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Background: Combined kidney-pancreas transplantation (CKPT) with its associated euglycemia has been shown to prevent or reduce recurrent diabetic nephropathy in the renal allograft. There has been no evaluation of residual native kidney function after CKPT. The purpose of this study was to determine whether native kidney function may be present in diabetic recipients years after CKPT., Methods: Between 1986 and 1992, 37 patients with type 1 insulin-dependent diabetes mellitus with renal failure underwent CKPT. In each case, a single native nephrectomy was performed. We studied 16 patients who had continuing renal and pancreas function more than 4 years after CKPT. Fourteen diabetics with a functioning renal allograft but no pancreas function were used as a control group. Simultaneous renal scans (technetium-99m diethylenetriamine pentaacetic acid) of the native and transplanted kidneys were obtained with a dual-head scintillation camera. Total glomerular filtration rate (GFR) was determined from the rate of clearance of the tracer from the extracellular space measured for 2 hr with an ambulatory renal monitor., Results: The study groups had similar pretransplant characteristics. At the time of the study, the mean serum creatinine level was not significantly different in the CKPT and control groups (1.7+/-0.7 vs. 1.5+/-0.3 mg/dl, respectively). In the CKPT and control groups, total GFRs were 70.1+/-33 vs. 72.1+/-16.5 ml/min (NS), allograft GFRs were 63+/-34.2 vs. 70.4+/-16 ml/min (NS), and native kidney GFRs were 7.1+/-7.2 vs. 1.7+/-1.9 ml/min (P < 0.05), respectively. In both groups, there was a significant correlation between total GFR and allograft GFR (P < 0.001), but not between total GFR and native kidney GFR. Significant single native kidney GFR (more than 8 ml/min) was found in 7/16 (44%) patients in the CKPT group, but in none of the controls., Conclusions: These results suggest that residual native kidney function can be present and contribute moderately to total GFR after CKPT. Euglycemia after CKPT may have a protective role in native kidneys.

The inadequacy of the current techniques to monitor renal function has been the most important limitation for determining the appropriateness of a particular form of therapy in acute renal failure. The objective of this study was to determine the advantage offered by a new method of accurate, noninvasive, and real-time monitoring of renal function during the critical care of patients. A radiation detector attached to a miniature data logger was used to monitor the clearance of the glomerular filtration agent 99mTc-diethylene triamine pentaacetic acid from the extracellular space in 20 patients admitted into an intensive care unit. The rate constant for this clearance was calculated online from 5-min epoch lengths of activity versus time. Changes in this constant were compared with changes in plasma creatinine and timed urine output. The results showed that the ambulatory renal monitor could accurately measure rapid changes in renal function during the critical care of patients who are at risk of acute renal failure with a resolution time of 5 to 10 min. The sensitivity and specificity of the technique are also superior to plasma creatinine and urine output because it can detect minimal and transient changes in renal function that otherwise may have gone undetected by these parameters. This unique approach should allow for the immediate institution and/or adjustment of the appropriate therapeutic procedure to preserve or improve the renal function.

Real-time changes in renal function were studied in a group of 20 patients at risk of contrast-material-induced acute renal failure during different angiographic procedures. Renal function was evaluated with an ambulatory renal monitor (ARM) after a single injection of the glomerular filtration agent technetium-99m diethylenetriaminepentaacetic acid (DTPA). The ARM was used to continuously monitor the clearance of Tc-99m DTPA activity from the extracellular space in the arm of the patient during angiography. A one-compartment model was used to calculate on-line the rate constant for clearance of Tc-99m DTPA from the extracellular space. Changes in the rate constant were compared with changes in plasma creatinine level measured 1-4 days after angiography. The results showed that the ARM measured rapid changes in renal function during angiography with a resolution time of 5-10 minutes in patients with normal to moderately decreased renal function and 15-20 minutes in patients with severe renal dysfunction. The sensitivity of this technique was superior to that of plasma creatinine level analysis.

