Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Vanderbilt Center for Kidney Disease, Nashville, Tennessee.
Am J Physiol Renal Physiol. 2021 Apr 1;320(4):F569-F577. doi: 10.1152/ajprenal.00476.2020. Epub 2021 Feb 1.
Ischemic heart disease is the leading cause of death worldwide and is frequently comorbid with chronic kidney disease. Physiological communication is known to occur between the heart and the kidney. Although primary dysfunction in either organ can induce dysfunction in the other, a clinical entity known as cardiorenal syndrome, mechanistic details are lacking. Here, we used a model of experimental myocardial infarction (MI) to test effects of chronic cardiac ischemia on acute and chronic kidney injury. Surprisingly, chronic cardiac damage protected animals from subsequent acute ischemic renal injury, an effect that was accompanied by evidence of chronic kidney hypoxia. The protection observed post-MI was similar to protection observed in a separate group of healthy animals housed in ambient hypoxic conditions prior to kidney injury, suggesting a common mechanism. There was evidence that chronic cardiac injury activates renal hypoxia-sensing pathways. Increased renal abundance of several glycolytic enzymes following MI suggested that a shift toward glycolysis may confer renal ischemic preconditioning. In contrast, effects on chronic renal injury followed a different pattern, with post-MI animals displaying worsened chronic renal injury and fibrosis. These data show that although chronic cardiac injury following MI protected against acute kidney injury via activation of hypoxia-sensing pathways, it worsened chronic kidney injury. The results further our understanding of cardiorenal signaling mechanisms and have implications for the treatment of heart failure patients with associated renal disease. Experimental myocardial infarction (MI) protects from subsequent ischemic acute kidney injury but worsens chronic kidney injury. Observed protection from ischemic acute kidney injury after MI was accompanied by chronic kidney hypoxia and increased renal abundance of hypoxia-inducible transcripts. These data support the idea that MI confers protection from renal ischemic injury via chronic renal hypoxia and activation of downstream hypoxia-inducible signaling pathways.
缺血性心脏病是全球范围内导致死亡的主要原因,并且常与慢性肾脏病并存。已知心脏和肾脏之间存在生理通讯。尽管任一器官的原发性功能障碍都可能导致另一器官的功能障碍,但缺乏一种称为心肾综合征的临床实体的机制细节。在这里,我们使用实验性心肌梗死 (MI) 模型来测试慢性心脏缺血对急性和慢性肾损伤的影响。令人惊讶的是,慢性心脏损伤保护动物免受随后的急性缺血性肾损伤,这种保护作用伴随着慢性肾脏缺氧的证据。MI 后观察到的保护作用与在另一组健康动物中观察到的保护作用相似,这些动物在肾损伤前被安置在环境缺氧条件下,这表明存在共同的机制。有证据表明,慢性心脏损伤激活了肾脏缺氧感应途径。MI 后肾脏中几种糖酵解酶的含量增加表明,向糖酵解的转变可能赋予了肾脏缺血预适应。相比之下,对慢性肾损伤的影响遵循不同的模式,MI 后的动物表现出更严重的慢性肾损伤和纤维化。这些数据表明,尽管 MI 后慢性心脏损伤通过激活缺氧感应途径保护急性肾损伤,但它会加重慢性肾脏损伤。这些结果进一步加深了我们对心肾信号机制的理解,并对患有相关肾脏疾病的心力衰竭患者的治疗具有重要意义。实验性心肌梗死 (MI) 可预防随后的缺血性急性肾损伤,但会加重慢性肾损伤。MI 后观察到的对缺血性急性肾损伤的保护作用伴随着慢性肾脏缺氧和缺氧诱导转录物的肾脏丰度增加。这些数据支持 MI 通过慢性肾脏缺氧和下游缺氧诱导信号通路的激活来提供对肾脏缺血性损伤的保护作用的观点。