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SM Journal of Nephrology and Kidney Diseases

Comparing the Effects of Bisphenol A and Bisphenol S on Human Podocyte Biology

[ ISSN : 2576-5450 ]

Abstract Citation Introduction Methods Results Discussion Conclusion Acknowledgement References
Details

Received: 28-Feb-2018

Accepted: 12-Mar-2018

Published: 16-Mar-2018

Sarah Podlich¹#, Ulrike Leppert²#, Claudia Plum¹, Karen Böhme¹, Petra Karsten¹, Jana Subrova¹, Anna C Cornelius¹, Reinhold Kreutz¹ and Andreas Eisenreich¹*

¹Institut für Klinische Pharmakologie und Toxikologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität, Humboldt-Universität zu Berlin and Berlin Institute of Health Berlin, Germany
²Institut für Physiologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health Berlin, Germany

#Both author’s contributed equally

Corresponding Author:

Andreas Eisenreich, Institut für Klinische Pharmakologie und Toxikologie, Charité -Universitätsmediz in Berlin, Germany, Tel: 0049 30 450525237; Fax: 0049 30 4507525112; Email: andreas.eisenreich@gmx.de

Keywords

Bisphenol; Podocytes; Cell Viability; Kidney; Nephrin, Podoplanin

Abstract

Human podocytes (hPC) are crucial for renal structural integrity and function. Loss of hPC plays an important role in pathogenesis of various renal disorders. Bisphenol A (BPA) is widely used in various everyday goods. Due to its potential cytotoxic activities, especially in the cardio-renal system, alternatives were used for “BPA-free” manufacturing, such as bisphenol S (BPS).Similar to BPA, BPS exhibits estrogenic activities and was suggested to induce cardiotoxic effects. In contrast to BPA, the renal impact of BPS is unknown so far. Here, we performed a comparative analysis of the effects of BPS and BPA on hPC viability and protein expression.

Functional assays were used for cell viability measurement and expression was characterized via real-time PCR and Western blotting in hPC. We found that BPA and BPS (0.01 µM - 1000 µM) differentially affect hPC viability as well as expression of nephrin, protein kinase B, podoplanin and nuclear factor ‘kappa-light-chainenhancer’ of activated B - cells p65 subunit RelA in renal cells in a dose-dependent manner. Inhibition of protein kinase B, RelA, or podoplanin, respectively, were also shown to reduce hPC viability. Moreover, 10 µM BPA but not BPS, induced interleukin-1 beta and Bcl-2-associated death promoter expression in hPC. Here, we provide first novel findings about potential cytotoxic effects of BPS on renal cells. Moreover, we show that BPA’s nephrotoxic impact on hPC viability and protein expressions were much stronger than that of BPS in this study.

Citation

Podlich S, Leppert U, Plum C, Böhme K, Karsten P, Subrova J, et al. Comparing the Effects of Bisphenol A and Bisphenol S on Human Podocyte Biology. J Nephrol Kidney Dis. 2018; 2(1): 1012.

Introduction

Bisphenol A (BPA) is one of the most important man-made synthetic polymers used for the production of various everyday articles, such as polycarbonate water bottles, plastic food container, baby bottles and the inner coating of tin cans [1]. This consequently leads to a high risk of customer exposure to BPA, e.g. by food contaminations [1]. BPA is metabolized in the liver and predominantly excreted renally [2]. Several studies indicated that BPA may mediate cytotoxic, genotoxic and carcinogenic activities in the context of different human pathologies, such as cardiovascular disease, reproductive disorders and in renal diseases [1,3,4]. However, these data are still controversially debated in the context BPA’s safety and its high industrial importance [5]. Due to BPA’s potential toxic effects, the European Food Safety Authority (EFSA) prohibited in 2011 its use in the manufacture of polycarbonate infant feeding bottles and limited BPA’s tolerable daily intake in the European Union (EU) to 4 µg/kg body weight per day in 2015 [6]. In consequence to these restrictions, manufacturers are increasingly tending to replace BPA by alternatives, such as bisphenol S (BPS) to manufacture “BPA-free” products [7,8]. BPS can be found in higher levels - amongst others - in thermal paper and food, which consequently leads to an increased risk for customer exposure to this compound, too [9]. BPS was shown to mediate estrogenic activities, comparable to that of BPA [10]. Furthermore, BPS was recently demonstrated to mediate arrhythmogenic effects by over-activating ventricular myocytes and increasing electrical activities in female rat hearts [11]. These data indicated that BPS induces cardiotoxic effects in the context of female-specific heart arrhythmias, similar to those reported for BPA [11]. However, renal activities of BPS, especially regarding its potential nephrotoxicity are largely unexplored.

Human podocytes (hPC) are crucial for renal structural integrity and function [12,13]. In this context, hPC play an essential role for maintenance of the glomerular filtration barrier via generating and providing essential compounds of the slit diaphragm, such as nephrin [14,15]. Beside nephrin as structural factor, biological function of hPC were also regulated via various other proteins, including factors involved in cell survival and viability, such as protein kinase B (Akt) or podoplanin (PDPN) [12,16,17] and proteins involved in gene expression control, e.g. the nuclear factor ‘kappa-light-chain-enhancer’ of activated B-cells (NFκB) p65 subunit RelA [15,18]. Damage or loss of hPC is of major importance for the pathogenesis of various renal disorders, including chronic kidney disease or diabetic nephropathy [14,19]. In this context, reduced hPC viability as consequence, e.g. of increased cell apoptosis or reduced survival, plays a crucial role in the development of renal insufficiency [17-19].

