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BackgroundNephrolithiasis (NL) is a complex multifactorial disease affecting up to 10%–20% of the human population and causing a significant burden on public health systems worldwide. It results from a combination of environmental and genetic factors. Hyperoxaluria is a major risk factor for NL.MethodsWe used a whole exome-based approach in a patient with calcium oxalate NL. The effects of the mutation were characterised using cell culture and in silico analyses.ResultsWe identified a rare heterozygous missense mutation (c.1519C>T/p.R507W) in theSLC26A6gene that encodes a secretory oxalate transporter. This mutation cosegregated with hyperoxaluria in the family. In vitro characterisation of mutant SLC26A6 demonstrated that Cl−-dependent oxalate transport was dramatically reduced because the mutation affects both SLC26A6 transport activity and membrane surface expression. Cotransfection studies demonstrated strong dominant-negative effects of the mutant on the wild-type protein indicating that the phenotype of patients heterozygous for this mutation may be more severe than predicted by haploinsufficiency alone.ConclusionOur study is in line with previous observations made in the mouse showing thatSLC26A6inactivation can cause inherited enteric hyperoxaluria with calcium oxalate NL. Consistent with an enteric form of hyperoxaluria, we observed a beneficial effect of increasing calcium in the patient’s diet to reduce urinary oxalate excretion.

BackgroundNephrotic syndrome (NS) is characterized by massive sodium chloride retention. Along the kidney tubule, sodium and chloride reabsorption are coupled via a combination of transcellular and paracellular transport pathways. The mechanism of sodium retention in NS has been extensively studied, but the associated chloride transport pathway has not been elucidated.MethodsTo investigate the pathway of chloride retention in NS, we assessed the expression levels of both paracellular and transcellular components of chloride transport in the CD of POD-ATTAC mice and PAN rats, two rodent models of NS. We also used cultured mouse cortical collecting duct cells to see how overexpression or silencing of claudin-4 affect paracellular permeability. Finally, human renal biopsies were used to confirm our in vivo results.ResultsIn control animals, claudin-4 was expressed at low levels in collecting duct (CD). In POD-ATTAC mice and PAN rats, claudin-4 expression was strongly increased in CD beta-intercalated cells (B-IC) and to a lesser extent in CD principal cells and was also induced in connecting tubules. Similarly, we found that claudin-4 was expressed at low levels in normal human kidneys and was dramatically increased in CD cells of nephrotic human kidneys (focal and segmental glomerulosclerosis). In parallel, the expression of pendrin, which exchanges chloride for bicarbonates in B-IC, was decreased in nephrotic compared to control animals. However, the increase in claudin-4 expression observed in NS is likely independent of pendrin abundance. Increased claudin-4 abundance is coupled with increased ENaC-dependent sodium transport. Overexpression or silencing of claudin-4 in mCCDcl1 cells confirmed the preferential permeability of claudin-4 to chloride over sodium.ConclusionsThese results suggest that during NS, transcellular Cl-/HCO - transport decreases while paracellular chloride transport via claudin-4 may increase along the collecting system. Paracellular chloride permeability may constitute a chloride shunt that favors Na+ reabsorption and opposes K+ secretion along the CD in NS.Significance StatementNephrotic syndrome is a common disease characterized by massive proteinuria, hypoalbuminemia and edema due to renal sodium-chloride retention. We demonstrate for the first time an induction of claudin-4 expression indicating a partial shift from transcellular to paracellular chloride transport in the renal collecting system of nephrotic rodents. We confirmed the increased expression of claudin-4 in kidney biopsies of nephrotic patients, highlighting the translational significance of these results. Whether the paracellular pathway may represent a novel target to treat edema in nephrotic syndrome remains to be elucidated.

Distal renal tubular acidosis is a rare renal tubular disorder characterized by hyperchloremic metabolic acidosis and impaired urinary acidification. Mutations in three genes (ATP6V0A4, ATP6V1B1 and SLC4A1) constitute a monogenic causation in 58–70% of familial cases of distal renal tubular acidosis. Recently, mutations in FOXI1 have been identified as an additional cause. Therefore, we hypothesized that further monogenic causes of distal renal tubular acidosis remain to be discovered. Panel sequencing and/or whole exome sequencing was performed in a cohort of 17 families with 19 affected individuals with pediatric onset distal renal tubular acidosis. A causative mutation was detected in one of the three “classical” known distal renal tubular acidosis genes in 10 of 17 families. The seven unsolved families were then subjected to candidate whole exome sequencing analysis. Potential disease causing mutations in three genes were detected: ATP6V1C2, which encodes another kidney specific subunit of the V-type proton ATPase (1 family); WDR72 (2 families), previously implicated in V-ATPase trafficking in cells; and SLC4A2 (1 family), a paralog of the known distal renal tubular acidosis gene SLC4A1. Two of these mutations were assessed for deleteriousness through functional studies. Yeast growth assays for ATP6V1C2 revealed loss-of-function for the patient mutation, strongly supporting ATP6V1C2 as a novel distal renal tubular acidosis gene. Thus, we provided a molecular diagnosis in a known distal renal tubular acidosis gene in 10 of 17 families (59%) with this disease, identified mutations in ATP6V1C2 as a novel human candidate gene, and provided further evidence for phenotypic expansion in WDR72 mutations from amelogenesis imperfecta to distal renal tubular acidosis.

