Thomson SC, Rieg T, Miracle C, Mansoury H, Whaley J, Vallon V, Singh P. Acute and chronic effects of SGLT2 blockade on glomerular and tubular function in the early diabetic rat. Am J Physiol Regul Integr Comp Physiol 302: R75-R83, 2012. First published September 21, 2011 doi:10.1152/ajpregu.00357.2011.-Tubuloglomerular feedback (TGF) stabilizes nephron function from minute to minute and adapts to different steady-state inputs to maintain this capability. Such adaptation inherently renders TGF less efficient at buffering long-term disturbances, but the magnitude of loss is unknown. We undertook the present study to measure the compromise between TGF and TGF adaptation in transition from acute to chronic decline in proximal reabsorption (Jprox). As a tool, we blocked proximal tubule sodium-glucose cotransport with the SGLT2 blocker dapagliflozin in hyperglycemic rats with early streptozotocin diabetes, a condition in which a large fraction of proximal fluid reabsorption owes to SGLT2. Dapagliflozin acutely reduced proximal reabsorption leading to a 70% increase in early distal chloride, a saturated TGF response, and a major reduction in single nephron glomerular filtration rate (SNGFR). Acute and chronic effects on Jprox were indistinguishable. Adaptations to 10 -12 days of dapagiflozin included increased reabsorption by Henle's loop, which caused a partial relaxation in the increased tone exerted by TGF that could be explained without desensitization of TGF. In summary, TGF contributes to long-term fluid and salt balance by mediating a persistent decline in SNGFR as the kidney adapts to a sustained decrease in Jprox.dapagliflozin; hyperfiltration AN ONGOING DISTURBANCE IN salt transport anywhere along the nephron will eventually be compensated by a combination of changes in glomerular filtration of salt, salt transport elsewhere along the nephron, and salt intake to fulfill the requirement for long-term balance. The kidney cannot obviate this requirement, but exerts some control over how it is achieved. Tubuloglomerular feedback (TGF) is one mechanism that the kidney can employ to influence how the response to an outside disturbance is compensated. TGF senses the amount of fluid and salt reaching the macula densa and evokes counterbalancing changes in single nephron glomerular filtration rate (SNGFR), thereby reducing the impact that an outside disturbance in proximal reabsorption would otherwise have on distal delivery. The usual way to measure the effectiveness of TGF is by in vivo micropuncture, which is most adapted to studying the TGF responses to events that occur on a time scale of several minutes (17). TGF responses over periods of 1-2 h have been partially characterized using carbonic anhydrase inhibitors to perturb proximal reabsorption (3). But little is known about the influence of TGF over the compensatory response to an outside disturbance lasting several days, which is the critical time frame over which the kidney regulates salt balance and blood pressure (5).The present studies were performed to...

Diabetic nephropathy is the commonest cause of end-stage renal disease. Inordinate kidney growth and glomerular hyperfiltration at the very early stages of diabetes are putative antecedents to this disease. The kidney is the only organ that grows larger with the onset of diabetes mellitus, yet there remains confusion about the mechanism and significance of this growth. Here we show that kidney proximal tubule cells in culture transition to senescence in response to oxidative stress. We further determine the temporal expression of G(1) phase cell cycle components in rat kidney cortex at days 4 and 10 of streptozotocin diabetes to evaluate changes in this growth response. In diabetic rats we observe increases in kidney weight-to-body weight ratios correlating with increases in expression of the growth-related proteins in the kidney at day 4 after induction of diabetes. However, at day 10 we find a decrease in this profile in diabetic animals coincident with increased cyclin-dependent kinase inhibitor expressions. We observe no change in caspase-3 expression in the diabetic kidneys at these early time points; however, diabetic animals demonstrate reduced kidney connexin 43 and increased plasminogen activator inhibitor-1 expressions and increased senescence-associated beta-galactosidase activity in cortical tubules. In summary, diabetic kidneys exhibit an early temporal induction of growth phase components followed by their suppression concurrent with the induction of cyclin-dependent kinase inhibitors and markers of senescence. These data delineate a phenotypic change in cortical tubules early in the pathogenesis of diabetes that may contribute to further downstream complications of the disease.

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Miracle CM, Rieg T, Mansoury H, Vallon V, Thomson SC. Ornithine decarboxylase inhibitor eliminates hyperresponsiveness of the early diabetic proximal tubule to dietary salt. Am J Physiol Renal Physiol 295: F995-F1002, 2008. First published June 18, 2008 doi:10.1152/ajprenal.00491.2007.-Heightened sensitivity of the diabetic proximal tubule to dietary salt leads to a paradoxical effect of salt on glomerular filtration rate (GFR) via tubuloglomerular feedback. Diabetic hyperfiltration is a feedback response to growth and hyperreabsorption by the proximal tubule. The present studies were performed to determine whether growth and hyperfunction of the proximal tubule are essential for its hyperresponsiveness to dietary salt and, hence, to the paradoxical effect of dietary salt on GFR. Micropuncture was performed in four groups of inactin-anesthetized Wistar rats after 10 days of streptozotocin diabetes drinking tap water or 1% NaCl. Kidney growth was suppressed with ornithine decarboxylase (ODC) inhibitor, DFMO (200 mg ⅐ kg Ϫ1 ⅐ day Ϫ1 ), or placebo. Single nephron GFR (SNGFR) was manipulated by perfusing Henle's loop so that proximal reabsorption (J prox) could be expressed as a function of SNGFR in each nephron, dissociating primary effects on the tubule from the effects of glomerulotubular balance. Alone, DFMO or high salt reduced SNGFR and suppressed J prox independent of SNGFR. Suppression of J prox was eliminated and SNGFR increased when high salt was given to rats receiving DFMO. ODC is necessary for hyperresponsiveness of the proximal tubule to dietary salt and for the paradoxical effect of dietary salt on GFR in early diabetes. This coupling of effects adds to the body of evidence that feedback from the proximal tubule is the principal governor of glomerular filtration in early diabetes. diabetic hyperfiltration; proximal tubular reabsorption; tubuloglomerular feedback; glomerulotubular balance GLOMERULAR HYPERFILTRATION is a cardinal feature of early diabetes mellitus (5). Several lines of evidence support a tubular hypothesis to explain how glomerular filtration rate (GFR) comes to be elevated in early diabetes (reviewed in Ref. 17). According to this hypothesis, hyperfiltration is rooted in a prior increase in proximal reabsorption with GFR rising secondarily via negative feedback through the macula densa. In the course of trying to determine how the initial increase in proximal reabsorption comes about, we previously discovered that it could be prevented by suppressing growth of the kidney (15), which is normally rapid in early diabetes (10). We also discovered that proximal reabsorption in early diabetes is overly sensitive to dietary salt, to the extent that, when placed on a high salt diet, a diabetic rat drops its proximal reabsorption sufficiently to activate tubuloglomerular feedback (TGF), thereby reducing single nephron GFR (SNGFR) (20, 21). Since a reciprocal effect of dietary salt on GFR is contrary to usual expectation, we refer to this phenomenon as the salt paradox. So far, the salt parad...