Literature regarding renal effects of BPS as well as data showing mechanistic insights into its mode of action in the renal context, especially in hPC are sparse. Therefore, we performed a comparative analysis of the impact of BPS and BPA on hPC viability. Moreover, we characterized the differential effects of both compounds on the expression of nephrin, Akt, PDPN and RelA inrenal cells. Finally, we studied the functional impact of Akt, RelA and PDPN on cell viability in hPC incubated with BPS or BPA, respectively. In sum, our data show for the first time that the nephrotoxic potential of BPS, regarding its impact on hPC viability and gene expression, is much lower than that of BPA.

Methods

Cell culture

Immortalized hPC were obtained from Dr. M. Saleem (University of Bristol, Bristol, UK) and were cultured in RPMI 1640 supplemented with fetal bovine serum (FBS; 10%), insulin-transferrin-selenium (1x) and penicillin/streptomycin (1%), all purchased from BIOCHROM GmbH, Berlin, Germany. These cells proliferate at 33°C and differentiate at 37°C for 14 d to mature hPC as described earlier [13]. Cells were incubated with different concentrations ranging from 0.01 µM to 1000 µM of BPA (BIOZOL GmbH, Eching, Germany) or BPS (BIOZOL GmbH, Eching, Germany) in FBS-free RPMI 1640 Medium (BIOCHROM GmbH, Berlin, Germany) for 24 h or 48 h, respectively. Controls were treated with corresponding amounts of ethanol (99.9%, solvent; Fisher Scientific GmbH, Schwerte, Germany). BAY 11-7082 (10 µM; Adipogen AG, Liestal, Switzerland) was used for pharmacological inhibition of NFκB and Akt was blocked via triciribine (10 µM; Selleck Chemicals, Houston, TX, USA) as described before [15,20]. Transfection of hPC was performed using LipofectamineTM 2000 (Life Technologies GmbH, Darmstadt, Germany) and 200 nM specific small interfering ribonucleic acid (siRNA) directed against PDPN (siPDPN, Sigma-Aldrich Chemie GmbH, Munich, Germany) or a non-sense control siRNA (siControl; Sigma-Aldrich Chemie GmbH, Munich, Germany), respectively. Transfection efficiency was 25% [12].

Cell viability assay

Calcein AM (acetoxymethyl) cell viability kit (Trevigen Inc. Gaithersburg, MD, USA) was used for measurement of hPC viability as described earlier. In brief, hPC (1 x 104/well) were cultured in 96-well plates and treated - as mentioned above - with different stimuli, inhibitors, or siRNAs, respectively, for 24 h. Following the manufacturer’s protocol, hPC were washed with phosphate-buffered saline (Life Technologies GmbH, Darmstadt, Germany) and then incubated for 30 min with calcein AM working solution. Finally, fluorescence was determined (490 nm excitation, 520 nm emission).

Western blot

Protein expression was determined in hPC cell lysates via sodium dodecyl sulfate polyacrylamide gel electrophoresis, followed by Western blot analyses as previously described [12,15]. Protein detection was done using specific antibodies: anti-nephrin (1:500; Thermo Fisher Scientific, Waltham, MA, USA), anti-PDPN (1:500; Sigma-Aldrich Chemie GmbH, Munich, Germany), anti-Akt (1:500, Merck Chemicals GmbH, Schwalbach, Germany), anti-GAPDH (1:20000, Calbiochem, Darmstadt, Germany), anti-RelA (1:500, Aviva Systems Biology, Corp., San Diego, CA, USA), rabbit anti-mouse and goat anti-rabbit (both 1:5000, DAKO, Glostrup, Denmark). Final quantification of protein expression was done via Gel-Pro AnalyzerTM software (version 4.0.00.001; Media Cybernetics, Bethesda, MD, USA).

Quantitative real-time polymerase chain reaction (qRT PCR)

Universal RNA purification kit (Roboklon GmbH, Berlin, Germany) was used for isolation of total RNA which was then reverse transcribed into cDNA templates via the High-Capacity cDNA Reverse Transcription Kit (Life Technologies GmbH, Darmstadt, Germany). For qRT-PCR a 7500 Fast Real-Time PCR System (Applied Biosystems, Carlsbad, CA, USA) was used under the following conditions: 50°C, 2 min; 95°C, 20 s; 45 cycles 95°C, 3 s; 60°C, 30 s. For analyses of the gene expression of Bcl-2-associated death promoter (BAD), interleukin-1 beta (IL-1β) and glyceraldehyde 3-phosphate dehydrogenase (GAPDH) TaqMan® Gene Expression Assays (Life Technologies GmbH, Darmstadt, Germany) were used following the manufacturer’s instructions.

Statistical analysis

Statistics were done via GraphPad Prism (version 6.00; Graph Pad Software, Inc., La Jolla, CA, USA). Data were analyzed via Student’s t-test or one-way analysis of variance (ANOVA), as appropriate and were expressed as mean ± SEM. A probability value (p) ≤0.05 was regarded as significant.