Introduction Anion exchanger 1 (AE1) (SLC4A1 gene product) is a membrane protein expressed in both kidney and red blood cells (RBCs): it exchanges extracellular bicarbonate (HCO3–) for intracellular chloride (Cl–) and participates in acid−base homeostasis. AE1 mutations in kidney α-intercalated cells can lead to distal renal tubular acidosis (dRTA). In RBC, AE1 (known as band 3) is also implicated in membrane stability: deletions can cause South Asian ovalocytosis (SAO). Methods We retrospectively collected clinical and biological data from patients harboring dRTA due to a SLC4A1 mutation and analyzed HCO3– and Cl– transports (by stopped-flow spectrophotometry) and expression (by flow cytometry, fluorescence activated cell sorting, and Coomassie blue staining) in RBCs, as well as RBC membrane stability (ektacytometry). Results Fifteen patients were included. All experience nephrolithiasis and/or nephrocalcinosis, 2 had SAO and dRTA (dRTA SAO+), 13 dominant dRTA (dRTA SAO−). The latter did not exert specific RBC membrane anomalies. Both HCO3– and Cl– transports were lower in patients with dRTA SAO+ than in those with dRTA SAO− or controls. Using 3 different extracellular probes, we report a decreased expression (by 52%, P < 0.05) in dRTA SAO+ patients by fluorescence activated cell sorting, whereas total amount of protein was not affected. Conclusion Band 3 transport function and expression in RBCs from dRTA SAO− patients is normal. However, in SAO RBCs, impaired conformation of AE1/band 3 corresponds to an impaired function. Thus, the driver of acid−base defect during dominant dRTA is probably an impaired membrane expression., Graphical abstract

Background: Distal renal tubular acidosis (dRTA) is characterized by an impairment of the urinary acidification process in the distal nephron. Complete or incomplete metabolic acidosis coupled with inappropriately alkaline urine are the hallmarks of this condition. Genetic forms of dRTA are caused by loss of function mutations of either SLC4A1, encoding the AE1 anion exchanger, or ATP6V1B1 and ATP6V0A4, encoding for the B1 and a4 subunits of the vH+ATPase, respectively. These genes are crucial for the function of A-type intercalated cells (A-IC) of the distal nephron. Summary: Alterations of acid-base homeostasis are variably associated with hypokalemia, hypercalciuria, nephrocalcinosis or nephrolithiasis, and a salt-losing phenotype. Here we report the diagnostic test and the underlying physiopathological mechanisms. The molecular mechanisms identified so far can explain the defect in acid secretion, but do not explain all clinical features. We review the latest experimental findings on the pathogenesis of dRTA, reporting mechanisms that are instrumental for the clinician and potentially inspiring a novel therapeutic strategy. Key Message: Primary dRTA is usually intended as a single-cell disease because the A-IC are mainly affected. However, novel evidence shows that different cell types of the nephron may contribute to the signs and symptoms, moving the focus from a single-cell towards a renal disease.

Objectif Le syndrome d’apnees du sommeil (SAS) est une pathologie frequente mais sous-estimee. Les malades renaux chroniques (MRC) ne sont actuellement pas cites dans les recommandations francaises, comme un groupe a risque de SAS. Nous estimons, dans notre etude, la prevalence du SAS et sa severite dans une cohorte de MRC du CHU de La Reunion. Methodes Il s’agit d’une etude observationnelle retrospective portant sur une population de malades renaux chroniques de stades 1 a 4, definis par une mesure du debit de filtration glomerulaire (DFG) a l’EDTA, ayant accepte un enregistrement du sommeil par polygraphie ventilatoire. Le SAS etait defini par un IAH > 5/H. Resultats Cent trente-trois patients malades renaux chroniques ont ete inclus. Un SAS de tout stade confondu a ete retrouve chez 51 % des patients (n = 68), majoritairement obstructif (n = 60) dont 47 patients (35 %) presentant un SAS modere a severe (IAH > 15/H). Le sexe masculin et l’âge etaient significativement associes au diagnostic de SAS. Le DFG etait plus bas dans le groupe SAS que dans le groupe non SAS (47,8 ± 19,6 vs 59 ± 21,16 mL/min/1,73 m2, p Conclusion Nous avons retrouve une forte prevalence du SAS dans notre population. Une etude prospective permettrait de mieux caracteriser les facteurs de risque qui y sont associes chez les malades renaux chroniques, et ses consequences sur le DFG et son declin.

The distal nephron is a heterogeneous part of the nephron composed by six different cell types, forming the epithelium of the distal convoluted (DCT), connecting, and collecting duct. To dissect the function of these cells, knockout models specific for their unique cell marker have been created. However, since this part of the nephron develops at the border between the ureteric bud and the metanephric mesenchyme, the specificity of the single cell markers has been recently questioned. Here, by mapping the fate of the aquaporin 2 (AQP2) and Na+-Cl−cotransporter (NCC)-positive cells using transgenic mouse lines expressing the yellow fluorescent protein fluorescent marker, we showed that the origin of the distal nephron is extremely composite. Indeed, AQP2-expressing precursor results give rise not only to the principal cells, but also to some of the A- and B-type intercalated cells and even to cells of the DCT. On the other hand, some principal cells and B-type intercalated cells can develop from NCC-expressing precursors. In conclusion, these results demonstrate that the origin of different cell types in the distal nephron is not as clearly defined as originally thought. Importantly, they highlight the fact that knocking out a gene encoding for a selective functional marker in the adult does not guarantee cell specificity during the overall kidney development. Tools allowing not only cell-specific but also time-controlled recombination will be useful in this sense.

