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Impairment in renal medulla development underlies salt wasting in Clc-k2 channel deficiency
Meng-Hsuan Lin, Jen-Chi Chen, Xuejiao Tian, Chia-Ming Lee, I-Shing Yu, Yi-Fen Lo, Shinichi Uchida, Chou-Long Huang, Bi-Chang Chen, Chih-Jen Cheng
Meng-Hsuan Lin, Jen-Chi Chen, Xuejiao Tian, Chia-Ming Lee, I-Shing Yu, Yi-Fen Lo, Shinichi Uchida, Chou-Long Huang, Bi-Chang Chen, Chih-Jen Cheng
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Research Article Nephrology

Impairment in renal medulla development underlies salt wasting in Clc-k2 channel deficiency

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Abstract

The prevailing view is that the ClC-Ka chloride channel (mouse Clc-k1) functions in the thin ascending limb to control urine concentration, whereas the ClC-Kb channel (mouse Clc-k2) functions in the thick ascending limb (TAL) to control salt reabsorption. Mutations of ClC-Kb cause classic Bartter syndrome, characterized by renal salt wasting, with perinatal to adolescent onset. We studied the roles of Clc-k channels in perinatal mouse kidneys using constitutive or inducible kidney-specific gene ablation and 2D and advanced 3D imaging of optically cleared kidneys. We show that Clc-k1 and Clc-k2 were broadly expressed and colocalized in perinatal kidneys. Deletion of Clc-k1 and Clc-k2 revealed that both participated in NKCC2- and NCC-mediated NaCl reabsorption in neonatal kidneys. Embryonic deletion of Clc-k2 caused tubular injury and impaired renal medulla and TAL development. Inducible deletion of Clc-k2 beginning after medulla maturation produced mild salt wasting resulting from reduced NCC activity. Thus, both Clc-k1 and Clc-k2 contributed to salt reabsorption in TAL and distal convoluted tubule (DCT) in neonates, potentially explaining the less-severe phenotypes in classic Bartter syndrome. As opposed to the current understanding that salt wasting in adult patients with Bartter syndrome is due to Clc-k2 deficiency in adult TAL, our results suggest that it originates mainly from defects occurring in the medulla and TAL during development.

Authors

Meng-Hsuan Lin, Jen-Chi Chen, Xuejiao Tian, Chia-Ming Lee, I-Shing Yu, Yi-Fen Lo, Shinichi Uchida, Chou-Long Huang, Bi-Chang Chen, Chih-Jen Cheng

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Figure 9

3D imaging of whole expanded mouse kidneys.

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3D imaging of whole expanded mouse kidneys.
(A) Whole-kidney view of Nkc...
(A) Whole-kidney view of Nkcc2-positive TALs. Scale bar: 1 mm. (B) Magnified view of a cross-section (marked by a yellow rectangle in A of Nkcc2-positive TALs. Scale bar: 1 mm. (C) 3D reconstruction of Nkcc2-positive TALs based on the fluorescence intensity of Nkcc2 (red: strong, blue: weak). (D) Quantitative Nkcc2 fluorescence analysis of whole-kidney TALs. The tracked renal tubules (black line) and NKCC-positive signal (red line) were plotted together in 3D space (upper panel) and as intensity versus length (lower panel). Fluorescence intensity of each TAL was linearized from the cortical end (high intensity) to the medullary end (low intensity). The x axis indicates the length of expanded TALs (not the real length in vivo). (E) Length analysis of whole-kidney TALs, ranging from 0.5 mm to 6 mm, in 250 μm increments. Note that the sample is physically expanded to approximately 4 times larger in each dimension.

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