Results

First of all, we compared the effects of BPA vs BPS on hPC viability post 24 h. Treatment of cells with 0.01 - 1 µM BPA had no significant influence on cell viability (Figure 1).

Figure 1: BPA and BPS differentially affect cell viability of hPC. Shown is the cell viability of hPC 24 h after incubated with different concentrations (0 µM - 1000 µM) of BPA or BPS, respectively? Controls were treated with an appropriate volume of ethanol (solvent; EtOH control). (*) P ≤ 0.05, (**) P ≤ 0.01, (****) P ≤ 0.0001; n = 5.

Compared to controls, incubation of hPC with 10 µM and 100 µM BPA led to a significant reduction of cell viability. Moreover, treatment of renal cells with 1000 µM led to a total loss of hPC at this time point. Compared to BPA, application of BPS ranging from 0.01 µM to 100 µM had no significant inhibitory effect on renal cell viability. In contrast to low BPS concentration, incubation of hPC with 1000 µM BPS significantly reduced cell viability. Compared to BPA, the impact of BPS on cell viability was significantly lower in cells treated with the same concentrations of BPA vs BPS (Figure 1).

Treatment of hPC with BPA and BPS for 24 h differentially modulated the protein expression of Akt, RelA, nephrin and PDPN (Figure 2).

Figure 2: Modulation of protein expression by BPA vs BPS in hPC. (A-D) Protein expression of (A) Akt, (B) RelA, (C) nephrin and (D) PDPN normalized against GAPDH expression in hPC post 24 h. Compared were hPC incubated with 0 µM, 0.1 µM, 10 µM and 1000 µMBPA or BPS, respectively. Control cells were treated with an appropriate volume of ethanol (EtOH control).Shown is the mean ± SEM of at least 3 independent experiments. (*) P ≤ 0.05, (**) P ≤ 0.01,(****) P ≤ 0.0001.

Compared to controls, incubation of renal cells with 0.1 µM and 10 µM BPA and BPS had no significant impact on Akt and RelA expression (Figure 2A,B). In contrast, treatment of hPC with 1000 µM BPA completely inhibited protein expression of both proteins in hPC. Whereas, treatment of cells with 1000 µM BPS led to a significant but only slight reduction of Akt and RelA (Figure 2A,B). Comparable results were also found for protein expression of nephrin and PDPN (Figure 2C,D). Low concentrations (0.1 µM and 10 µM) of BPA and BPS had no effect on the expression of nephrin and PDPN in hPC. Compared to controls, application of 1000 µM BPA significantly reduced nephrin and PDPN protein, whereas, 1000 µM BPS had no significant influence on protein expression of both factors in hPC (Figure 2C,D).

Next, we characterized the impact of BPA vs BPS on Akt, RelA, nephrin and PDPN protein expression in hPC after 48 h (Figure 3).

Figure 3: BPA vs BPS differentially affect Akt, RelA, nephrin, and PDPN in hPC. Depicted is the ratio of (A) Akt/GAPDH, (B) RelA/GAPDH,(C) nephrin/ GAPDH and (D)PDPN/GAPDH protein expression 48 h post incubation of hPC with different concentrations (0 µM - 100 µM) of BPA or BPS, respectively. Application of an equal amount of the used solvent ethanol to hPC was used as control (EtOH control).Shown is the mean ± SEM of at least 3 independent experiments. (*) P ≤ 0.05, (**) P ≤ 0.01,(****) P ≤ 0.0001.

Compared to control cells, treatment of hPC with low concentrations of BPA ranging from 0.01 µM - 10 µM had no impact on the expression of Akt, RelA, nephrin and PDPN (Figure 3A-D). Whereas, incubation of cells with 100 µM BPA led to a significant reduction of Akt, RelA, nephrin and PDPN. Compared to controls, treatment of renal cells with BPS did not affect Akt, RelA, nephrin, and PDPN expression at any tested concentration (0.01 µM - 100 µM) (Figure 3A-D). Moreover, there was a significant difference regarding the impact of 100 µM BPA compared to the influence of 100 µM BPS on the expression of all four analyzed proteins.

Since, Akt, RelA and PDPN were shown to modulate cell survival and viability of renal cells [12,17,18] we studied the role of these factors in modulating cell viability of hPC treated with BPA or BPS, respectively (Figure 4).

Figure 4: The influence of Akt, RelA, and PDPN on hPC viability. (A) Cell viability of hPC 24 h after inhibition of RelA-associated NFκB activity by 10 µM BAY 11-7082 or Akt via incubation with 10 µM triciribine, respectively, in cells activated with 10 µM BPA and BPS. Control cells were treated with an appropriatevolume of ethanol (EtOH control). (B) Shows the reduction of hPC viability by siRNA-mediated inhibition of PDPN. (siPDPN, 200 nM). A non-functional siRNA (siControl, 200 nM) was used as control. (*) P ≤ 0.05, (****) P ≤ 0.0001,(n.s.) no significant difference; n = 5.

Compared to non-treated control cells, inhibition of Aktby application of 10 µM triciribine alone led to a significant decrease of hPC viability post 24 h (Figure 4A). Co-treatment of renal cells with triciribine and BPA or BPS, respectively, exhibited no further reductive effects on cell viability. Blocking of RelA-associated NFκB activity by the pharmacological inhibitor BAY 11-7082 (10 µM) also decreased hPC viability. Compared to cells only treated with BAY 11-7082, additional incubation of cells with BPA or BPS, respectively, led to a further significant reduction of cell viability in those treated cells (Figure 4A). Moreover, siRNA-mediated knockdown of PDPN also reduced hPC viability (Figure 4B).