The value of estimated glomerular filtration rate (eGFR) in living kidney donors screening is unclear. A recently published web-based application derived from large cohorts, but not living donors, calculates the probability of a measured GFR (mGFR) lower than a determined threshold. Our objectives were to validate the clinical utility of this tool in a cohort of living donors and to test two other strategies based on chronic kidney disease epidemiology collaboration (CKD-EPI) and on MDRD-eGFR. GFR was measured using 51 Cr- ethylene-diamine tetraacetic acid urinary clearance in 311 potential living kidney donors (178 women, mean age 50 ± 11.6 years). The web-based tool was used to predict those with mGFR < 80 mL/min/1.73 m2 . Inputs to the application were sex, age, ethnicity, and plasma creatinine. In our cohort, a web-based probability of mGFR

Background and objectives The predictors of long–term renal function in living kidney donors are currently discussed. Our objectives were to describe the predictors of functional gain of the remaining kidney after kidney donation. We hypothesized that GFR of the remaining kidney divided by volume of this kidney (rk-GFR/vol) would reflect the density of functional nephrons and be inversely associated with functional gain of the remaining kidney. Design, setting, participants, & measurements We conducted a prospective monocentric study including 63 living donors (26 men; 50.3±11.8 years old) who had been evaluated for 51Cr-EDTA and measured GFR, split renal function by scintigraphy before donation (between 2004 and 2009), and measured GFR at 5.7±0.5 years after donation. For 52 donors, volume of the remaining kidney (measured and estimated with the ellipsoid formula using renal computed tomography scannography) was determined before donation. We tested our hypothesis in an external validation cohort of 39 living donors (13 men; 51.0±9.4 years old) from another single center during the same time period. Results For the main cohort, the mean measured GFR was 97.6±13.0 ml/min per 1.73 m2 before donation and 63.8±9.4 ml/min per 1.73 m2 at 5 years. Functional gain averaged 16.2±7.2 ml/min per 1.73 m2 (+35.3%±16.7%). Multivariate analysis showed that age, body mass index, and rk-GFR/vol at donation were negatively correlated with functional gain and had strong predictive power of the 5-year functional gain (adjusted 5-year functional gain for age: −0.4 [95% confidence interval (95% CI), −0.5 to −0.1]; body mass index: −0.3 [95% CI, −0.6 to −0.1]; rk-GFR/vol: −55.1 [95% CI, −92.3 to −17.9]). We tested this model in the external validation cohort (adjusted 5-year functional gain for age: −0.1 [95% CI, −0.5 to 0.3]; body mass index: −0.9 [95% CI, −1.8 to −0.1]; rk-GFR/vol: −97.6 [95% CI, −137.5 to −57.6]) and confirmed that rk-GFR/vol was inversely associated with 5-year functional gain. Conclusions For given age and body mass index, the long–term functional gain of the remaining kidney is inversely associated with the new variable rk-GFR/vol at donation.

Pseudohypoaldosteronism type II (PHAII) is a genetic disease characterized by association of hyperkalemia, hyperchloremic metabolic acidosis, hypertension, low renin, and high sensitivity to thiazide diuretics. It is caused by mutations in the WNK1, WNK4, KLHL3 or CUL3 gene. There is strong evidence that excessive sodium chloride reabsorption by the sodium chloride cotransporter NCC in the distal convoluted tubule is involved. WNK4 is expressed not only in distal convoluted tubule cells but also in β-intercalated cells of the cortical collecting duct. These latter cells exchange intracellular bicarbonate for external chloride through pendrin, and therefore, account for renal base excretion. However, these cells can also mediate thiazide-sensitive sodium chloride absorption when the pendrin-dependent apical chloride influx is coupled to apical sodium influx by the sodium-driven chloride/bicarbonate exchanger. Here we determine whether this system is involved in the pathogenesis of PHAII. Renal pendrin activity was markedly increased in a mouse model carrying a WNK4 missense mutation (Q562E) previously identified in patients with PHAII. The upregulation of pendrin led to an increase in thiazide-sensitive sodium chloride absorption by the cortical collecting duct, and it caused metabolic acidosis. The function of apical potassium channels was altered in this model, and hyperkalemia was fully corrected by pendrin genetic ablation. Thus, we demonstrate an important contribution of pendrin in renal regulation of sodium chloride, potassium and acid-base homeostasis and in the pathophysiology of PHAII. Furthermore, we identify renal distal bicarbonate secretion as a novel mechanism of renal tubular acidosis. Pseudohypoaldosteronism type II (PHAII) is a genetic disease characterized by association of hyperkalemia, hyperchloremic metabolic acidosis, hypertension, low renin, and high sensitivity to thiazide diuretics. It is caused by mutations in the WNK1, WNK4, KLHL3 or CUL3 gene. There is strong evidence that excessive sodium chloride reabsorption by the sodium chloride cotransporter NCC in the distal convoluted tubule is involved. WNK4 is expressed not only in distal convoluted tubule cells but also in beta-intercalated cells of the cortical collecting duct. These latter cells exchange intracellular bicarbonate for external chloride through pendrin, and therefore, account for renal base excretion. However, these cells can also mediate thiazide-sensitive sodium chloride absorption when the pendrin-dependent apical chloride influx is coupled to apical sodium influx by the sodium-driven chloride/bicarbonate exchanger. Here we determine whether this system is involved in the pathogenesis of PHAII. Renal pendrin activity was markedly increased in a mouse model carrying a WNK4 missense mutation (Q562E) previously identified in patients with PHAII. The upregulation of pendrin led to an increase in thiazide-sensitive sodium chloride absorption by the cortical collecting duct, and it caused metabolic acidosis. The function of apical potassium channels was altered in this model, and hyperkalemia was fully corrected by pendrin genetic ablation. Thus, we demonstrate an important contribution of pendrin in renal regulation of sodium chloride, potassium and acid-base homeostasis and in the pathophysiology of PHAII. Furthermore, we identify renal distal bicarbonate secretion as a novel mechanism of renal tubular acidosis.

