Robin S. Goldstein

Biochemical mechanisms of cephaloridine nephrotoxicity: time and concentration dependence of peroxidative injury.

These experiments were designed to elucidate the initiating biochemical events mediating cephaloridine (CPH) nephrotoxicity. Renal cortical slices from naive male Fischer-344 rats were incubated at 37 degrees C in a phosphate- or bicarbonate-buffered medium containing 0, 1, 5, or 10 mM CPH. Slices were incubated for 15, 30, 45, 60, 90, 120, and 180 min and evaluated for accumulation of organic ions [p-aminohippurate (PAH) and tetraethylammonium (TEA)], pyruvate-stimulated gluconeogenesis, malondialdehyde (MDA) production, and reduced glutathione (GSH) content. Renal cortical slice accumulation of PAH and TEA was decreased by 5 and 10 mM CPH as early as 120 and 90 min of incubation, respectively. CPH-induced MDA production by renal cortical slices preceded the effects of CPH on organic ion accumulation. Coincubation of CPH with the antioxidants promethazine and N,N-diphenyl-p-phenylenediamine inhibited CPH-induced lipid peroxidation and changes in organic ion accumulation. In contrast, 5 or 10 mM CPH inhibited gluconeogenic capacity at all time points examined, an effect which was not influenced by antioxidant treatment. Depletion of renal cortical GSH by 5 or 10 mM CPH was evident following 30 min of incubation and was also unaffected by antioxidant treatment. These results support the hypothesis that lipid peroxidation mediates the effects of CPH on renal organic ion transport. The early and profound inhibition of gluconeogenesis by CPH suggests that the biochemical pathways of gluconeogenesis are either proximal to or represent a primary target for CPH nephrotoxicity.

Cisplatin nephrotocity: Role of filtration and tubular transport of cisplatin in isolated perfused kidneys

Isolated perfused rat kidneys were used to determine the contribution of filtration and tubular transport of cisplatin to its nephrotoxicity. Perfusion of kidneys with 0.5 mM cisplatin concomitantly reduced tubular reabsorption of electrolytes and glomerular filtration rate in a time-dependent manner. These renal functional changes were similar to those obtained following in vivo cisplatin treatment (10 mg/kg). In vitro exposure to cisplatin reduced the renal clearance of organic ions without reducing renal perfusate flow, suggesting that renal hemodynamic changes do not mediate cisplatin-induced proximal tubular dysfunction. Inhibition of organic ion transport also was observed in non-filtering perfused kidneys treated with 0.5 mM cisplatin, implying that filtration of cisplatin is not a prerequisite for induction of toxicity. These data also suggest that cisplatin transport from a basolateral site may be important in the development of acute nephrotoxicity.

Acetaminophen and p-Aminophenol Nephrotoxicity in Aging Male Sprague-Dawley and Fischer 344 Rats

Strain differences in susceptibility of rats to acetaminophen (APAP)-induced nephrotoxicity have been reported previously. Young adult male Fischer 344 (F344) rats are susceptible, whereas weight-matched Sprague-Dawley (SD) rats are not susceptible to APAP nephrotoxicity. Susceptibility to APAP nephrotoxicity is also age dependent, at least in F344 rats. Middle-aged (12-15 months old) male F344 rats are more susceptible to APAP-induced nephrotoxicity than are young adult (2-4 months old) males. APAP nephrotoxicity in aging SD rats has not been evaluated. The present studies were designed to define strain differences in the nephrotoxicity of APAP and p-aminophenol (PAP), a nephrotoxic metabolite of APAP, using 2-, 3-, and 9- to 12-month-old F344 and SD rats. At 2 months of age, F344, but not SD, rats were susceptible to APAP-induced nephrotoxicity. However, at 3 months of age, strain differences were less marked, as susceptibility to APAP nephrotoxicity appeared to increase between 2 and 3 months of age only in SD rats. By 9-12 months of age, susceptibility to APAP nephrotoxicity was comparable in F344 and SD rats. No age- or strain-related differences were observed in the excretory pattern of urinary APAP and metabolites that might explain the increased susceptibility of aging rats to APAP nephrotoxicity. Strain differences in age-matched rats were not marked for PAP-induced nephrotoxicity. Susceptibility of both 3- and 12-month-old F344 and SD rats to PAP-induced nephrotoxicity was greater compared to strain-matched 2-month-old rats. In both F344 and SD rats, PAP nephrotoxicity increased only modestly between 3 and 12 months of age, indicating that increased susceptibility to PAP probably does not play a major role in the age-dependent increase in APAP nephrotoxicity. Thus, strain differences in APAP nephrotoxicity decrease with advancing age. The mechanisms mediating the increased susceptibility to APAP nephrotoxicity in middle-aged rats are not known but may relate, at least in part, to age-dependent differences in pharmacokinetics. The present study highlights the importance of considering the age of rats when evaluating drug toxicity. Even in young adult rats, subtle maturational changes in drug metabolism and/or disposition may occur, making toxicological evaluation in weight-matched rats of different strains and ages inappropriate.