Compared to controls, application of 10 nM BPA induced the expression of pro-apoptotic BAD in renal cells (Figure 5A).

Figure 5: The impact BPA and BPS of BAD and IL-1β mRNA expression. Shown is the mRNA expression of (A) BAD and (B) IL-1β normalized against GAPDH in hPC. Compared were cells treated for 24 h with 10 µM BPA or 10 µM BPS, respectively. Application of an appropriate volume of ethanol (solvent) was used as control (EtOH control). (**) P ≤ 0.01; n=3.

In contrast to BPA, treatment of hPC with BPS had no significant effect on BAD generation. Moreover, BPA incubation also increased the expression of pro-inflammatory IL-1β (Figure 5B). Compared to control cells, treatment of hPC with 10 nM BPS did not affect the generation of IL-1β.

Discussion

BPAwas indicated to mediate cytotoxic effects in the context of different human pathologies, such in renal diseases [1,3,4]. In order to manufacture “BPA-free” products, BPS was used as alternative to BPA [7,8]. Similar to BPA, BPS was found to mediate estrogenic activities and to induce cardiotoxic effects in the context of female-specific heart arrhythmias [10,11]. However, in contrast to BPA [4,5], little is known about potential nephrotoxic effects of its substitute BPS.

Loss of hPC and their function plays a central role in the pathogenesis of various renal diseases, such as chronic kidney disease or diabetic nephropathy [14,19]. Data regarding renal effects of BPS, especially thoseshowing mechanistic insights are sparse. Therefore, we set out to perform a comparative analysis of the impact of BPS and BPA on hPC viability and the expression of factors, involved in renal cell function control, such as nephrin, PDPN, Akt and RelA. Here, we showed for the first time that high dose BPS reduced hPC viability. Moreover, BPA had no significant effects on the expression of nephrin, PDPN, Akt and RelA in hPC. And, BPA’s renotoxic effectson hPC viability and protein expression were much stronger than that of BPS in this experimental setting.

In our study, we found that BPA reduce hPC viability in a dose-dependent manner. Low BPA doses (up to 1µM) had no significant influence, whereas, higher doses (10 µM and 100 µM) significantly diminished cell viability with a complete hPC loss at 1000 µM BPA. In line with our findings, Michalowicz et al. demonstrated that low level of BPA (<220 µM) had no effect on Human Peripheral Blood Mononuclear Cell (PBMC) viability after 4 h [21]. Treatment of cells with higher BPA doses (220 µM - 440 µM) led to a concentration-dependent reduction of PBMC viability [21]. Comparable data showing dose-dependent effects of BPA on cell viability were also published by others [4,22]. In our experiments, we further found that there was no significant impact of BPS on cell viability at concentrations ranging from 0.01 µM - 100 µM. Solely, treatment of hPC with the highest tested BPS dose (1000 µM) led to a significant but moderate reduction of viability. Substantiating this, Zhang et al. also showed that low BPS doses (0 µM - 100 µM) exhibited no relevant cytotoxic effects on primary isolated murine renal cells whereas, high BPS concentration (300 µM - 1000 µM) led to a significant reduction of renal cell viability. Moreover, we demonstrated in this study for the first time that BPA’s cytotoxic and viability-reducing effect on human renal cells was significantly higher than that of BPS. This is in line with the findings of different groups in other experimental settings [21-23]. In this context, Ma and colleagues depicted that application of 300 µM BPA led to a diminished viability of chicken embryonic hepatocytes, whereas, BPS mediated no cytotoxic effects at the same concentration [23]. Substantiating this, Michalowicz et al. also demonstrated 100 µM BPA to reduce PBMC viability, whereas, BPS mediated no cytotoxic activities at this concentration [21].

Modulation of cell viability,as consequence of increased cell apoptosis and/or diminished cell survival, is highly regulated via expression and function of different factors, such as structural proteins (e.g., PDPN and nephrin) [4,12,15], kinases involved in pr-survival signaling (i.e., Akt) [12,16] and transcription-modulating factors, such as NFκB p65 subunit RelA [18,24]. In our study, we found BPS and BPA to differentially affect Akt, RelA, nephrin and PDPN expression in hPC. Treatment of renal cells with low doses (0.1 µM - 10 µM) of BPA or BPS, respectively, had no significant influence on the expression of these factors. In contrast to low concentration, high BPA doses (100 µM - 1000 µM) led to reduced level of Akt, RelA, nephrin and PDPN in hPC, whereas, 100 µM and 1000 µM BPS did not affects protein expression. In line with our data, Benigni and colleagues showed in 2006 that application of with 25 µM of BPA diglycidyl ether to human renal tubulus cells (HK-2) reduced promotor activity and expression of the nephrin gene. Recently, this was further substantiated by findings of Olea-Herrero et al. which demonstrated that activation of primary isolated Murine Podocytes (mPC) with BPA led to reduced expression of nephrin in the context of BPA-induced proteinuria in mice [4].