The nephron cortical collecting duct (CCD) is composed of principal cells, which mediate Na, K, and water transport, and intercalated cells (ICs), which are specialized for acid-base transport. There are two canonical IC forms: acid-secreting α-ICs and HCO3-secreting β-ICs. Chronic acidosis increases α-ICs at the expense of β-ICs, thereby increasing net acid secretion by the CCD. We found by growth factor quantitative PCR array that acidosis increases expression of mRNA encoding SDF1 (or CXCL12) in kidney cortex and isolated CCDs from mouse and rabbit kidney cortex. Exogenous SDF1 or pH 6.8 media increased H+ secretion and decreased HCO3 secretion in isolated perfused rabbit CCDs. Acid-dependent changes in H+ and HCO3 secretion were largely blunted by AMD3100, which selectively blocks the SDF1 receptor CXCR4. In mice, diet-induced chronic acidosis increased α-ICs and decreased β-ICs. Additionally, IC-specific Cxcr4 deletion prevented IC subtype alterations and magnified metabolic acidosis. SDF1 was transcriptionally regulated and a target of the hypoxia-sensing transcription factor HIF1α. IC-specific deletion of Hif1a produced no effect on mice fed an acid diet, as α-ICs increased and β-ICs decreased similarly to that observed in WT littermates. However, Hif1a deletion in all CCD cells prevented acidosis-induced IC subtype distribution, resulting in more severe acidosis. Cultured principal cells exhibited an HIF1α-dependent increase of Sdf1 transcription in response to media acidification. Thus, our results indicate that principal cells respond to acid by producing SDF1, which then acts on adjacent ICs.

Because majority of biological processes are dependent on pH, maintaining systemic acid-base balance is critical. The kidney contributes to systemic acid-base regulation, by reabsorbing HCO3 (-) (both filtered by glomeruli and generated within a nephron) and acidifying urine. Abnormalities in those processes will eventually lead to a disruption in systemic acid-base balance and provoke metabolic acid-base disorders. Research over the past 30 years advanced our understanding on cellular and molecular mechanisms responsible for those processes. In particular, a variety of transgenic animal models, where target genes are deleted either globally or conditionally, provided significant insights into how specific transporters are contributing to the renal acid-base regulation. Here, we broadly overview the mechanisms of renal ion transport participating to acid-base regulation, with emphasis on data obtained from transgenic mice models.

International audience; Distal nephron acid secretion is mediated by highly specialized type A intercalated cells (A-ICs), which contain vacuolar H +-ATPase (V-type ATPase)-rich vesicles that fuse with the apical plasma membrane on demand. Intra-cellular bicarbonate generated by luminal H + secretion is removed by the basolateral anion-exchanger AE1. Chronically reduced renal acid excretion in distal renal tubular acidosis (dRTA) may lead to nephrocalcinosis and renal failure. Studies in MDCK monolayers led to the proposal of a dominant-negative trafficking mechanism to explain AE1-associated dominant dRTA. To test this hypothesis in vivo, we generated an Ae1 R607H knockin mouse, which corresponds to the most common dominant dRTA mutation in human AE1, R589H. Compared with wild-type mice, heterozygous and homozygous R607H knockin mice displayed incomplete dRTA characterized by compensatory upregulation of the Na + /HCO 3 2 cotransporter NBCn1. Red blood cell Ae1-mediated anion-exchange activity and surface polypeptide expression did not change. Mutant mice expressed far less Ae1 in A-ICs, but basolateral targeting of the mutant protein was preserved. Notably, mutant mice also exhibited reduced expression of V-type ATPase and compromised targeting of this proton pump to the plasma membrane upon acid challenge. Accumulation of p62-and ubiquitin-positive material in A-ICs of knockin mice suggested a defect in the degradative pathway, which may explain the observed loss of A-ICs. R607H knockin did not affect type B intercalated cells. We propose that reduced basolateral anion-exchange activity in A-ICs inhibits trafficking and regulation of V-type ATPase, compromising luminal H + secretion and possibly lysosomal acidification.

International audience; Chloride transport by the renal tubule is critical for blood pressure (BP), acid-base, and potassium homeostasis. Chloride uptake from the urinary fluid is mediated by various apical transporters, whereas basolateral chloride exit is thought to be mediated by ClC-Ka/K1 and ClC-Kb/K2, two chloride channels from the ClC family, or by KCl cotransporters from the SLC12 gene family. Nevertheless, the localization and role of ClC-K channels is not fully resolved. Because inactivating mutations in ClC-Kb/K2 cause Bartter syndrome, a disease that mimics the effects of the loop diuretic furosemide, ClC-Kb/K2 is assumed to have a critical role in salt handling by the thick ascending limb. To dissect the role of this channel in detail, we generated a mouse model with a targeted disruption of the murine ortholog ClC-K2. Mutant mice developed a Bartter syndrome phenotype, characterized by renal salt loss, marked hypokalemia, and metabolic alkalosis. Patch-clamp analysis of tubules isolated from knockout (KO) mice suggested that ClC-K2 is the main basolateral chloride channel in the thick ascending limb and in the aldosterone-sensitive distal nephron. Accordingly, ClC-K2 KO mice did not exhibit the natriuretic response to furosemide and exhibited a severely blunted response to thiazide. We conclude that ClC-Kb/K2 is critical for salt absorption not only by the thick ascending limb, but also by the distal convoluted tubule.