Phorbol 12-myristate 13-acetate (PMA) decreases the tight junction conductance (TJC) during the reorganization of LLC-PK1A monolayers, but has the opposite effect in LLC-PK1B4, MDCK, and MDCK4 cells. Because no protein synthesis was required for the effects of PMA on the TJC of LLC-PK1A monolayers, we conclude that the regulation of the tight junction by protein kinase C (PKC) is a posttranslational event. In LLC-PK1A monolayers with existing tight junctions, PMA produced an initial increase in the TJC that reverted later to control values despite the continuous presence of PMA and cycloheximide. The inhibitory effect of PMA on the other cell lines was not revertible. A downregulation of total PKC activity and phorbol ester receptors was only observed during the reorganization of LLC-PK1A monolayers. PMA further increases this downregulation. This indicates that the peculiar response to PMA observed in LLC-PK1A monolayers is the result of two concurrent events: 1) the early activation of the enzyme just before the reorganization of the tight junctions begin, and 2) its late downregulation induced after prolonged exposure to phorbol esters. We conclude that PKC regulates the development of the occluding junctions, but through different mechanisms dependent on the characteristics of the cells.

This study analyzes the differential characteristics of the Na(+)-H+ antiport systems observed in several epithelial and non-epithelial renal cell lines. Confluent monolayers of LLC-PK1A cells have a Na(+)-H+ antiport system located in the apical membrane of the cell. This system, however, is not expressed during cell proliferation or after incubation in the presence of different mitogenic agents. In contrast, confluent monolayers of MDCK4 express minimal Na(+)-H+ antiport activity in the confluent monolayer state but reach maximal antiport activity during cell proliferation or after activation of the cells by different mitogenic agents. Similar results were obtained with the renal fibroblastic cell line BHK. The system present in MDCK4 cells is localized in the basolateral membrane of the epithelial cell. In LLC-PK1A cells, an increase in the extracellular Na+ concentration produces a hyperbolic increase in the activity of the Na(+)-H+ antiporter. In MDCK4 and BHK cells, however, an increase in external Na+ produces a sigmoid activation of the system. Maximal activation of the system occur at a pHo 7.5 in LLC-PK1A cells and pHo 7.0 in MDCK4 cells. The Na(+)-H+ antiporter of LLC-PK1A cells is more sensitive to the inhibitory effect of amiloride (Ki 1.8 x 10(-7) M) than is the antiporter of MDCK4 cells (Ki 7.0 x 10(-6) M). Moreover, 5-(N-methyl-N-isobutyl)amiloride is the most effective inhibitor of Na(+)-H+ exchange in LLC-PK1A cells, but the least effective inhibitor in MDCK4 cells. Conversely, the analog, 5-(N,N-dimethyl)amiloride, is the most effective inhibitor of Na(+)-H+ exchange in MDCK4 cells, but is the least effective inhibitor in LLC-PK1A cells. These results support the hypothesis that Na(+)-H+ exchange observed in LLC-PK1A and other cell lines may represent the activity of different Na(+)-H+ antiporters.

The transport of D-aspartate has been studied in an epithelial cell line from a pig kidney. The amino acid is accumulated by LLC-PK1 cells without evidence of metabolism. The accumulation against a concentration gradient occurs through a mechanism with several features of a carrier-mediated process. The influx may be accounted for by a saturable Na+-dependent and nonsaturable Na+-independent process. The presence of Na+ in the incubation medium increases Vmax without affecting Km. A number of differences in the apparent affinities and specifities allows one to differentiate between this and the acidic amino acid transport system from other tissues. Polarized uptake from either side of the monolayers indicates that the acidic amino acid transport system is preferentially located in the apical membrane of the cultured renal cells. The apical localization of this system clearly contrasts with the basolateral localization of the other three neutral amino acid transport systems reported previously, indicating a high degree of cell polarization. The present study shows a close similarity between the Na+-dependent acidic amino acid transport system in LLC-PK1 cells and the system present in the apical membrane of the proximal tubular cells.