Regarding modulation of Akt, other groups also showed high but not low BPA doses to reduce Akt expression in other experimental settings, which is in line with our observations in hPC [25-27]. Zhao et al. depicted in 2014 that incubation of primary isolated murine ovaries with low BPA concentrations ranging from 0.1 µM to 10 µM had no significant impact on Akt expression [26]. Comparable results were published by Kim et al., also showing no significant impact of low BPA doses (0.1 nM - 10 nM) on protein level of Akt in testicular rat cells [27]. Recently, Vahdati Hassaniet al. depicted that Akt protein expression was reduced in the liver of Wistar rats exposed to high dose BPA (0.5 mg/kg) for 30 d. Together, these findings are in line with our data.

Until now, BPA’s impact on RelA and PDPN expression as well as the influence of BPS on Akt, RelA, nephrin, and PDPN was completely uncharted. Here, we found high doses of BPA to reduce expression of these factors, whereas, BPS had no significant effects on protein expression of all analyzed factors. In 2014 Peyre et al. demonstrated that BPS is less cytotoxic that BPA in the context of metabolic syndromes [28]. They showed that BPA’shepatotoxic potential was mediated viaexpression modulationof different toxicity-, stress-, and transport-, and lipid metabolism-related factors, such as cytochromes P450 (CYP)2B6 and fatty acid synthase in different human hepatocellular cell lines treated with 1 µM - 100 µM of this compound. In contrast to BPA, 1 µM - 100 µM BPS had no influence on these proteins and mediated no toxic effects in hepatocytes [28]. In another experimental setting, Ma et al. also showed 1 µM - 10 µM BPA or BPS, respectively, to differentially affect gene expression of different factors involved in toxicological pathways in chicken embryonic hepatocytes [23]. BPA-mediated modulation of the gene expression pattern was associated with decreased cell viability, whereas, BPS had exhibited no cytotoxic activities in this context [23]. In line with these findings, we also found high doses of BPA to reduce protein generation of factors involved in gene expression control, survival signaling and structural integrity of hPC, such as RelA, Akt, nephrin and PDPN [4,12,16,18]. BPS had no impact on these factors as well as on hPC viability at the same concentrations. Moreover, we found that inhibition of Akt, RelA-dependent NFκB activity and PDPN (Figure 4) led to reduced hPC viability, too. Therefore, reduced expression of these proteins by BPA but not by BPS, may - at least in part - be involved in mediating BPA’s more potent viability-reducing effects in hPC, compared to BPS.

Finally, we found 10 µM BPA to induce expression of pro-apoptotic BAD and pro-inflammatory IL-1β in hPC, which was associated with reduced hPC viability. In contrast to BPA, 10 µM BPS had no effect on these factors or renal cell viability. This is in line with results of different other groups [29-31]. In 2012, Kuan et al. depicted incubation of murine RAW267.7 macrophages with BPA-derivates to induce IL-1β expression, which consequently led to increased oxidative stress and pro-inflammatory activation of these cells [29]. In another experimental setting, Bontempo et al. demonstrated that application of 60 µM BPA led to increased BAD activity in human leukemia NB4 cells in vitro [30]. In 2014, Wang and colleagues also showed treatment of rats with 0.25 mg/kg BPA to induce BAD activation in rat mammary glands in vivo [31]. In both studies, BPA-induced BAD activation was associated with increased cell apoptosis in vitro and in vivo [30,31]. In this context, our findings suggest that increased expression of pro-inflammatory IL-1β and pro-apoptotic BAD in BPA-activated hPC may also be involved in mediating BPA’s cytotoxic effects in these cells.

Conclusion

In this study, we showed BPA to reduce cell viability of human renal cells which was associated with reduced expression of proteins involved in transcriptional control, cell survival and renal structural integrity (RelA, Akt, nephrin and PDPN) [4,12,16,18] and increased generation of pro-inflammatory IL-1β and pro-apoptotic BAD [29,30]. Furthermore, we found that these effects of BPA were mediated in a dose-dependent manner in hPC. Finally, we demonstrated for the first time that BPS had no significant impact on the expression of the abovementioned factors in human renal cells and exhibited a much lower hPC viability-reducing potential, compared to BPA. In sum, this leads to the conclusion that BPS exhibits less nephrotoxic potential than BPA in hPC. Therefore, BPS may be indicated to be “safer” than BPA in renal settings. However, further experiments, especially in the context of adequate in vivo studies, are needed to substantiate and validate these first experimental findings in human renal cells.

Acknowledgement

We thank Dr. Anja Brehm for experimental and technical support.

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Other Articles

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High-Dose Statin Associated with Rhabdomyolysis, Acute Kidney Injury, Cholestatic Liver Injury, and Thrombocytopenia

Introduction: Statins are the drugs of choice to reduce cholesterol and the incidence of cardiovascular events. Although rare, the side effects of these drugs may be severe (especially when given in the high doses recommended by the cardiologists), including: muscle damage, renal and liver injury and compromised function, and polyneuropathy.