International audience; Background: Pendrin, the chloride/bicarbonate exchanger of β-intercalated cells of the renal connecting tubule and the collecting duct, plays a key role in NaCl reabsorption by the distal nephron. Therefore, pendrin may be important for the control of extracellular fluid volume and blood pressure.Methods: Here, we have used a genetic mouse model in which the expression of pendrin can be switched-on in vivo by the administration of doxycycline. Pendrin can also be rapidly removed when doxycycline administration is discontinued. Therefore, our genetic strategy allows us to test selectively the acute effects of loss of pendrin function.Results: We show that acute loss of pendrin leads to a significant decrease of blood pressure. In addition, acute ablation of pendrin did not alter significantly the acid-base status or blood K + concentration.Conclusion: By using a transgenic mouse model, avoiding off-target effects related to pharmacological compounds, this study suggests that pendrin could be a novel target to treat hypertension.

International audience; We recently described a novel thiazide-sensitive electroneutral NaCl transport mechanism resulting from the parallel operation of the Cl-/HCO3- exchanger pendrin and the Na+-driven Cl-/2HCO3- exchanger (NDCBE) in β-intercalated cells of the collecting duct. Although a role for pendrin in maintaining Na+ balance, intravascular volume, and BP is well supported, there is no in vivo evidence for the role of NDCBE in maintaining Na+ balance. Here, we show that deletion of NDCBE in mice caused only subtle perturbations of Na+ homeostasis and provide evidence that the Na+/Cl- cotransporter (NCC) compensated for the inactivation of NDCBE. To unmask the role of NDCBE, we generated Ndcbe/Ncc double-knockout (dKO) mice. On a normal salt diet, dKO and single-knockout mice exhibited similar activation of the renin-angiotensin-aldosterone system, whereas only dKO mice displayed a lower blood K+ concentration. Furthermore, dKO mice displayed upregulation of the epithelial sodium channel (ENaC) and the Ca2+-activated K+ channel BKCa. During NaCl depletion, only dKO mice developed marked intravascular volume contraction, despite dramatically increased renin activity. Notably, the increase in aldosterone levels expected on NaCl depletion was attenuated in dKO mice, and single-knockout and dKO mice had similar blood K+ concentrations under this condition. In conclusion, NDCBE is necessary for maintaining sodium balance and intravascular volume during salt depletion or NCC inactivation in mice. Furthermore, NDCBE has an important role in the prevention of hypokalemia. Because NCC and NDCBE are both thiazide targets, the combined inhibition of NCC and the NDCBE/pendrin system may explain thiazide-induced hypokalemia in some patients.

The human ClC-Kb channel plays a key role in exporting chloride ions from the cytosol and is known to be involved in Bartter syndrome type 3 when its permeation capacity is decreased. The ClC-Kb channel has been recently proposed as a potential therapeutic target to treat hypertension. In order to gain new insights into the sequence-structure-function relationships of this channel, to investigate possible impacts of amino-acid substitutions, and to design novel inhibitors, we first built a structural model of the human ClC-Kb channel using comparative modeling strategies. We combined in silico and in vitro techniques to analyze amino acids involved in the chloride ion pathway as well as to rationalize the possible role of several clinically observed mutations leading to the Bartter syndrome type 3. Virtual screening and drug repositioning computations were then carried out. We identified six novel molecules, including 2 approved drugs, diflusinal and loperamide, with Kd values in the low micromolar range, that block the human ClC-Kb channel and that could be used as starting point to design novel chemical probes for this potential therapeutic target.

Metabolic acidosis is associated with increased urinary calcium excretion and related sequelae, including nephrocalcinosis and nephrolithiasis. The increased urinary calcium excretion induced by metabolic acidosis predominantly results from increased mobilization of calcium out of bone and inhibition of calcium transport processes within the renal tubule. The mechanisms whereby acid alters the integrity and stability of bone have been examined extensively in the published literature. Here, after briefly reviewing this literature, we consider the effects of acid on calcium transport in the renal tubule and then discuss why not all gene defects that cause renal tubular acidosis are associated with hypercalciuria and nephrocalcinosis.

Two end-stage renal disease (ESRD) risk calculators were recently developed by Grams et al., and Ibrahim et al. to calculate ESRD risk before donation among living kidney donors. However, those calculators have never been studied among potential donors for whom donation was refused due to medical contraindications and compared to a group of donors. We compared 15-year and lifetime ESRD risk of donors and nondonors due to medical cause as estimated by those two calculators. Nondonors due to medical cause (n = 27) had a significantly higher 15-year ESRD risk compared to donors (n = 288) with both calculators (0.25 vs. 0.14, P < 0.001 for that developed by Grams et al. and 2.21 vs. 1.43, P = 0.002 for that developed by Ibrahim et al.). On the contrary, lifetime ESRD risk was not significantly different between the two groups. At both times (15 years and lifetime), we observed a significant overlap of ESRD risk between the two groups. ESRD risk calculators could be complementary to standard screening strategy but cannot be used alone to accept or decline donation.