Confluent monolayers of LLC-PK1 cells, an epithelial cell derived from a normal pig kidney, contain high levels of alkaline phosphatase and gamma-glutamyl transpeptidase activities. Inhibition studies show a close similarity between alkaline phosphatase and the so-called liver-bone-kidney isoenzyme. Nearly complete recovery of both activities in the microsomal fraction demonstrates the membrane-bound characteristics of these enzymes. Histochemical localization of the enzymes activities on the apical membrane of LLC-PK1 cells confirms this observation. The activity of both enzymes decreases to very low levels when the cells are in exponential growth. Confluent monolayers of LLC-PK1 cells plated at saturation density with cells that were in active growth show a progressive increase in the activity of alkaline phosphatase and gamma-glutamyl transpeptidase. This increase is dependent on the synthesis de novo of RNA and protein and supports the conclusion that the activity of both enzymes is regulated at the transcriptional level. The development of these enzymes is delayed with respect to the development of the occluding junctions. This delay and the direct appearance of alkaline phosphatase activity in the apical membrane indicate that the different components of this membrane are inserted after the limits of the membrane have been established by the synthesis and assembly of the occluding junctions. Alkaline phosphatase activity of confluent monolayers can be further induced by reducing the concentration of phosphate in the medium. When the junctions are dissociated by incubating the monolayers in Ca2+-free medium, the alkaline phosphatase activity migrates freely beyond the limits of the apical membrane until it covers the entire cell surface. Both enzymes are synthesized even in the absence of contact between the cells, suggesting that the occluding junctions in LLC-PK1 monolayers are involved in the polarized distribution, but not in the modulation, of the synthesis of these enzymes. In addition, the progressive decrease in enzyme synthesis that is obtained by reducing the cell-substratum adhesion supports the idea that it is the cell-to-substrate and not the cell-to-cell interaction which is involved in the modulation of these enzymatic markers of the apical membrane.

At confluency, LLC-PK1 monolayers develop a transepithelial electrical resistance of 127 omega X cm2 and a spontaneous electrical potential that very seldom exceeds 1 mV. The monolayer shows a linear current-voltage relation in symmetrical solutions. The total conductance increases linearly with increases in the electrolyte concentration of the bathing solution. These characteristics indicate that the membrane that controls the permeability properties of the monolayer is a single membrane that it does not contain very weakly charged sites and it is sufficiently thick to obey the principle of microscopic electroneutrality. The sodium-to-chloride permeability determined from dilution potentials or from direct measurements of unidirectional Na+ and Cl- flux are 0.30 and 0.38, respectively, almost identical to the ratio obtained in the straight segment of the renal proximal tubule. The steady-state value of the electrical resistance depends on the Ca2+ concentration in the incubation medium with an apparent Km of 0.1 mM. A transitory opening of the occluding junctions results in a more uniform distribution of the Na+-dependent sugar transport system, which is normally confined to the apical membrane of the epithelial cell. This result indicates that the occluding junctions in LLC-PK1 monolayers act as a mechanical barrier, preventing the intermixing of extrinsic as well as intrinsic membrane proteins.

The uptake of inorganic phosphate was studied in an epithelial cell line of renal origin. Phosphate was accumulated through a mechanism with several features of a carrier-mediated process. The influx was accounted for by a saturable Na+-dependent and a nonsaturable Na+-independent process. Kinetic analysis at pH 6.6 and 7.4 suggests that the dibasic form of phosphate is the form transported by the saturable Na+-dependent system. The presence of Na+ in the incubation medium increased Vmax without affecting Km. Arsenate competitively inhibited the Na+-dependent phosphate transport with a Ki of 1.2 mM at 140 mM Na+ and pH 7.4. Other known inhibitors of phosphate reabsorption in the proximal tubule also inhibited phosphate transport by this cell line. Uptake studies from either side of the monolayers indicated that this transport system is preferentially located in the apical membrane of the cultured renal cells. These results show a close similarity between the Na+-dependent phosphate transport system in LLC-PK1 cells and the system present in the apical membrane of the proximal tubular cells.