Case Report: We report a case of statin-induced rhabdomyolysis, acute kidney and liver failure and thrombocytopenia that developed in a 76-year-old man, who was referred to our department because of severe generalized myalgia and muscle weakness, extreme fatigue, loss of appetite, dark brown urine. Following an acute myocardial infarction 8 months previously he was put on atorvastatin 80 mg once daily. Laboratory evaluation at presentation revealed much increased levels of muscle enzymes, aminotransferases, total and conjugated bilirubin, and nitrogenous waste products, and low platelets. A diagnosis of acute renal and liver failure secondary to the long-term intensive statin therapy was made. Atorvastatin was discontinued and forced alkaline diuresis was started. After five days of oliguria and slight but persistent increase in creatinine levels dialysis was initiated, but discontinued after 4 sessions, once urine output increased. At discharge the patient’s serum creatine kinase level was in the normal range, creatinine was significantly decreased the thrombocyte count was better, aminotransferase were much lower but not completely normalized, but the bilirubin remained at the same level. The patient was discharged and instructed to avoid any potentially nephrotoxic and hepatotoxic drugs until next outpatient evaluation.

Conclusions: Our case report is meant to raise concerns about prescribing high dose statins. Unfortunately the prescribing cardiologists may be insufficiently aware of the potential for severe adverse effects as these come to the attention of clinicians from different specialities, especially nephrologists.

Dorin Dragos1,2, Diana Pruteanu2 and Rodica Constantin2


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Infections in Pediatric Dialysis Patients in Mubarak Al-Kabeer Hospital, Kuwait: 10 Year

Objective: As the incidence of End Stage Renal Disease (ESRD) worldwide has increased, so has the need for performing Hemodialysis (HD) and Peritoneal Dialysis (PD). We sought to identify risk factors and measure the rate of infections in pediatric patients undergoing dialysis.

Design: A retrospective study

Setting: Single pediatric dialysis center in Kuwait from July 2003-July 2013

Subjects: Pediatric patients undergoing PD or HD

Interventions: Follow up of risk factors and rate of infections incidents

Main outcome measures: Risk factors, incidence rate of infections and microbiological profile of organisms causing dialysis-related infections were determined in HD or PD patients.

Results: A total of 91 patients underwent HD and 63 patients underwent PD. The episodes of infection were documented in 13 patients in each of the two groups. Our rates of infection were found to be one peritonitis episode per 20 patient-months in PD group and 0.41 infection episodes per patient-year in HD group. The commonest organisms isolated in PD-related infections were Pseudomonas aeruginosa and CoagulaseNegative Staphylococci (CNST) whereas in HD-related infections CNST was the leading organism. Among the risk factors in both groups, personal hygiene was the most significant with a P-value of

Conclusion: Our infection rates were consistent with international reports and consistent with others in proving poor personal hygiene as a significant risk factor for infection in patients undergoing renal dialysis.

Wadha Alfouzan¹˒²*, Faisal Alkandari³, Ayman Yosri³, Fawaz Azizieh⁴, Haya Al Tawalah⁵ and Dhar R²


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Evaluating the Kidney Stones; are the Volume and Size Equal in One or Two Dimensions? Accustomed Inaccuracy

Urinary lithiasis is a common disease, prevalence rates vary from 1% to 20%, according to gender, dietary, ethnic, the geographical, and genetic factors.

Musab Ilgi*, Kaya Horasanli and Sinan Levent Kirecci


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Biochemical and Histological Evaluation of Kidney Function in Rats after a Single Administration of Cyclophosphamide and Ifosfamide

Background: Cyclophosphamide (CP) and Ifosfamide (IF) are widely used cytotoxic agents. Both CP and IF exert some characteristic adverse drug reactions including kidney damage taking various clinical forms, depending on the applied dose or administration route. The aim of our study was to estimate kidney function using selected, classical biochemical parameters as well as analyzing the urinary concentration and excretion of a modern “kidney troponin” - neutrophil gelatinase-associated lipocalin-1 (NGAL-1) in rats after administration of a single CP or IF dose.

Methods: 30 rats were divided into three groups (n=10 each; half males and females): group 1 - control (rats receiving i.p. saline solution); groups 2 and 3 – rats intraperitoneally treated with a single CP or IF dose of 150 mg/kg b.w., respectively. Following saline/CP/IF administration, animals were housed in single metabolic cages, to assess 24-hour diuresis and to obtain urinary samples for further laboratory assays. Finally, blood samples were collected and rats were sacrificed to perform autopsy with cystectomy and nephrectomy with subsequent histopathological analysis. Standard parameters of kidney function were assayed either in blood or in urine with an additional assessment of the urine NGAL-1 level.

Results: Single administration of both CP and IF resulted in decreased pH of urine and proteinuria accompanied by an increased 24-hour urinary NGAL-1 excretion. Moreover, CP-treated rats demonstrated polyuria. Concentrations and 24-hour excretion of most classical, low-weight parameters were not different in both CP- and IF-treated rats compared to values observed in control animals.

The histopathological analysis in CP/IF treated animals revealed presence of cystic inflammatory lesions and a normal kidney structure, with the exception of a mild to moderate congestive hyperemia.

Conclusion: A single administration of CP and IF caused a functional kidney tubulopathy in study rats manifested by marked proteinuria with increased 24-hour NGAL-1 urinary excretion.

