In the present study, we investigated the pathophysiological mechanisms of the hemodynamic alteration in diabetes. Glomerular hyperfiltration occurs in the early stage of diabetes mellitus and has been recognized to promote the pathogenesis of diabetic nephropathy. We determine the role of TGF response and the vascular tone of Af-Art in diabetic hyperfiltration and we found that 1) tubular high glucose directly activates NOS1 and increases NO generation in the macula densa, which inhibits TGF response and increases GFR; 2) high glucose dilates renal Af-Art through GLUT1 and mediated by NOS3-derived NO generation; 3) in diabetes, blunted TGF mediated by NOS1 in the macula densa promotes glomerular hyperfiltration. The prevalence of hypertension is much higher in diabetic subjects than non-diabetic population. We studied the potential mechanisms of blood pressure regulation in diabetes, including TGF response and renal afferent arteriolar response to vasoconstrictors, and we found that 1) inadequate NOS1 in the macula densa enhances TGF, which restricts glomerular hyperfiltration and induces hypertension in diabetes; 2) hemodynamic responses to ANG II is increased in diabetes, which is associated with increased expression and activity of AT1 receptors in the Af-Art; 3) Ang II upregulates the expression and activity of Nox2 and Nox4 in the macula densa, which enhances TGF response.

<p>One of the key mechanisms that mediate renal autoregulation is the tubuloglomerular feedback (TGF) system, which is a negative feedback loop in the kidney that balances glomerular filtration with tubular reabsorptive capacity. In this dissertation, we develop several mathematical models of the TGF system to study TGF-mediated model dynamics. </p><p>First, we develop a mathematical model of compliant thick ascending limb (TAL) of a short loop of Henle in the rat kidney, called TAL model, to investigate the effects of spatial inhomogeneous properties in TAL on TGF-mediated dynamics. We derive a characteristic equation that corresponds to a linearized TAL model, and conduct a bifurcation analysis by finding roots of that equation. Results of the bifurcation analysis are also validated via numerical simulations of the full model equations. </p><p>We then extend the TAL model to explicitly represent an entire short-looped nephron including the descending segments and having compliant tubular walls, developing a short-looped nephron model. A bifurcation analysis for the TGF loop-model equations is similarly performed by computing parameter boundaries, as functions of TGF gain and delay, that separate differing model behaviors. We also use the loop model to better understand the effects of transient as well as sustained flow perturbations on the TGF system and on distal NaCl delivery.</p><p>To understand the impacts of internephron coupling on TGF dynamics, we further develop a mathematical model of a coupled-TGF system that includes any finite number of nephrons coupled through their TGF systems, coupled-nephron model. Each model nephron represents a short loop of Henle having compliant tubular walls, based on the short-looped nephron model, and is assumed to interact with nearby nephrons through electrotonic signaling along the pre-glomerular vasculature. The characteristic equation is obtained via linearization of the loop-model equations as in TAL model. To better understand the impacts of parameter variability on TGF-mediated dynamics, we consider special cases where the relation between TGF delays and gains among two coupled nephrons is specifically chosen. By solving the characteristic equation, we determine parameter regions that correspond to qualitatively differing model behaviors. </p><p>TGF delays play an essential role in determining qualitatively and quantitatively different TGF-mediated dynamic behaviors. In particular, when noise arising from external sources of system is introduced, the dynamics may become significantly rich and complex, revealing a variety of model behaviors owing to the interaction with delays. In our next study, we consider the effect of the interactions between time delays and noise, by developing a stochastic model. We begin with a simple time-delayed transport equation to represent the dynamics of chloride concentration in the rigid-TAL fluid. Guided by a proof for the existence and uniqueness of the steady-state solution to the deterministic Dirichlet problem, obtained via bifurcation analysis and the contraction mapping theorem, an analogous proof for stochastic system with random boundary conditions is presented. Finally we conduct multiscale analysis to study the effect of the noise, specifically when the system is in subcritical region, but close enough to the critical delay. To analyze the solution behaviors in long time scales, reduced equations for the amplitude of solutions are derived using multiscale method.</p> / Dissertation

Diabetic nephropathy is the main cause for initiation of renal replacement therapy and early symptoms in patients include increased glomerular filtration rate (GFR), decreased oxygen tension and albuminuria, followed by a progressive decline in GFR and loss of kidney function. Experimental models of diabetes display increased GFR, decreased tissue oxygenation and nitric oxide bioavailability. These findings are likely to be intertwined in a mechanistic pathway to kidney damage and this thesis investigated their roles in the development of diabetic nephropathy. In vivo, diabetes-induced oxidative stress stimulates renal tubular Na+ transport and in vitro, proximal tubular cells from diabetic rats display increased transport-dependent oxygen consumption, demonstrating mechanisms contributing to decreased kidney oxygenation. In control animals, endogenous adenosine reduces vascular resistance of the efferent arteriole via adenosine A2-receptors resulting in reduced filtration fraction. However, in diabetes, adenosine A2-signalling is dysfunctional resulting in increased GFR via increased filtration fraction. This is caused by reduced adenosine A2a receptor-mediated vasodilation of efferent arterioles. The lack of adenosine-signaling in diabetes is likely due to reduced local adenosine concentration since adenosine A2a receptor activation reduced GFR only in diabetic animals by efferent arteriolar vasodilation. Furthermore, sub-optimal insulin treatment also alleviates increased filtration pressure in diabetes. However, this does not affect GFR due to a simultaneously induction of renal-blood flow dependent regulation of GFR by increasing the filtration coefficient. In diabetes, there is decreased bioavailability of nitric oxide, resulting in alterations that may contribute to diabetes-induced hyperfiltration and decreased oxygenation. Interestingly, increased plasma concentration of l-arginine, the substrate for nitric oxide production, prevents the development of increased GFR and proteinuria, but not increased oxygen consumption leading to sustained intra-renal hypoxia in diabetes. This thesis concludes that antioxidant treatment directed towards the NADPH oxidase as well maneuvers to promote nitric oxide production is beneficial in diabetic kidneys but is targeting different pathways i.e. transport-dependent oxygen consumption in the proximal tubule by NADPH oxidase inhibition and intra-renal hemodynamics after increased plasma l-arginine. Also, the involvement and importance of efferent arteriolar resistance in the development of diabetes-induced hyperfiltration via reduced adenosine A2a signaling is highlighted.