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      Endothelin A receptor blocker and calcimimetic in the adenine rat model of chronic renal insufficiency

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          Abstract

          Background

          We studied whether endothelin receptor antagonist and calcimimetic treatments influence renal damage and kidney renin-angiotensin (RA) components in adenine-induced chronic renal insufficiency (CRI).

          Methods

          Male Wistar rats ( n = 80) were divided into 5 groups for 12 weeks: control ( n = 12), 0.3% adenine (Ade; n = 20), Ade + 50 mg/kg/day sitaxentan ( n = 16), Ade + 20 mg/kg/day cinacalcet (n = 16), and Ade + sitaxentan + cinacalcet (n = 16). Blood pressure (BP) was measured using tail-cuff, kidney histology was examined, and RA components measured using RT-qPCR.

          Results

          Adenine caused tubulointerstitial damage with severe CRI, anemia, hyperphosphatemia, 1.8-fold increase in urinary calcium excretion, and 3.5-fold and 18-fold increases in plasma creatinine and PTH, respectively. Sitaxentan alleviated tubular atrophy, while sitaxentan + cinacalcet combination reduced interstitial inflammation, tubular dilatation and atrophy in adenine-rats. Adenine diet did not influence kidney angiotensin converting enzyme (ACE) and AT 4 receptor mRNA, but reduced mRNA of renin, AT 1a, AT 2, (pro)renin receptor and Mas to 40–60%, and suppressed ACE2 to 6% of that in controls. Sitaxentan reduced BP by 8 mmHg, creatinine, urea, and phosphate concentrations by 16–24%, and PTH by 42%. Cinacalcet did not influence BP or creatinine, but reduced PTH by 84%, and increased hemoglobin by 28% in adenine-rats. The treatments further reduced renin mRNA by 40%, while combined treatment normalized plasma PTH, urinary calcium, and increased ACE2 mRNA 2.5-fold versus the Ade group ( p < 0.001).

          Conclusions

          In adenine-induced interstitial nephritis, sitaxentan improved renal function and tubular atrophy. Sitaxentan and cinacalcet reduced kidney renin mRNA by 40%, while their combination alleviated tubulointerstitial damage and urinary calcium loss, and increased kidney tissue ACE2 mRNA.

          Electronic supplementary material

          The online version of this article (10.1186/s12882-017-0742-z) contains supplementary material, which is available to authorized users.

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          Most cited references43

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          The intrarenal renin-angiotensin system: from physiology to the pathobiology of hypertension and kidney disease.

          In recent years, the focus of interest on the role of the renin-angiotensin system (RAS) in the pathophysiology of hypertension and organ injury has changed to a major emphasis on the role of the local RAS in specific tissues. In the kidney, all of the RAS components are present and intrarenal angiotensin II (Ang II) is formed by independent multiple mechanisms. Proximal tubular angiotensinogen, collecting duct renin, and tubular angiotensin II type 1 (AT1) receptors are positively augmented by intrarenal Ang II. In addition to the classic RAS pathways, prorenin receptors and chymase are also involved in local Ang II formation in the kidney. Moreover, circulating Ang II is actively internalized into proximal tubular cells by AT1 receptor-dependent mechanisms. Consequently, Ang II is compartmentalized in the renal interstitial fluid and the proximal tubular compartments with much higher concentrations than those existing in the circulation. Recent evidence has also revealed that inappropriate activation of the intrarenal RAS is an important contributor to the pathogenesis of hypertension and renal injury. Thus, it is necessary to understand the mechanisms responsible for independent regulation of the intrarenal RAS. In this review, we will briefly summarize our current understanding of independent regulation of the intrarenal RAS and discuss how inappropriate activation of this system contributes to the development and maintenance of hypertension and renal injury. We will also discuss the impact of antihypertensive agents in preventing the progressive increases in the intrarenal RAS during the development of hypertension and renal injury.
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            Role of the Intrarenal Renin-Angiotensin-Aldosterone System in Chronic Kidney Disease