Łukasz Dobrek*, Agnieszka Baranowska, Beata Skowron and Piotr Thor


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Serum Glycoprotein Chondrex (YKL-40) and High Sensitivity C- Reactive Protein (hscrp) in Type 2 Diabetic Patients in Relation to Cardiovascular Complications

In Type 2 diabetes, C-Reactive Protein (CRP) as an inflammatory marker may be elevated. The glycoprotein Chondrex or YKL-40 is over expressed in many inflammatory conditions. The aim is to study serum hsCRP and YKL-40 in Type 2 diabetic patients in relation to cardiovascular complications.

Methods: Eighty subjects were divided into 3 groups: GROUP 1:16 apparently healthy controls, GROUP 2:16 patients suffering from Type 2 DM without cardiovascular complications and GROUP 3: 48 patients suffering from Type 2 DM with cardiovascular complications. Subjects with acute or chronic inflammation, autoimmune disease or malignancy were excluded. Electrocardiography, Carotid Intima Thikness, Fundus Examination, laboratory investigations: (Complete urine analysis, urinary albumin, Creatinine and calculation of urinary albumin to creatinine ratio, fasting and postprandial glucose, glycated hemoglobin, Creatinine and uric acid, lipid profile, glomerular filtration rate, CRP and YKL-40) were done to all subjects.

Results: High sensitivity CRP levels were significantly elevated in the diabetic group with cardiovascular complications when compared to the diabetic group without cardiovascular complications (p=0.024). YKL-40 was significantly higher in patients with type 2 diabetes mellitus than controls (p=0.017) and cardiovascular complications (p<0.001) contributed to its greater elevation.YKL-40 was positively correlated with triglycerides, systolic and mean blood pressure in the group of diabetic patients without cardiovascular complications and with duration of diabetes and urinary albumin to creatinine ratio in the group with cardiovascular complications. By drawing receiver operating characteristic (ROC) curve between diabetic patients without and with cardiovascular complications the AUC for hsCRP was (0.676, p=0.036) and for YKL-40 was (0.743, p=0.004). By studying the diagnostic performance, YKL-40 had a better specificity and positive predictive value than hsCRP.

Conclusion: YKL-40 has a better specificity and positive predictive value than hsCRP in discriminating between diabetic patients with cardiovascular complications from those without cardiovascular complications.

El-Attar HA¹*, El-Deeb MM¹ and El-Ghlied LA²


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Is There An Association Between Angiotensin II Type 1 Receptor A1166C Gene Polymorphism and Renal Scarring Susceptibility?

Relationship between Angiotensin II Type 1 Receptor (AT1R) A1166C gene polymorphism and renal scarring risk is still controversial. This meta-analysis was performed to evaluate the association of AT1R A1166C gene polymorphism and renal scarring risk susceptibility. A predefined literature search and selection of eligible relevant studies were performed to collect data from electronic databases of PubMed, Embase and Cochrane Library. Three literatures were identified and included for the analysis of the relationship between AT1R A1166C gene polymorphism and renal scarring risk. We found that AT1R A1166C gene polymorphism was not associated with renal scarring susceptibility using the comparison of patients with scarring vs patients without scarring (C: OR=1.33, 95%CI: 0.83-2.13, P=0.23; CC: OR=1.71, 95%CI: 0.22-13.56, P=0.61; AA: OR=0.69, 95%CI: 0.39-1.21, P=0.20). Furthermore, AT1R A1166C gene polymorphism was also not associated with renal scarring risk using the comparison of patients with scarring vs healthy control. In conclusion, AT1R A1166C gene polymorphism was not associated with renal scarring risk susceptibility. However, more studies should be performed in the future.

Tianbiao Zhou*#, Weiji Xie#, Zhijun Lin# and Zhensheng Yang


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Evaluation of Antidiabetic Plants used by Tribes of Telangana State on Diabetic Complications like Neuropathy, Nephropathy and Cardiomyopathy in Rats

Background: India is “diabetes capital of the world”. Diabetes Atlas 2006 published by International Diabetes Federation, India currently around 40.9 million is expected to rise to 69.9 million by 2025 unless urgent preventive steps are taken. Over the past 30 yr, the status of diabetes has changed from being considered as a mild disorder to major causes of morbidity and mortality.

Methods: Rats treated with Alloxan (150 mg/kg) i.p. results diabetic rats given ethanol extract of Senna auriculata leaf, Syzygium cumini (L.) Skeels seeds and Syzygium cumini (L.) Skeels seeds (150 mg/kg) p.o., respectively for 42 days. Biochemical parameters of diabetic neuropathy, nephropathy and cardiomyopathy and histopathology of sciatic nerve, kidney and heart was done at the end of study.