Distal nephron acid secretion is mediated by highly specialized type A intercalated cells (A-ICs), which contain vacuolar H+-ATPase (V-type ATPase)-rich vesicles that fuse with the apical plasma membrane on demand. Intracellular bicarbonate generated by luminal H+ secretion is removed by the basolateral anion-exchanger AE1. Chronically reduced renal acid excretion in distal renal tubular acidosis (dRTA) may lead to nephrocalcinosis and renal failure. Studies in MDCK monolayers led to the proposal of a dominant-negative trafficking mechanism to explain AE1-associated dominant dRTA. To test this hypothesis in vivo, we generated an Ae1 R607H knockin mouse, which corresponds to the most common dominant dRTA mutation in human AE1, R589H. Compared with wild-type mice, heterozygous and homozygous R607H knockin mice displayed incomplete dRTA characterized by compensatory upregulation of the Na+/HCO3− cotransporter NBCn1. Red blood cell Ae1-mediated anion-exchange activity and surface polypeptide expression did not change. Mutant mice expressed far less Ae1 in A-ICs, but basolateral targeting of the mutant protein was preserved. Notably, mutant mice also exhibited reduced expression of V-type ATPase and compromised targeting of this proton pump to the plasma membrane upon acid challenge. Accumulation of p62- and ubiquitin-positive material in A-ICs of knockin mice suggested a defect in the degradative pathway, which may explain the observed loss of A-ICs. R607H knockin did not affect type B intercalated cells. We propose that reduced basolateral anion-exchange activity in A-ICs inhibits trafficking and regulation of V-type ATPase, compromising luminal H+ secretion and possibly lysosomal acidification.

International audience; ATPase H+-transporting lysosomal accessory protein 2 (Atp6ap2), also known as the (pro)renin receptor, is a type 1 transmembrane protein and an accessory subunit of the vacuolar H+-ATPase (V-ATPase) that may also function within the renin-angiotensin system. However, the contribution of Atp6ap2 to renin-angiotensin-dependent functions remains unconfirmed. Using mice with an inducible conditional deletion of Atp6ap2 in mouse renal epithelial cells, we found that decreased V-ATPase expression and activity in the intercalated cells of the collecting duct impaired acid-base regulation by the kidney. In addition, these mice suffered from marked polyuria resistant to desmopressin administration. Immunoblotting revealed downregulation of the medullary Na+-K+-2Cl- cotransporter NKCC2 in these mice compared with wild-type mice, an effect accompanied by a hypotonic medullary interstitium and impaired countercurrent multiplication. This phenotype correlated with strong autophagic defects in epithelial cells of medullary tubules. Notably, cells with high accumulation of the autophagosomal substrate p62 displayed the strongest reduction of NKCC2 expression. Finally, nephron-specific Atp6ap2 depletion did not affect angiotensin II production, angiotensin II-dependent BP regulation, or sodium handling in the kidney. Taken together, our results show that nephron-specific deletion of Atp6ap2 does not affect the renin-angiotensin system but causes a combination of renal concentration defects and distal renal tubular acidosis as a result of impaired V-ATPase activity.

Screening of living kidney donors may require scintigraphy to split glomerular filtration rate (GFR). To determine the usefulness of computed tomography (CT) to split GFR, we compared scintigraphy-split GFR to CT-split GFR. We evaluated CT-split GFR as a screening test to detect scintigraphy-split GFR lower than 40 mL/min/1.73 m2/kidney. This was a monocentric retrospective study on 346 potential living donors who had GFR measurement, renal scintigraphy, and CT. We predicted GFR for each kidney by splitting GFR using the following formula: Volume-split GFR for a given kidney = measured GFR*[volume of this kidney/(volume of this kidney + volume of the opposite kidney)]. The same formula was used for length-split GFR. We compared length- and volume-split GFR to scintigraphy-split GFR at donation and with a 4-year follow-up. A better correlation was observed between length-split GFR and scintigraphy-split GFR (r = 0.92) than between volume-split GFR and scintigraphy-split GFR (r = 0.89). A length-split GFR threshold of 45 mL/min/1.73 m2/kidney had a sensitivity of 100 % and a specificity of 75 % to detect scintigraphy-split GFR less than 40 mL/min/1.73 m2/kidney. Both techniques with their respective thresholds detected living donors with similar eGFR evolution during follow-up. Length-split GFR can be used to detect patients requiring scintigraphy. • Excellent correlation between kidney length and scintigraphy predicted GFR • Kidney length screening detects all donors with GFR lower than 40 mL/min/1.73 m 2 • Kidney length screening can replace scintigraphy screening.

