Calcium entry and 5-HT2 receptor blockade in oliguric ischaemic acute renal failure: effects of levemopamil in conscious rats.

1. Unilateral left renal artery occlusion for 1 h in a group of 8 untreated female Sprague-Dawley rats resulted in oliguric acute renal failure (ARF) persisting for more than 6 h after reflow, i.e. after reperfusion of the kidney by removal of the arterial clamp. In a second group of 8 rats with left unilateral ARF the effects of levemopamil (L), a calcium entry blocker with 5-hydroxytryptamine2 (5-HT2) receptor antagonistic properties, were studied. Rats received L as a continuous infusion (6 mg kg-1 h-1) from 1 h before ischaemia until 6 h after reflow. 2. Endogenous creatinine clearance, an estimate of glomerular filtration rate (GFR), of left ischaemic kidneys of untreated rats was almost completely abolished and urine flow was 0.05 +/- 0.02 and 0.03 +/- 0.01 ml h-1 100 g-1 body weight (body wt.) at 2 and at 6 h of reflow, respectively. In contrast, left ischaemic kidneys of L-treated rats revealed significantly higher GFR (0.10 +/- 0.02 and 0.03 +/- 0.01 ml min-1 g-1 kidney weight (k.wt.); P < 0.01) and urine flow (0.51 +/- 0.05 and 0.15 +/- 0.04 ml h-1 100 g-1 body wt.; P < 0.05) at 2 and 6 h of reflow, respectively. 3. At 6 h of reflow, mitochondria from the cortex of left ischaemic kidneys of untreated rats showed significantly reduced ATP synthesis when compared to right intact kidneys (0.06 +/- 0.02 vs 0.26 +/- 0.02 mumol ATP mg-1 protein min-1 (P < 0.01)). In contrast, in L-treated rats, ATP synthesis of left ischaemic kidneys was largely preserved (0.17 +/- 0.01 mumol ATP mg-1 protein min-1). 4. Ischaemia of left kidneys resulted in a significant decrease in medullary Na-K-ATPase activity to 9.6 +/- 2.4 as compared to 20.4 +/- 3.7 mumol P(i) h-1 mg-1 protein in the intact right kidneys which was not prevented by L (9.4 +/- 2.4 mumol P(i) h-1 mg-1 protein). 5. In untreated rats the calcium content in cortical mitochondria from left ischaemic kidneys had risen 2 fold to 23.0 +/- 1.8 at 6 h of reflow as compared to 12.2 +/- 0.3 nmol mg-1 protein in right intact kidneys (P < 0.01). This rise in mitochondrial calcium was not significantly attenuated by treatment with L (19.9 +/- 1.7 nmol mg-1 protein). 6. The results show that L transiently converted oliguria into non-oliguria during the early phase after reflow in ischaemic ARF, i.e. after reperfusion following 1 h of complete interruption of renal perfusion. The present data suggest indirectly that the 5-HT2-antagonistic properties of L rather than its calcium channel blocking action maintains GFR at low level and protects mitochondrial function early after reflow in this model of ischaemic ARF.