Mechanisms mediating cephaloridine inhibition of renal gluconeogenesis

Incubation of renal cortical slices with cephaloridine (CPH) markedly inhibits pyruvate-supported gluconeogenesis, an effect which is independent of CPH-induced lipid peroxidation. CPH was found to inhibit pyruvate-supported gluconeogenesis in a time-and concentration-dependent manner. Pyruvate-supported gluconeogenesis was inhibited as early as 10 min following incubation of renal cortical slices with 5 mM CPH. Similarly, endogenous gluconeogenesis was impaired following CPH treatment. CPH depressed the renal cortical slice content of ATP by 50%, but only following 90 and 120 min of drug exposure, suggesting that mitochondrial dysfunction does not mediate the inhibition of gluconeogenesis by CPH. To identify the intracellular site(s) of CPH inhibition of gluconeogenesis, the effects of CPH on glucose production were evaluated using substrates catalyzed by rate-limiting reactions. CPH inhibited renal cortical slice gluconeogenesis when the following substrates were used: pyruvate (mitochondrial), oxaloacetate and fructose-1,6-diphosphate (FDP) (postmitochondrial), and glucose-6-phosphate (G6P, endoplasmic reticulum). Inhibition of G6P-supported gluconeogenesis occurred within 5 min of incubation with 5 mM CPH. Direct addition of CPH to microsomal suspensions inhibited G6Pase activity in a concentration-dependent fashion. By contrast, addition of CPH to cytosolic fractions did not affect FDPase activity. CPH increased the Km and decreased the Vmax of G6Pase, indicating mixed competitive and noncompetitive inhibition. These data indicate that the profound inhibition of renal cortical slice gluconeogenesis by CPH is mediated by inhibition of microsomal G6Pase activity.

Cephaloridine nephrotoxicity in aging male fischer-344 rats

Age-related differences in susceptibility to cephaloridine nephrotoxicity were evaluated in male Fischer-344 rats. Rats, 2.5, 4, 10-12 and 27-29 months old, were administered a single intraperitoneal dose of cephaloridine and renal function evaluated 24 h later. Susceptibility to cephaloridine-induced nephrotoxicity was age-related. Older rats (10-12 and 27-29 months) were the most susceptible to cephaloridine nephrotoxicity as indicated by a dose-related increase in relative kidney weight, elevation in blood urea nitrogen concentrations and a diminished capacity of renal cortical slices to accumulate the organic anion, p-aminohippurate (PAH) and the organic cation, tetraethylammonium (TEA). Impaired renal function following cephaloridine treatment was not detected in 2.5-month-old, apparent to a slight extent in 4-month-old, and most pronounced in 10-12- and 27-29-month-old rats. Serum and renal cortical concentrations of cephaloridine tended to be greater in older rats compared to that of young adults. Thus, the enhanced susceptibility of older rats to cephaloridine nephrotoxicity may be related in part to the increased renal cortical accumulation of cephaloridine.

Biochemical mechanisms of cephaloridine nephrotoxicity

Large doses of the cephalosporin antibiotic, cephaloridine, produce acute proximal tubular necrosis in humans and in laboratory animals. Cephaloridine is actively transported into the proximal tubular cell by an organic anion transport system while transport across the lumenal membrane into tubular fluid appears restricted. High intracellular concentrations of cephaloridine are attained in the proximal tubular cell which are critical to the development of nephrotoxicity. There is substantial evidence indicating that oxidative stress plays a major role in cephaloridine nephrotoxicity. Cephaloridine depletes reduced glutathione, increases oxidized glutathione and induces lipid peroxidation in renal cortical tissue. The molecular mechanisms mediating cephaloridine-induced oxidative stress are not well understood. Inhibition in gluconeogenesis is a relatively early biochemical effect of cephaloridine and is independent of lipid peroxidation. Furthermore, cephaloridine inhibits gluconeogenesis in both target (kidney) and non-target (liver) organs of cephaloridine toxicity. Since glucose is not a major fuel of proximal tubular cells, it is unlikely that cephaloridine-induced tubular necrosis is mediated by the effects of this drug on glucose synthesis.