The transport of three neutral amino acid analogs has been studied in an epithelial cell line from a pig kidney. 2-Aminoisobutyric acid is accumulated by LLC-PK1 cells against a concentration gradient through a mechanism with several features of a carrier-mediated process. The influx is accounted for by a saturable Na+-dependent and nonsaturable Na+-independent process. The total influx of 2-(methylamino)isobutyric acid is also mediated through Na+-dependent and Na+-independent systems. Part of the Na+-dependent influx of 2-aminoisobutyric acid was competitively inhibited by 2-(methylamino)isobutyric acid (Ki = 4.2 mM).l Selectivity studies indicate that the 2-(methylamino)isobutyric acid-sensitive part of 2-aminoisobutyric acid influx is mediated through the A system, whereas the insensitive part occurs through the ASC system. Cycloleucine transport also involves a Na+-dependent and Na+-independent process. The Na+-dependent influx is completely inhibited by 2-aminoisobutyric acid but not perceptibly by 2-(methylamino)isobutyric acid. This influx probably represents entry through the ASC system. The Na+-independent component is completely inhibited by 2-aminobicyclo(2,2,1)heptane-2-carboxylic acid, a specific substrate for the L system. Uptake studies from either side of the monolayers indicate that these transport systems are exclusively located in basolateral membranes of the cultured renal cells.

We quantitated the presence of intracellular oxidizing species in response to oxidative stimuli using fluorescent cell analytic techniques. The studies were performed with a laser-activated flow cytometry system using 2',7'-dichlorofluorescin diacetate (DCFDA) as a probe for intracellular oxidation events. Oxygen radical formation was initiated by the addition of FeCl2 or xanthine oxidase to the culture media. Xanthine oxidase and FeCl2 both increased intracellular DCFDA oxidation over control (p less than .001). Increases in intracellular DCFDA oxidation in response to xanthine oxidase exposure were inhibited by extracellular superoxide dismutase, catalase and dimethyl sulfoxide (p less than 0.001), implicating the superoxide anion, hydrogen peroxide, and the hydroxyl radical in producing the changes in intracellular dichlorofluorescein fluorescence. Increases in intracellular DCFDA oxidation in response to xanthine oxidase correlated with loss of cellular viability, as established by decreased plating efficiency. We conclude that relative intracellular oxidation can be quantitated within the cultured renal cell and that some extracellularly generated radicals may be capable of traversing the intact cell membrane to oxidize DCFDA in the cell interior.

LLC-PK1 cells from trypsin-treated confluent cultures formed a continuous monolayer when plated at high cell density on collagen-coated Nuclepore filters. These monolayers developed a significant transepithelial electrical resistance that reached a maximum at 20 h. At 48 h, the resistance decreased to a value usually one-half the value obtained at 20 h. These changes were associated with an increase in the cell density of the monolayers. The drop in electrical resistance at 48 h was not observed when cell growth was arrested with excess thymidine. A hyperbolic relationship was demonstrated between cell density and electrical resistance. Although the increase in cell density was associated with an increase in the unidirectional flux of mannitol across the monolayers, selectivity studies indicated that the intrinsic properties of the occluding junctions were similar in the high and low cell density monolayers. These results indicate that, when cell growth is not arrested, changes in transepithelial electrical resistance observed after plating correspond to an increase in cell density and not to changes in the intrinsic properties of the occluding junctions. The development of transepithelial electrical resistance was delayed when the cells were in exponential growth. No such delay was observed, however, when exponential growth was synchronized. These findings and results obtained with the antimicrotubular agent Nocodazole indicate that the delay in the development of transepithelial electrical resistance is due to the asynchronous transit of the cells through the mitotic phase of the cell cycle: a time when most of the intercellular junctions are probably disrupted. Further investigation revealed that inhibition of protein but not mRNA synthesis blocked the development of occluding junctions in cells from confluent and exponentially growing cultures alike. These results indicate that, in contrast to MDCK cells, regulation of the occluding junctions in exponentially growing LLC-PK1 cells occurs at the translational not at the transcriptional level of protein synthesis.