Introduction L’acidose tubulaire distale (ATD) a ete associee a des mutations du gene de la sous-unite a4 de la pompe a protons (ATP6V0A4). Cette maladie se caracterise par une acidose, une concentration plasmatique basse en bicarbonate et une hypokaliemie. Dans le rein, la sous-unite a4 est exprimee dans le tubule proximal et dans les cellules intercalaires du canal collecteur. Ces deux compartiments sont particulierement importants pour la regulation de l’etat acidobasique. Materiels et methodes Pour comprendre la physiopathologie de l’ATD, deux modeles murins d’inactivation de la sous-unite a4 ont ete generes, l’un ou la deletion du gene est totale et l’autre ou la deletion s’effectue uniquement dans les cellules intercalaires renales. Une etude en cage a metabolisme a permis de determiner l’etat acidobasique de ces animaux. Une charge en NH4Cl a permis d’etudier ces modeles lors d’une charge acide. Resultats La deletion totale de la sous-unite a4 entraine une acidose metabolique massive et letale (7–8 semaines de survie). Ces souris presentent une capacite reduite a acidifier leurs urines. Une analyse histologique des tubules proximaux et des cellules intercalaires montrent que le trafic de la pompe a protons est particulierement altere. Une atteinte fonctionnelle du tubule proximal est caracterisee dans ce modele par une proteinurie de bas poids moleculaire. Lorsque la sous-unite a4 est inactivee dans les cellules intercalaires, les souris presentent une acidose tubulaire distale incomplete recapitulant la plupart des caracteristiques de cette atteinte : pH urinaire eleve, defaut d’acidification de l’urine en charge acide. Discussion La sous-unite a4 est donc un composant fondamental permettant l’assemblage de la pompe a protons. Alors que l’inactivation dans les cellules intercalaires entrainent un phenotype modere, l’inactivation totale provoque un phenotype particulierement severe. Cette observation souligne l’importance, jusqu’alors meconnue, de la pompe a protons dans le tubule proximal. Conclusion En conclusion, la pompe a protons est un complexe necessaire a l’acidification de l’urine et au maintien des capacites de reabsorption du tubule proximal.

The pendrin gene ( SLC26A4 ) was initially identified through the positional cloning in patients with Pendred syndrome, a heritable recessive genetic disorder (MIM #274600) characterized by deafness and goiter (Everett et al. 1997). Pendrin encodes for a transmembrane electroneutral exchanger for monovalent anions (e.g. I−, formate, HCO3−, and Cl−). As predicted from the linkage between pendrin gene and characteristics of Pendred's syndrome, pendrin is highly expressed in the inner ear and thyroid gland, where it controls the volume and pH of the endolymphatic fluid, and the transport of iodide required for organification of thyroid hormones, respectively. Pendrin is also highly expressed in the kidney where it controls the final excretion of bicarbonate (Royaux et al. 2001) and NaCl reabsorption and overall blood pressure (Eladari et al. 2014). Although physiological roles of pendrin have been most extensively investigated in the three organs discussed above, pendrin is also expressed in airway epithelia, mammary gland and liver (Wangemann 2013). In these different organs, the function of pendrin is still unknown. However, there is an emerging interest in the relevance of pendrin in airway surface epithelia, because several studies show a possible association of pendrin with asthma. For example, Nakao et al. (Nakao et al. 2008) demonstrated that forced expression …

Calcineurin inhibitors (CNI) are immunosuppressive treatments widely used in transplantation. In mice, CNI activate the renal NaCl cotransporter (NCC), and thereby they cause high blood pressure, metabolic acidosis and hyperkalemia. This association of symptoms is also observed in patients suffering Gordon syndrome, a genetic disease also caused by inappropriate stimulation of NCC. Recently, it has been reported that acidosis of Gordon syndrome also involves stimulation of the Cl-/HCO3- exchanger pendrin. In humans, little is known about the prevalence of Gordon-like syndrome phenotype in patients treated with CNI. Interestingly, NCC and pendrin expression can be assessed by immunoblots using urinary exosomes, small extracellular vesicles that reflect the composition of the plasma membrane of their parental cells. We designed two studies including incident CNI-treated kidney transplants 3 months after transplantation: a retrospective study was designed to determine the prevalence of Gordon-like phenotype, then a prospective one to evaluate NCC and pendrin expression in urinary exosomes. 172 patients were included in the retrospective study: 26% exhibited Gordon-like syndrome phenotype. Then, 58 patients were prospectively included and compared to 58 healthy volunteers. Again ~ 24% of kidney transplant recipients exhibited the Gordon-like phenotype. We show, however, that KT with Gordon-like phenotype do not exhibit a significant increase in NCC, pNCC or pendrin abundance. Furthermore, we show that CNI-treated KT have a marked down regulation of NCC, pNCC protein abundance in urinary exosomes compared to healthy volunteers., Les anticalcineurines sont les immunosuppresseurs les plus utilisés en transplantation rénale. Chez la souris, ils activent le co-transporteur rénal sodium chlore NCC, entrainant un phénotype associant hypertension, acidose métabolique et hyperkaliémie. Ce phénotype est également observé dans une maladie génétique appelée syndrome de Gordon, causée par une stimulation inappropriée de NCC. Récemment, il a été montré que l’acidose dans le Gordon impliquait une stimulation de l’échangeur Cl-/HCO3- pendrine. Chez l’homme, il existe peu de données sur la prévalence d’un phénotype Gordon-like syndrome chez les patients traités par anticalcineurines. De manière intéressante, l’expression de NCC et/ou de pendrine peut être appréhendée par immunoblot en utilisant les exosomes urinaires, qui sont des vésicules extracellulaires dont le contenu dépend de l’activité des cellules émettrices. Nous avons mené deux études qui ont inclus des patients greffés rénaux incidents trois mois après la greffe : Une étude rétrospective pour déterminer la prévalence du phénotype Gordon-like, puis une prospective pour évaluer l’expression de NCC et de pendrine dans les exosomes urinaires. 172 patients ont été inclus dans l’étude rétrospective, dont 26 % présentait le phénotype. Nous avons ensuite recruté 58 patients et 58 volontaires sains. A nouveau, 24 % des greffés présentait le phénotype Gordon-like. Nous montrons, cependant, que les greffés ayant ce phénotype ne présentent pas d’augmentation d’abondance de NCC, pNCC ou pendrine. De plus, nous montrons que les patients greffés sous anticalcineurines ont une abondance significativement moindre de NCC, pNCC dans les exosomes urinaires comparativement aux volontaires.

