Schramm Lothar, Seibold Alexandra, Schneider Reinhard, Zimmermann Josef, Netzer Kai-Olaf, Wanner Christoph
Division of Nephrology, Department of Medicine, Julius-Maximilians-University, Würzburg, Germany.
J Nephrol. 2008 Mar-Apr;21(2):229-35.
Regulation of renal hemodynamics -- especially intraglomerular hemodynamics -- is closely related to the L-arginine (L-Arg)/nitric oxide (NO) pathway, both under basal conditions and in acute renal failure (ARF). Also, superoxide anions -- which may react with NO -- play a role in ischemic ARF. L-Arg not only has beneficial effects on glomerular filtration rate (GFR) but also reduces O2(-) production and prevents NO synthase isoform I up-regulation. Thus, it is of interest to elucidate whether the potential beneficial effects of L-Arg in reperfusion can be augmented by additional treatment with superoxide dismutase (SOD).
ARF was induced by renal artery clamping for 40 minutes. Animals were treated with either L-Arg, SOD, a combination of both, or saline. GFR, renal plasma flow (RPF), filtration fraction (FF) and blood pressure were recorded at baseline, after induction of ARF, during drug infusion and thereafter.
Renal artery clamping induces a severe drop of GFR, RPF and FF, which all are improved by L-Arg and SOD. Increasing GFR is mainly due to better renal perfusion. FF fell after reperfusion and increased with L-Arg and SOD, indicating improvement of disturbed intrarenal hemodynamics. Combined administration of L-Arg and SOD showed similar effects in comparison with each substance alone, but did not induce additional effects on GFR and RPF.
L-Arg and SOD exert beneficial effects in ischemic ARF. Probably, improvements in reducing NO availability and in enhancing O2(-) formation are both playing a mediating role. The underlying mechanisms regulating the interplay between NO availability and O2(-) formation need to be elucidated in further studies using -- aside from other means -- selective NOS inhibitors, intervention in different experimental phases and treatment for a longer period.
无论是在基础状态下还是急性肾衰竭(ARF)时,肾血流动力学的调节,尤其是肾小球内血流动力学的调节,都与L-精氨酸(L-Arg)/一氧化氮(NO)途径密切相关。此外,可与NO发生反应的超氧阴离子在缺血性ARF中起作用。L-Arg不仅对肾小球滤过率(GFR)有有益作用,还能减少O2(-)生成并防止一氧化氮合酶同工型I上调。因此,阐明超氧化物歧化酶(SOD)的额外治疗是否能增强L-Arg在再灌注中的潜在有益作用是很有意义的。
通过夹闭肾动脉40分钟诱导ARF。动物分别接受L-Arg、SOD、两者联合治疗或生理盐水治疗。在基线、诱导ARF后、药物输注期间及之后记录GFR、肾血浆流量(RPF)、滤过分数(FF)和血压。
肾动脉夹闭导致GFR、RPF和FF严重下降,L-Arg和SOD均可改善这些指标。GFR增加主要是由于肾灌注改善。再灌注后FF下降,L-Arg和SOD可使其升高,表明肾内血流动力学紊乱得到改善。与单独使用每种物质相比,L-Arg和SOD联合给药显示出相似的效果,但对GFR和RPF没有额外影响。
L-Arg和SOD在缺血性ARF中发挥有益作用。可能,减少NO可用性和增强O2(-)生成的改善均起介导作用。在进一步的研究中,除其他方法外,还需要使用选择性NOS抑制剂、在不同实验阶段进行干预以及延长治疗时间来阐明调节NO可用性和O2(-)生成之间相互作用的潜在机制。