Junctional permeability determinations after microinjection of the fluorescent tracer, Lucifer Yellow CH, show that the cells in confluent monolayers of the renal epithelial cell lines LLC-PK1 and A6 are interconnected by intercellular junctions. This cell-to-cell communication network permits the fluorescent dye to diffuse from the microinjected cell into multiple adjacent neighboring cells. Cell-to-cell diffusion of the fluorescent dye was not observed at pH 6.0. Full recovery occurred, however, when the pH of the extracellular medium was adjusted to 7.4. To provide a sensitive index of the averaged efficacy of junctional communication, we measured the number of cells that survived ouabain treatment in a 50% mixture of wild and ouabain-resistant mutant LLC-PK1 cells. Electron probe microanalysis in uncoupled cells showed that ouabain treatment produced two populations of cells, with totally different intracellular Na+ and K+ content. Under this condition, only 50% of the population survived after 48 h of treatment. When ouabain treatment was initiated 24 h after plating, however, 100% survival was observed, and the cells contained uniform intracellular Na+ and K+ concentration. This finding is consistent with the theory that this protective effect is mediated through the presence of the functional communicating intercellular junctions. When ouabain was applied at different times after plating, full protection is reached by 2 h. The early development of cell-to-cell communication, which precedes the development of the occluding junctions and several transport systems by several hours, is consistent with the involvement of the intercellular junctions in the synchronization of the polarization process.

Studies of the localization of the Na+-dependent sugar transport in monolayers of LLC PK1 cells show that the uptake of a methyl alpha-D-glucoside, a nonmetabolizable sugar which shares the glucose-galactose transport system, occurs mainly from the apical side of the monolayer. Kinetics of [3H]phlorizin binding to monolayers of LLC PK1 cells were also measured. These studies demonstrate the presence of two distinct classes of receptor sites. The class comprising high affinity binding sites had a dissociation constant (Kd) of 1.2 microM and a concentration of high affinity receptors of 0.30 mumol binding sites per g DNA. The other class involving low affinity sites had a Kd of 240 microM with the number of binding sites equal to 12 mumol/g DNA. Phlorizin binding at high affinity binding sites is a Na+-dependent process. Binding at the low affinity sites on the contrary is Na+-independent. The mode of action of Na+ on the high affinity binding sites was to increase the dissociation constant without modifying the number of binding sites. The Na+ dependence and the matching of Kd for high affinity binding sites with the Ki of phlorizin for the inhibition of methyl alpha-D-glucoside strongly suggest that the high affinity phlorizin binding site is, or is part of the methyl alpha-D-glucoside transport system. Binding studies from either side of the monolayer also show that the binding of phlorizin at the Na+ dependent high affinity binding sites occurs mainly from the apical rather than the basolateral side. The specific location of the Na+-dependent sugar transport system in the apical membrane of LLC PK1 cells is, therefore, another expression of the functional polarization of epithelial cells that is retained under tissue culture condition. In addition, since this sugar transport almost disappears after the cells are brought into suspension, it can be used as a marker to study the development of the apical membrane in this cell line.

A Na+-dependent hexose transport system with similar characteristics that observed in the kidney is retained in a cultured epithelial cell line from pig kidney (LLC-PK1). The active transport of oc methyl-D-glucoside (oc MGP), a nonmetabolizable sugar, which shares the glucose-galactose transport system in kidney cells is mediated through a Na+-dependent, substrate-saturable process. The kinetic analysis of the effect of Na+ on the uptake of ocMGP indicated that the Na+-sugar cotransport system is an affinity type system in which the binding of either sugar or Na+ carrier increases the affinity for the other ligand without affecting the Vmax. The sequence of selectivity for different sugars studied by the inhibition produced in the uptake of ocMGP is very similar to that reported in rat kidney, rabbit kidney cortex slices, and rabbit renal brush border membrane vesicles. Phlorizin, even at very low concentration, almost completely inhibits ocMGP uptake. Conversely, phloretin at the same low concentration stimulated the sugar accumulation by inhibition of efflux, probably at the level of the basolateral membrane. Sulfhydryl group inhibitors also blocked the ocMGP uptake, suggesting that these groups were required for normal functioning of the sugar carrier system. This sugar transport system is an important functional marker to study the molecular events associated with the development of polarization in epithelial cells.