Kidney plays a major role in several biological fonctions as sodium balance or acid-base homeostasis. Chloride transport in the distal nephron is a key element of these two processes. During my thesis, i have worked on two projects related to physiology and pathophysiology of chloride transport in distal nephron. The first study is the functionnal and molecular characterization of a mouse model bearing the most common dominant dRTA mutation in human AE1, R589H, which corresponds to R607H in the mouse. R607H knock-in mice display incomplete dRTA. Our results showed that reduced basolateral anion exchange activity in type A intercalated cells inhibits trafficking and regulation of V-type ATPase, compromising luminal H+ secretion. In the second study, we investigated the role of a phosphorylation site in the regulation of chloride transport by the ClC-Kb/Barttin channels complex. Our results indicates that Barttin phosphorylation stimulates chloride transport by ClC-Kb channels by increasing the number of active channels in the membrane and hence are involved in the mechanisms of adaptation of renal chloride absorption in response to changes in dietary NaCl intake., Le rein joue un rôle crucial dans de multiples processus biologiques, tels que le maintien de l’homéostasie acide-base et de la balance sodée. Le transport de chlore dans le néphron distal est un élément majeur de ces deux fonctions physiologiques. Au cours de ma thèse, j’ai travaillé sur deux projets relatifs à la physiologie et la physiopathologie du transport de chlore dans le néphron distal. Le premier travail concerne la caractérisation fonctionnelle et moléculaire d’un modèle murin dont le gène Slc4a1 codant pour l’échangeur d’anion de type 1 (AE1) a été modifié, pour introduire une mutation ponctuelle (R589H) dans la séquence protéique. Cette mutation est la plus fréquente des mutations de cette protéine responsable d’acidose tubulaire rénale distale chez l’Homme. Comme les patients, ces souris présentent une acidose tubulaire distale. Nos résultats ont montré que la diminution de l’activité d’échange Cl-/HCO3-, due à la baisse drastique de l’expression d’AE1 dans les cellules -intercalaires du canal collecteur, affecte l’expression et la distribution apicale de la pompe à protons, ce qui altère de ce fait la fonction d’acidification de l’urine. Le second travail porte sur l’étude de la régulation du transport de chlore par le complexe protéique ClC-Kb/Barttin, par phosphorylation de la Barttin. Ce travail démontre que la phosphorylation de la Barttin stimule le transport de chlore du canal ClC-Kb, en augmentant la distribution et la stabilité du complexe ClC-Kb/Barttin à la membrane. Ainsi, la phosphorylation de la Barttin pourrait représenter un mécanisme d’adaptation du transport de chlore en réponse à des variations des apports alimentaires en NaCl.

Kidney plays a major role in several biological fonctions as sodium balance or acid-base homeostasis. Chloride transport in the distal nephron is a key element of these two processes. During my thesis, i have worked on two projects related to physiology and pathophysiology of chloride transport in distal nephron. The first study is the functionnal and molecular characterization of a mouse model bearing the most common dominant dRTA mutation in human AE1, R589H, which corresponds to R607H in the mouse. R607H knock-in mice display incomplete dRTA. Our results showed that reduced basolateral anion exchange activity in type A intercalated cells inhibits trafficking and regulation of V-type ATPase, compromising luminal H+ secretion. In the second study, we investigated the role of a phosphorylation site in the regulation of chloride transport by the ClC-Kb/Barttin channels complex. Our results indicates that Barttin phosphorylation stimulates chloride transport by ClC-Kb channels by increasing the number of active channels in the membrane and hence are involved in the mechanisms of adaptation of renal chloride absorption in response to changes in dietary NaCl intake., Le rein joue un rôle crucial dans de multiples processus biologiques, tels que le maintien de l’homéostasie acide-base et de la balance sodée. Le transport de chlore dans le néphron distal est un élément majeur de ces deux fonctions physiologiques. Au cours de ma thèse, j’ai travaillé sur deux projets relatifs à la physiologie et la physiopathologie du transport de chlore dans le néphron distal. Le premier travail concerne la caractérisation fonctionnelle et moléculaire d’un modèle murin dont le gène Slc4a1 codant pour l’échangeur d’anion de type 1 (AE1) a été modifié, pour introduire une mutation ponctuelle (R589H) dans la séquence protéique. Cette mutation est la plus fréquente des mutations de cette protéine responsable d’acidose tubulaire rénale distale chez l’Homme. Comme les patients, ces souris présentent une acidose tubulaire distale. Nos résultats ont montré que la diminution de l’activité d’échange Cl-/HCO3-, due à la baisse drastique de l’expression d’AE1 dans les cellules -intercalaires du canal collecteur, affecte l’expression et la distribution apicale de la pompe à protons, ce qui altère de ce fait la fonction d’acidification de l’urine. Le second travail porte sur l’étude de la régulation du transport de chlore par le complexe protéique ClC-Kb/Barttin, par phosphorylation de la Barttin. Ce travail démontre que la phosphorylation de la Barttin stimule le transport de chlore du canal ClC-Kb, en augmentant la distribution et la stabilité du complexe ClC-Kb/Barttin à la membrane. Ainsi, la phosphorylation de la Barttin pourrait représenter un mécanisme d’adaptation du transport de chlore en réponse à des variations des apports alimentaires en NaCl.