Results: In Diabetic Group found Blood Glucose Level (BGL) (84.42±6.384 to 369.36±7.784mg/dl); Muscle Grip Strength (MGS) (59.32±1.052 to 13.52±0.883seconds); Thermal Pain Response (TPR) (5.55±0.621 to 13.67±1.164seconds). blood protein (7.48±0.051 to 25.18±0.046mg/dl); urine protein (0.692±0.061 to 2.68±0.056mg/dl); blood albumin (1.94±0.043 to 0.248±0.007mg/dl); urine albumin (0.082±0.009 to 2.68±0.056mg/dl); blood myoglobin (0.042±0.00274 to 0.056±0.00207ng/dl); urine myoglobin (0.0048±0.00142 to 0.0098±0.00107mg/dl); Blood Urea Nitrogen (BUN) (23.04±1.093 to 124.81±1.238 mg/dl); Serum Creatinine (84.06±6.723 to 218.56±7.586 (µMol/dl). Etholic extract of Senna auriculata leaf, Phyllanthus emblica.L. fruits and Syzygium cumini (L.) Skeels seeds & combination treated groups found BGL124.42±7.042, 112.07±6.942, 126.25±7.051 & 98.83±6.932mg/dl; MGS 49.06±0.962, 52.05±1.247, 54.06±1.268 & 56.79±1.125 seconds; TPR 6.54±0.841, 7.38±0.802, 6.45±1.062 & 6.14±0.837 seconds; blood protein 7.98±0.039, 8.02±0.053, 8.06±0.039 & 7.48±0.045mg/dl; urine protein 1.22±0.058, 0.94±0.049, 0.96±0.056 & 0.82±0.062mg/dl; blood albumin 1.64±0.033, 1.82±0.036, 1.87±0.044 & 1.96±0.039mg/dl; urine albumin 0.122±0.008, 0.098±0.007, 0.132±0.009 & 0.108±0.011mg/dl; blood myoglobin 0.045±0.00189, 0.036±0.00177, 0.041±0.00223 & 0.043±0.00175ng/dl; urine myoglobin 0.0042±0.00129, 0.0052±0.00119, 0.0064±0.00126 & 0.0036±0.00125mg/dl; BUN 35.81±1.186, 36.06±1.123, 34.53±1.177 & 29.03±1.229mg/dl; Serum Creatinine 98.42±5.526, 99.73±6.064, 101.97±6.052 & 94.83±6.678µMol/dl.

Conclusion: Ethanol extract of Senna auriculata leaf, Phyllanthus emblica L. fruit and Syzygium cumini (L.) Skeels seeds (150mg/kg) and its combination normalizes biochemical parameters & Morphological changes in sciatic nerve, myocardium & kidney and improvement of the general behavioral parameters. Combination was found to be more effective in these diabetic complications.

Syed Ahmed Hussain and Ashish Kumar Sharma*


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Uric Acid, Metabolic Risk Factors, and Chronic Kidney Disease: Clinical Investigation in a Female Elderly Occupational Population in Taipei, Taiwan

Purpose: To explore the prevalence and associated factors for Chronic Kidney Disease (CKD) among female elderly fishing and agricultural population in Taipei, Taiwan.

Methods: Females (n=1,606) aged 65 years and over voluntarily admitted to a teaching hospital for a physical check-up were collected in 2010.

Results: The prevalence of CKD was 8.2%. Age, hyperuricemia, and hyperglycemia were statistical significantly related to CKD. The sensitivity and specificity of serum uric acid and fasting blood glucose concentration as a marker of CKD were estimated 76.5%, 70.9% and 51.5%, 53.5%, respectively.

Conclusion: Hyperuricemia and hyperglycemia independently affect the prevalent CKD in this sub-population.

Ya-Ting Liang¹, Hsi-Che Shen²˒³˒⁴, Yi-Chun Hu²˒³˒⁵, Yu-Fen Chen⁶˒⁷˒⁸ and Tao-Hsin Tung⁹˒¹⁰˒¹¹*


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Pseudohypercreatininemia after Sustanon Injection

The drugs used in the treatment of certain diseases may give impression of impaired renal function. These drugs cause a false high serum creatinine level. Laboratory findings other than serum creatinine and hypertriglyceridemia were normal. We presented a 28-year-old male with a high serum creatinine level, who was referred for consideration of urgent renal replacement therapy. The results of the investigations revealed that the result was the falsely-elevated serum creatinine due to the sustenance injection.

Can Hüzmeli¹, Mustafa Sağlam¹, Bariş Döner¹, Serkan Çağlar² and Özkan Güngör³


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Peripheral Arterial Disease Holding Central Stage in Chronic Kidney Disease (Kdoqi Stage 3-5): Prevalence and Related Risk Factors - Experience from Kashmir Valley Tertiary Care Centre

Patients with CKD are highly predisposed for developing accelerated atherosclerosis. These patients have non-traditional risk factors such inflammation, malnutrition and increased oxidative stress that enhance and accelerate atherosclerosis in addition to traditional risk factors. Although relation between cardiovascular and cerebrovascular diseases with CKD is well established, studies are suggesting about association of Peripheral Arterial Disease (PAD) with CKD. PAD is associated with increased morbidity and mortality in patients of CKD.

This study is rendezvous to look for PAD and related risk factors in patients of CKD having eGFR less than 60 ml/ min/ 1.73 m2 (MDRDS) and not on RRT.

Two hundred ten subjects with CKD attending department of nephrology at tertiary care institute in valley were included in study. Out of 210 subjects selected, 30 were having PAD that constituted 14% of study population. IC was seen in 25 (11.9%) of 210 subjects. Out of PAD patients 16 (53.3%) were having history of IC and 14 (46.7%) were asymptomatic. As reported in literature, prevalence of peripheral arterial disease in CKD patients not on dialysis ranged from 7% to 32% in previous cases. This study will sensitize us to plan more effective screening, preventive and management strategies. This will go long way to decrease morbidity and mortality in patients.

Mohamad Muzzafer Mir*, Mohamad Saleem Najar, Bipin Kumar Sharma, Mangit Singh, Ursilla Taranum Mir and Majid Khalil Rather