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Modification of disease progression in rats with inherited polycystic kidney disease
B D Cowley1, J J Grantham, M J Muessel
1Department of Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA.
Abstract:
The most common inherited form of human polycystic kidney disease (PKD), autosomal dominant PKD (ADPKD), is a leading cause of chronic renal failure, but has a variable clinical presentation, with end-stage renal disease occurring in only 25% to 75%. Several findings are consistent with the idea that factors in addition to the primary mutation can affect the progression of cystic change and chronic renal failure in PKD. Epithelial cell proliferation is a central element in the pathogenesis of renal cysts. We postulated that the superimposition of a growth-promoting stimulus might promote more intense proliferation of cystic epithelial cells in inherited cystic disease. To study this, we subjected Han:SPRD rats, with a form of ADPKD that resembles human ADPKD, from 4 until 10 weeks of age to diets designed to promote tubule cell growth. The diets included supplemental NH4Cl (280 mmol/L in drinking water), limited dietary K+ (0.016% of diet; control diet was 1.1% K+), and increased dietary protein (50%; control diet was 23% protein). Treatments designed to promote cell growth caused more aggressive PKD in males and females, worsened azotemia in males, and resulted in azotemia in females (which normally develop PKD but not azotemia at the ages studied). NH4Cl, K+ restriction, and increased dietary protein each caused greater kidney enlargement in males (kidney weight/body weight ratios increased by 35%, 78%, and 105%, respectively) and worsened azotemia in males (serum urea nitrogen values increased by 63%, 514%, and 224%, respectively); in contrast, decreased dietary protein (4%) caused less severe PKD in males (kidney weight/body weight ratios decreased by 43%) and lessened azotemia in males (serum urea nitrogen values decreased by 49%). Similarly, NH4Cl and K+ restriction caused greater kidney enlargement in females (kidney weight/body weight ratios increased by 206% and 203%, respectively) and caused azotemia in females (serum urea nitrogen values increased by 177% and 430%, respectively). On the basis of these results, we conclude that growth-promoting stimuli can alter the expression of hereditary renal cystic disease. These findings demonstrate that the progression of hereditary renal cystic disease can be altered by factors in addition to the primary genetic defect.
Insights
Growth-promoting stimuli, such as specific diets, can worsen polycystic kidney disease (PKD) progression in rats. These findings highlight that factors beyond genetics influence the severity of inherited renal cystic disease.
Area of Science:
- Nephrology
- Genetics
- Molecular Biology
Background:
- Autosomal dominant polycystic kidney disease (ADPKD) is a common inherited kidney disorder leading to chronic renal failure.
- Clinical presentation and progression of ADPKD are variable, suggesting non-genetic factors influence disease severity.
- Epithelial cell proliferation is a key mechanism in renal cyst development in PKD.
Purpose of the Study:
- To investigate whether growth-promoting stimuli can exacerbate inherited renal cystic disease.
- To determine if dietary interventions mimicking growth promotion affect the progression of ADPKD in a rat model.
Main Methods:
- Han:SPRD rats, a model for human ADPKD, were fed diets promoting tubule cell growth from 4 to 10 weeks of age.
- Diets included supplemental NH4Cl, limited dietary K+, and increased dietary protein.
- Control groups received standard diets.
Main Results:
- Growth-promoting diets significantly worsened PKD in both male and female rats.
- Azotemia (elevated blood urea nitrogen) was exacerbated in males and induced in females.
- Kidney enlargement was significantly increased in both sexes with specific dietary interventions.
- Dietary protein restriction lessened PKD severity and azotemia in males.
Conclusions:
- Growth-promoting stimuli can significantly alter the expression and progression of hereditary renal cystic disease.
- Factors beyond the primary genetic defect, including diet, play a crucial role in modulating PKD.
- These findings suggest potential therapeutic targets for managing ADPKD progression.