Strain differences in acetaminophen nephrotoxicity in rats: role of pharmacokinetics

Strain differences in susceptibility of rats to acetaminophen (APAP)-induced nephrotoxicity have been previously reported. Young adult male Fischer-344 (F-344) rats are susceptible whereas weight-matched Sprague-Dawley (SD) rats are not susceptible to APAP nephrotoxicity. The present study was designed to evaluate the role of pharmacokinetics in strain-dependent APAP nephrotoxicity. Age-matched (2-month-old) male F-344 and SD rats received 250-750 mg APAP/kg, i.v., or 0-1000 mg APAP/kg, i.p. Pharmacokinetic variables were evaluated following i.v. APAP and 24 h urinary excretion of APAP and major metabolites was determined following both i.v. and i.p. administration of APAP. Following i.p. administration, nephrotoxicity was observed only in F-344 rats following 1000 mg APAP/kg; SD rats were not susceptible to APAP-induced nephrotoxicity. In contrast, nephrotoxicity did not occur in either F-344 or SD rats administered APAP i.v. Pharmacokinetic variables (volume of distribution, apparent systemic clearance, and apparent terminal half-life) of APAP were similar in F-344 and SD rats. No striking differences in the pattern of specific urinary metabolites were observed between F-344 and SD rats treated with i.p. or i.v. APAP. Thus, strain differences in APAP-induced nephrotoxicity do not appear to be due to differences in pharmacokinetics or major pathways of APAP metabolism.

Effects of gentamicin on renal function in isolated perfused kidneys from male and female rats

The isolated perfused rat kidney was used to determine whether sex differences in gentamicin nephrotoxicity are related to intrinsic differences in renal response to gentamicin. Acute exposure to gentamicin decreased fractional reabsorption of water and electrolytes without changes in glomerular filtration rate in both sexes. Gentamicin decreased the tubular reabsorption of lysozyme but not glomerular permeability to lysozyme. No sex differences in renal responses were observed following in vitro exposures to gentamicin, suggesting that sex differences in susceptibility to gentamicin in vivo may be attributable to extrarenal factors, such as pharmacokinetics.

Cephaloridine Nephrotoxicity: Strain and Sex Differences in Mice

Marked species and sex differences have been observed in the nephrotoxicity to the cephalosporin antibiotic cephaloridine (CPH). Preliminary studies have also indicated significant strain differences in mice to CPH nephrotoxicity. To investigate these findings further, male and female C57BL, BALB/c, CD-1, CFW, CBA/J, and DBA/2 mice were given either 4000 or 6000 mg/kg of CPH, sc. Renal function was assessed 48 hr later by the ability of renal cortical slices to accumulate the organic ions p-aminohippurate (PAH) and tetraethylammonium (TEA), changes in blood urea nitrogen (BUN) and kidney-to-body wt ratios. CPH produced dose-dependent nephrotoxicity in C57BL female mice. After 6000 mg/kg, PAH and TEA slice-to-medium (S/M) ratios were reduced by 70 and 49%, respectively; BUN was elevated 10-fold. The same dose given to CFW females had no effect. BALB/c, CD-1, CBA/J, and DBA/2 females showed intermediate signs of toxicity. Male mice of all strains tested exhibited no nephrotoxicity. CPH nephrotoxicity has been correlated with the concentration of CPH within the tubular cell; and C57BL female mice had relatively greater intracellular accumulation of CPH than C57BL male mice and CFW female mice in vitro and in vivo. Thus, differences in net renal cortical accumulation of CPH suggest possible differences in transport, binding, and/or metabolism of CPH may exist among strains and between sexes of mice.

Intrinsic susceptibility of the kidney to acetaminophen toxicity in middle-aged rats

Acetaminophen (APAP)-induced nephrotoxicity is age-dependent in male Sprague-Dawley (SD) rats: middle-aged (9-12 months old) rats exhibit nephrotoxicity at lower dosages of APAP than do young adults (2-3 months old). The present study was designed to test the hypothesis that the intrinsic susceptibility of renal tissue to APAP toxicity is increased in middle-aged rats. APAP toxicity was evaluated in renal slices from naive 3- and 12-month-old male SD rats incubated with 0-50 mM APAP for 2-8 h. Renal slice glutathione (GSH) and APAP concentrations were determined; renal function was assessed by organic anion (para-aminohippurate, PAH) and cation (tetraethylammonium, TEA) accumulation; and cell viability was assessed by lactate dehydrogenase (LDH) leakage. At each concentration of APAP tested, accumulation of APAP by renal slices was similar in 3- and 12-month-olds. APAP toxicity in renal slices from both 3- and 12-month-old rats was characterized by concentration-dependent increases in LDH leakage. In contrast to APAP nephrotoxicity in vivo, APAP toxicity in renal slices was accompanied by decreased accumulation of PAH and TEA. Additionally, APAP produced marked reductions in renal slice GSH content in a concentration-dependent manner: however, in contrast to APAP nephrotoxicity in vivo, APAP-induced GSH depletion in vitro did not precede cytotoxicity. No consistent age-dependent differences in the time- and concentration-response curves for APAP nephrotoxicity were observed. These data suggest that APAP cytotoxicity in vitro is not increased in 12-month-old rats. However, since the pattern (and mechanisms) of APAP cytotoxicity in vitro appears to be different from that observed in vivo, extrapolation of in vitro cytotoxicity to in vivo nephrotoxicity is limited. Therefore, age differences in intrinsic susceptibility of the intact kidney cannot be excluded as a mechanism contributing to enhanced APAP nephrotoxicity in middle-aged rats.