            The existence of local or tissue-based renin-angiotensin-aldosterone systems (RAAS) is well documented and has been implicated as a key player in the pathogenesis of cardiovascular and renal diseases. The kidney contains all elements of the RAAS, and intrarenal formation of angiotensin II not only controls glomerular hemodynamics and tubule sodium transport, but also activates a number of inflammatory and fibrotic pathways. Experimental and clinical studies have shown that the intrarenal RAAS is activated early in diabetic nephropathy, the leading cause of chronic kidney disease (CKD). Although angiotensin-converting enzyme inhibitors and angiotensin receptor blockers decrease the rate of decline in kidney function in patients with diabetic and non-diabetic nephropathy, many patients still progress to end-stage renal disease or die from cardiovascular events. There is still a clear need for additional strategies to block the RAAS more effectively to reduce progression of CKD. The focus of this paper is to review the importance of the intrarenal RAAS in CKD and recent findings in renin-angiotensin biology pertinent to the kidney. We also discuss additional strategies to inhibit the RAAS more effectively and the potential impact of direct renin inhibition on the prevention and management of CKD.
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              Endothelin and Endothelin Antagonists in Chronic Kidney Disease

              The incidence and prevalence of chronic kidney disease (CKD), with diabetes and hypertension accounting for the majority of cases, is on the rise, with up to 160 million individuals worldwide predicted to be affected by 2020. Given that current treatment options, primarily targeted at the renin angiotensin system, only modestly slow down progression to end-stage renal disease, the urgent need for additional effective therapeutics is evident. Endothelin-1 (ET-1), largely through activation of endothelin A receptors, has been strongly implicated in renal cell injury, proteinuria, inflammation and fibrosis leading to CKD. Endothelin receptor antagonists (ERAs) have been demonstrated to ameliorate or even reverse renal injury and/or fibrosis in experimental models of CKD, while clinical trials indicate a substantial antiproteinuric effect of ERAs in diabetic and non-diabetic CKD patients even on top of maximal renin angiotensin system blockade. This review summarizes the role of ET in CKD pathogenesis and discusses the potential therapeutic benefit of targeting the ET system in CKD, with attention to the risks and benefits of such an approach.
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                Author and article information

                Contributors
                tormanen.suvi.a@student.uta.fi
                +358 3 3551 6890 , ilkka.porsti@uta.fi
                paivi.lakkisto@helsinki.fi
                ilkka.tikkanen@helsinki.fi
                onni.niemela@epshp.fi
                timo.paavonen@staff.uta.fi
                jukka.mustonen@uta.fi
                arttu.eraranta@uta.fi
                Journal
                BMC Nephrol
                BMC Nephrol
                BMC Nephrology
                BioMed Central (London )
                1471-2369
                27 October 2017
                27 October 2017
                2017
                : 18
                : 323
                Affiliations
                [1 ]ISNI 0000 0001 2314 6254, GRID grid.5509.9, Faculty of Medicine and Life Sciences, University of Tampere, ; Tampere, Finland
                [2 ]ISNI 0000 0004 0628 2985, GRID grid.412330.7, Department of Internal Medicine, , Tampere University Hospital, ; Tampere, Finland
                [3 ]Minerva Institute for Medical Research, Helsinki, Finland
                [4 ]ISNI 0000 0004 0410 2071, GRID grid.7737.4, Clinical Chemistry and Hematology, , University of Helsinki and Helsinki University Hospital, ; Helsinki, Finland
                [5 ]ISNI 0000 0004 0410 2071, GRID grid.7737.4, Abdominal Center, Nephrology, , University of Helsinki and Helsinki University Hospital, ; Helsinki, Finland
                [6 ]ISNI 0000 0004 0391 502X, GRID grid.415465.7, Medical Research Unit, , Seinäjoki Central Hospital, ; Seinäjoki, Finland
                [7 ]Fimlab Laboratories, Tampere, Finland
                [8 ]ISNI 0000 0001 2314 6254, GRID grid.5509.9, School of Medicine / Internal Medicine, FIN-33014 University of Tampere, ; Tampere, Finland
                Author information
                http://orcid.org/0000-0001-5758-8296
                Article
                742
                10.1186/s12882-017-0742-z
                5659028
                29078759
                bc5e8529-17b7-446b-a7e5-e5a4d603bd70
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 11 January 2017
                : 17 October 2017
                Funding
                Funded by: Finnish Kidney Foundation
                Funded by: FundRef http://dx.doi.org/10.13039/501100005633, Sydäntutkimussäätiö;
                Funded by: Competitive State Research Financing of the Expert Responsibility Area of Tampere University Hospital
                Award ID: 9F061
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100005431, Pirkanmaan Rahasto;
                Funded by: Competitive Research Funding of the Hospital District of Helsinki and Uusimaa
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Nephrology
                chronic kidney disease,sitaxentan,cinacalcet,creatinine,parathyroid hormone,renal renin-angiotensin system

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