Inhibition Of Renal Injury

National Institute Of Diabetes And Digestive And Kidney Diseases

Investigators

Linked publications & trials

Abstract

Acute kidney injury (previously known as acute renal failure) has a high morbidity and mortality. After developing a novel model of sepsis-induced AKI that employs cecal ligation puncture in elderly mice treated with fluids and antibiotics, we are using the model to study the pathophysiology of injury, to screen drugs, and to study their mechanisms of action, including conscious blood pressure by telemetry. We adjusted our mouse model by using outbred mice, which develop AKI at a younger age, and we established another model using comorbidity, namely pre-existing renal dysfunction, which is thought to increase susceptibility to AKI in patients. This acute-on-chronic syndrome has not been studied in animals, and the nephrology field is trying to gain more information about how this is manifest in patients. Because the model we used for pre-existing renal dysfunction is reversible, unlike the progression seen in CKD patients, we started with a partial renal ablation (5/6 nephrectomy) procedure, a classic rat CKD model, then adapted it to the mouse. We have characterized our model, and it has several hallmarks of progressive CKD, including hypertension, proteinuria, glomerulosclerosis, interstitial renal tubular fibrosis, anemia, and cardiac fibrosis. In order to make our CKD mouse model compatible with our sepsis AKI models, we tested three mouse strains, which had differential susceptibility to CKD. In the most susceptible strain, all aspects of CKD could be lowered by an angiotensin receptor blocker (olmesartan). Conversely, angiotensin II could convert a resistant strain to a susceptible strain. However, this effect is largely independent of blood pressure. 1) We are continuing our collaboration with Tom Eggerman, where we used CD36 KO, SR-BI/II KO and double knockout to protect against sepsis and sepsis-AKI. We are developing a cellular approach to therapy. 2) We are developing a mouse model for sepsis and sepsis-AKI where mice are simultaneously monitored non-invasively for heart rate, blood pressure, and body temperature, in order to optimize clinically relevant pressor treatments. 3) We are modifying our acute-on-chronic model to replace 5/6 nephrectomy with renal ischemia/reperfusion. In doing so, we have found a new phenotype where there is dissociation of renal and non-renal outcomes of organ damage and systemic inflammation. We continue to explore potential mechanisms and treatments for sepsis-AKI, CKD, and acute-on-chronic kidney disease. We also continue to develop models for acute and chronic kidney disease.