Nagase Miki, Matsui Hiromitsu, Shibata Shigeru, Gotoda Takanari, Fujita Toshiro
Department of Nephrology and Endocrinology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
Hypertension. 2007 Nov;50(5):877-83. doi: 10.1161/HYPERTENSIONAHA.107.091058. Epub 2007 Sep 17.
Aldosterone is implicated in the pathogenesis of proteinuria and chronic kidney disease. We previously demonstrated the contribution of elevated serum aldosterone in the early nephropathy of SHR/NDmcr-cp (SHR/cp), a rat model of metabolic syndrome. In the present study, we investigated the effect of salt loading on renal damage in SHR/cps and explored the underlying mechanisms. SHR/cps fed a high-sodium diet for 4 weeks developed severe hypertension, massive proteinuria, and advanced renal lesions. High salt also worsened glomerular podocyte impairment. Surprisingly, selective mineralocorticoid receptor (MR) antagonist eplerenone dramatically ameliorated the salt-induced proteinuria and renal injury in SHR/cps. Although salt loading reduced circulating aldosterone, it increased nuclear MR and expression of aldosterone effector kinase Sgk1 in the kidney. Gene expressions of transforming growth factor-beta1 and plasminogen activator inhibitor-1 were also enhanced in the kidneys of salt-loaded SHR/cps, and eplerenone completely inhibited these injury markers. To clarify the discrepancy between decreased aldosterone and enhanced MR signaling by salt, we further investigated the role of oxidative stress, a putative key factor mediating salt-induced tissue damage. Interestingly, antioxidant Tempol attenuated the salt-evoked MR upregulation and Sgk1 induction and alleviated proteinuria and renal histological abnormalities, suggesting the involvement of oxidative stress in salt-induced MR activation. MR activation by salt was not attributed to increased serum corticosterone or reduced 11beta-hydroxysteroid dehydrogenase type 2 activity. In conclusion, sodium loading exacerbated proteinuria and renal injury in metabolic syndrome rats. Salt reduced circulating aldosterone but caused renal MR activation at least partially via induction of oxidative stress, and eplerenone effectively improved the nephropathy.
醛固酮与蛋白尿和慢性肾脏病的发病机制有关。我们先前已证明血清醛固酮升高在SHR/NDmcr-cp(SHR/cp)早期肾病中的作用,SHR/cp是一种代谢综合征大鼠模型。在本研究中,我们调查了盐负荷对SHR/cp大鼠肾脏损伤的影响,并探讨了其潜在机制。给予高钠饮食4周的SHR/cp大鼠出现了严重高血压、大量蛋白尿和晚期肾脏病变。高盐还加重了肾小球足细胞损伤。令人惊讶的是,选择性盐皮质激素受体(MR)拮抗剂依普利酮显著改善了盐诱导的SHR/cp大鼠蛋白尿和肾损伤。尽管盐负荷降低了循环醛固酮水平,但它增加了肾脏中的核MR以及醛固酮效应激酶Sgk1的表达。盐负荷的SHR/cp大鼠肾脏中转化生长因子-β1和纤溶酶原激活物抑制剂-1的基因表达也增强,而依普利酮完全抑制了这些损伤标志物。为了阐明盐导致醛固酮降低与MR信号增强之间的差异,我们进一步研究了氧化应激的作用,氧化应激是介导盐诱导组织损伤的一个假定关键因素。有趣的是,抗氧化剂Tempol减弱了盐诱发的MR上调和Sgk1诱导,并减轻了蛋白尿和肾脏组织学异常,表明氧化应激参与了盐诱导的MR激活。盐诱导的MR激活并非归因于血清皮质酮增加或11β-羟基类固醇脱氢酶2型活性降低。总之,钠负荷加剧了代谢综合征大鼠的蛋白尿和肾损伤。盐降低了循环醛固酮水平,但至少部分通过诱导氧化应激导致肾脏MR激活,而依普利酮有效改善了肾病