The sequence and magnitude of acute changes in renal blood flow following administration of captopril were determined in a canine model of acute unilateral renal artery stenosis using rubidium-82 and positron emission tomography. Data were recorded in each of nine dogs under three conditions: 1) during a baseline control interval, 2) during renal artery stenosis, and 3) during stenosis with intravenous injection of captopril (1.2 mg/kg). Mean arterial blood pressure was 108 +/- 12 mm Hg at control, increased significantly to 125 +/- 13 mm Hg (p less than 0.01) during stenosis, and decreased to 98 +/- 13 mm/Hg (p less than 0.01) after captopril infusion. Mean renal blood flow was calculated using a steady state single compartment model from the images produced by positron emission tomography. The estimated flow to the affected kidney was 3.37 +/- 1.48 ml/min/g at control, 0.86 +/- 0.62 ml/min/g during stenosis (p less than 0.01), and 0.64 +/- 0.57 ml/min/g after captopril administration (p = NS compared with precaptopril value). The estimated flow to the contralateral kidney was minimally reduced from a baseline of 3.84 +/- 0.95 to 3.24 +/- 1.13 ml/min/g (p = NS) during stenosis and increased after captopril infusion (4.08 +/- 0.94 ml/min/g; p = 0.01). These data suggest that repetitive imaging with positron emission tomography can be used to delineate acute changes in renal perfusion following captopril administration.

On solid substrates MDCK, a cell line derived from normal dog kidney, forms a confluent monolayer that is studded with "blisters". Previous studies with this cell line suggest that these hemicysts develop as a result of active fluid accumulation between cell sheet and substratum. One factor that may determine when and how hemicysts appear only in localized sites is the interruption of occluding junctions in nonhemicyst areas. To study this possibility, we compared the permeability characteristics of the occluding junctions in hemicysts and in an uninterrupted monolayer of MDCK grown on a permeable support of collagen-coated nucleopore filter. The spontaneous electrical potential differences were small, without statistical differences between them. Relative ionic permeability coefficients were evaluated from the voltage deflections to imposed salt gradients or to a single ion substitution across both structures. The results showed that the relative permeability ratios for Na+, K+, choline+, and Cl- were the same in hemicysts and the uninterrupted monolayer. These and other results indicate that the junctional complex encircling the apical surface of a sheet of MDCK cells can provide an effective permeability barrier constituting a true occluding junction with the same properties in hemicyst and nonhemicyst areas.

The formation of intercellular communication during epithelial reorganization of LLC-PK1 cells was studied with a new, nondisruptive flow cytometric technique. The assembly of these junctions, as demonstrated by cell-to-cell transfer of the fluorescent dye carboxy dimethyl fluorescein, occurs very early during epithelial reorganization. Close cell-to-cell interaction is required for the assembly to occur. Low temperature, treatment with 10(-3) M ouabain, or treatment with the Ca2+ ionophore A23187 inhibits assembly of these junctions. Removal of Ca2+ from the incubation medium, on the other hand, has no effect. Cycloheximide (10(-6) M) is also without effect, suggesting that protein synthesis is not required during the assembly of the junctions and that either the trypsin used to disperse the cells does not affect the junctional components or the cells have a rather extensive reserve pool of junctional precursors. The concomitant delay in the development of intercellular communication and the reorganization of the epithelial membrane, as previously observed with cells in asynchronous growth [Am. J. Physiol. 251 (Renal Fluid Electrolyte Physiol. 20): F978-F987, 1986], is consistent with the theory that junctional intercellular communication coordinates cellular activity during epithelial reorganization.