaneous production of other radicals, and the activity of arginase. High-output NO has been implicated in injury in only one model of GN, and no effect of iNOS knockout found in another. The concept is emerging that constitutive NO is critical for offsetting increased vasoconstriction in the injured glomerulus.     

Nitric oxide and hemodialysis

Nitric oxide (NO), previously thought of as a noxious gas, is now recognized as an important mediator of vascular responsiveness. Soon after its discovery, it was realized that the actions of NO are similar to the previously described endothelium-derived relaxing factor (EDRF). It is synthesized in the vascular endothelium utilizing the enzyme nitric oxide synthase (NOS) and diffuses in the adjacent vascular media, where it has a vasodilatory action. Opposing actions of NO and vasoconstrictor agents (such as endothelin-1, angiotensin IotaIota, and others) maintain the vascular tone of the renal arteries. The same balance at the level of the macula densa maintains glomerular filtration rate (GFR) during varying levels of salt excretion. Lack of NO can result in disruption of this fine balance, with resultant vasoconstriction and disease progression, hypertension, and accelerated atherosclerosis. In addition, hypertension may result from positive salt balance that occurs when macula densa NOS is inhibited. While most investigators report low levels of NO in uremic subjects, the levels in hemodialysis (HD) patients have not been characterized adequately. This is primarily because HD patients are exposed to both stimulatory and inhibitory factors for NO synthesis. Retention of inhibitors of NOS tends to decrease NO levels, whereas production of NO will be increased by cytokines generated during blood-dialyzer interaction. There is less disagreement, however, over the finding of elevated levels in those with dialyzer reactions and dialysis-induced hypotension. Recent developments in the isolation of inducible and constitutive forms of NOS makes understanding of its pathophysiologic effects more complete. Newer treatment directed at inhibiting only the inducible forms of NOS (sparing the constitutive forms) may soon be found useful for the treatment and prevention of hypotension and dialyzer reactions in HD patients.     

Nitric oxide, inflammation and acute burn injury

Nitric oxide (NOz.rad;) is a diatomic mediator liberated on oxidation of L-arginine by the nitric oxide synthase (NOS) family of enzymes. It has complex and wide ranging functions in vivo and has been implicated in the development of the profound inflammatory response that occurs as a result of cutaneous burn injury. In addition, dysregulation of NOS activity has been associated with multiple organ failure in human burn patients and may therefore represent a novel therapeutic target in such circumstances. This review focuses on the role of NOz.rad; in inflammation, with particular emphasis on the acute post-burn inflammatory response. Specific areas of discussion include the maintenance of microvascular haemostasis, leukocyte recruitment and remote organ dysfunction following thermal injury.     

Nitric oxide and tubuloglomerular feedback

Glomerular filtration is closely coupled to tubular reabsorption by a system of tubuloglomerular feedback (TGF). TGF operates within the juxtaglomerular apparatus (JGA) of each nephron, where changes are sensed in the salt content of fluid at the luminal macula densa and that information is transmitted to the glomerular microvasculature to elicit compensatory changes in single nephron glomerular filtration rate (GFR). Type I nitric oxide synthase (NOS) is expressed in the macula densa. Other NOS isoforms may be produced in the mesangium, and glomerular microvessels. These NOSs are strategically positioned to influence each step of the TGF process. However, micropuncture experiments using NOS antagonists have shown that nitric oxide (NO) does not mediate TGF. Instead, local NOS blockade causes the curve that represents TGF to shift leftward and become more steep. Changes in macula densa NO production may underlie the resetting of TGF, which is required in order to keep the TGF curve aligned with ambient tubular flow as tubular flow changes to accommodate physiologic circumstances. Also, macula densa NO production may be substrate limited and dissociated from NOS protein content. The importance of NO to TGF resetting and the substrate dependence of NO production have both been found during changes in dietary salt.