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慢性使用氯喹会通过降低内髓质中的 cAMP 水平来破坏尿液浓缩机制。

Chronic use of chloroquine disrupts the urine concentration mechanism by lowering cAMP levels in the inner medulla.

机构信息

Department of Medicine, Renal Division, Emory University School of Medicine, Atlanta, Georgia 30322, USA.

出版信息

Am J Physiol Renal Physiol. 2012 Sep 15;303(6):F900-5. doi: 10.1152/ajprenal.00547.2011. Epub 2012 Jul 11.

Abstract

Chloroquine, a widely used anti-malaria drug, has gained popularity for the treatment of rheumatoid arthritis, systemic lupus erythematosus (SLE), and human immunodeficiency virus (HIV). Unfortunately, chloroquine may also negatively impact renal function for patients whose fluid and electrolyte homeostasis is already compromised by diseases. Chronic administration of chloroquine also results in polyuria, which may be explained by suppression of the antidiuretic response of vasopressin. Several of the transporters responsible for concentrating urine are vasopressin-sensitive including the urea transporters UT-A1 and UT-A3, the water channel aquaporin-2 (AQP2), and the Na(+)-K(+)-2Cl(-) cotransporter (NKCC2). To examine the effect of chloroquine on these transporters, Sprague-Dawley rats received daily subcutaneous injections of 80 mg·kg(-1)·day(-1) of chloroquine for 4 days. Twenty-four hour urine output was twofold higher, and urine osmolality was decreased by twofold in chloroquine-treated rats compared with controls. Urine analysis of treated rats detected the presence chloroquine as well as decreased urine urea and cAMP levels compared with control rats. Western blot analysis showed a downregulation of AQP2 and NKCC2 transporters; however, UT-A1 and UT-A3 abundances were unaffected by chloroquine treatment. Immunohistochemistry showed a marked reduction of UT-A1 and AQP2 in the apical membrane in inner medullary collecting ducts of chloroquine-treated rats. In conclusion, chloroquine-induced polyuria likely occurs as a result of lowered cAMP production. These findings suggest that chronic chloroquine treatment would exacerbate the already compromised fluid homeostasis observed in diseases like chronic kidney disease.

摘要

氯喹是一种广泛用于治疗疟疾的药物,也因其对类风湿关节炎、系统性红斑狼疮(SLE)和人类免疫缺陷病毒(HIV)的治疗效果而受到关注。不幸的是,对于那些因疾病已经导致液体和电解质平衡受损的患者,氯喹可能会对肾功能产生负面影响。慢性氯喹给药也会导致多尿,这可能是由于抑制了抗利尿激素对加压素的反应。负责浓缩尿液的几种转运体对加压素有反应性,包括尿素转运体 UT-A1 和 UT-A3、水通道蛋白 2(AQP2)和 Na(+)-K(+)-2Cl(-)共转运体(NKCC2)。为了研究氯喹对这些转运体的影响,Sprague-Dawley 大鼠每天接受 80mg·kg(-1)·day(-1)的氯喹皮下注射,共 4 天。与对照组相比,氯喹处理组的 24 小时尿量增加了一倍,尿渗透压降低了一倍。与对照组相比,处理组大鼠的尿液分析显示存在氯喹,以及尿液尿素和 cAMP 水平降低。Western blot 分析显示 AQP2 和 NKCC2 转运体下调;然而,氯喹处理对 UT-A1 和 UT-A3 的丰度没有影响。免疫组织化学显示氯喹处理组大鼠的内髓集合管顶端膜上的 UT-A1 和 AQP2 明显减少。总之,氯喹引起的多尿可能是由于 cAMP 产生减少所致。这些发现表明,慢性氯喹治疗会加剧慢性肾脏病等疾病中已经受损的液体平衡。

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