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2014 ; 184
(7
): 1957-66
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Tubular obstruction leads to progressive proximal tubular injury and atubular
glomeruli in polycystic kidney disease
#MMPMID24815352
Galarreta CI
; Grantham JJ
; Forbes MS
; Maser RL
; Wallace DP
; Chevalier RL
Am J Pathol
2014[Jul]; 184
(7
): 1957-66
PMID24815352
show ga
In polycystic kidney disease (PKD), renal parenchyma is destroyed by cysts,
hypothesized to obstruct nephrons. A signature of unilateral ureteral
obstruction, proximal tubular atrophy leads to formation of atubular glomeruli.
To determine whether this process occurs in PKD, kidneys from pcy mice
(moderately progressive PKD), kidneys from cpk mice (rapidly progressive PKD),
and human autosomal dominant PKD were examined in early and late stages.
Integrity of the glomerulotubular junction and proximal tubular mass were
determined in sections stained with Lotus tetragonolobus lectin. Development of
proximal tubular atrophy and atubular glomeruli was determined in serial sections
of individual glomeruli. In pcy mice, most glomerulotubular junctions were normal
at 20 weeks, but by 30 weeks, 56% were atrophic and 25% of glomeruli were
atubular; glomerulotubular junction integrity decreased with increasing cyst area
(r = 0.83, P < 0.05). In cpk mice, all glomerulotubular junctions were normal at
10 days, but by 19 days, 26% had become abnormal. In early-stage autosomal
dominant PKD kidneys, 50% of glomeruli were atubular or attached to atrophic
tubules; in advanced disease, 100% were abnormal. Thus, proximal tubular injury
in cystic kidneys closely parallels that observed with ureteral obstruction.
These findings support the hypothesis that, in renal cystic disorders,
cyst-dependent obstruction of medullary and cortical tubules initiates a process
culminating in widespread destruction of proximal convoluted tubules at the
glomerulotubular junction.