Exploring the Impact of Continuous Ethinylestradiol and Drospirenone Administration on Kidney Morphofunction in Female Mice with or Without a High-Fat Diet
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Abstract
Introduction: Combined oral contraceptives (COCs) are composed of estrogen and progestin and are among the most used contraceptive methods worldwide. Being overweight may increase the risk of kidney diseases, especially in women. However, whether the continuous use of COCs can affect renal health remains unclear. Objective: To investigate the effects of continuous administration of a COC containing ethinylestradiol (EE) and drospirenone (DRSP) on the renal morphofunction of female mice, with or without a high-fat diet (HFD). Methods: For 65 days, adult Swiss female mice were fed a standard diet (SD) or a high-fat diet (HFD) and received a daily oral gavage of 200 µL distilled water [control SD (CTL-SD) and CTL-HFD groups, respectively], containing or not 0.6 µg EE plus 60 µg DRSP (COC-SD and COC-HFD, respectively). Results: COC-SD females exhibited increased water intake and urine excretion, reduced fasting glycemia and urine creatinine levels, but higher Na+ and K+ urinary excretion. In contrast, the COC-HFD group displayed increased glycemia and reductions in water intake, urinary volume, and Na+ and K+ excretion. COC administration caused a reduction in Bowman’s space of renal corpuscles of COC-SD females, and tubular injury in the renal cortex and medulla. Nephrons of COC-HFD females showed reductions in glomerular area and an enlargement of Bowman’s space, but tubular injury like that observed for COC-SD. Conclusion: Continuous administration of EE and DRSP can cause morphological kidney damage, which is a concerning finding, as these modifications occur before any apparent changes in renal function parameters in plasma and urine.
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1. United Nations. Department of Economic and Social Affairs. Contraceptive use by method 2019. Available from: https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/files/documents/2020/Jan/un_2019_contraceptiveusebymethod_databooklet.pdf.
2. Cooper D, Patel P, Mahdy H. Oral Contraceptive Pills. Available from: https://europepmc.org/article/NBK/nbk430882#__NBK430882_ai_
3. Pollow K, Juchem M, Elger W, Jacobi N, Hoffmann G, Möbus V. Dihydrospirorenone (ZK30595): A novel synthetic progestagen-characterization of binding to different receptor proteins. Contraception. 1992;46(6):561-74. https://doi.org/10.1016/0010-7824(92)90121-9
4. Fuhrmann U, Krattenmacher R, Slater EP, Fritzemeier KH. The novel progestin drospirenone and its natural counterpart progesterone: biochemical profile and antiandrogenic potential. Contraception. 1996;54(4):243-51. https://doi.org/10.1016/S0010-7824(96)00195-3
5. Sitruk-Ware R. New progestagens for contraceptive use. Hum Reprod Update. 2006;12(2):169-78. https://doi.org/10.1093/humupd/dmi046
6. Quinkler M, Bujalska IJ, Kaur K, Onyimba CU, Buhner S, Allolio B, et al. Androgen Receptor–Mediated Regulation of the α-Subunit of the Epithelial Sodium Channel in Human Kidney. Hypertension. 2005;46(4):787-98. https://doi.org/10.1161/01.HYP.0000184362.61744.c1
7. Thomas W, Harvey BJ. Estrogen-induced signalling and the renal contribution to salt and water homeostasis. Steroids. 2023;199:109299. https://doi.org/10.1016/j.steroids.2023.109299
8. Elabida B, Edwards A, Salhi A, Azroyan A, Fodstad H, Meneton P, et al. Chronic potassium depletion increases adrenal progesterone production, which is necessary for efficient renal retention of potassium. Kidney Int. 2011;80(3):256-62. https://doi.org/10.1038/ki.2011.15
9. Wang Y, Chen X, Song Y, Caballero B, Cheskin LJ. Association between obesity and kidney disease: A systematic review and meta-analysis. Kidney Int. 2008;73(1):19-33. https://doi.org/10.1038/sj.ki.5002586
10. The GBD 2015 Obesity Collaborators. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N Engl J Med. 2017;377(1):13-27. https://doi.org/10.1056/NEJMoa1614362
11. Forman D, Vincent TJ, Doll R. Cancer of the liver and the use of oral contraceptives. Br Med J. 1986;292(6532):1357-61. https://doi.org/10.1136/bmj.292.6532.1357
12. Smith JS, Green J, Gonzalez AB, Appleby P, Peto J, Plummer M, et al. Cervical cancer and use of hormonal contraceptives: a systematic review. Lancet. 2003;361(9364):1159-67. https://doi.org/10.1016/S0140-6736(03)12949-2
13. Oliveira CAR, Araujo TR, Aguiar GS, Silva Junior JA, Vettorazzi JF, Freitas IN, et al. Combined oral contraceptive in female mice causes hyperinsulinemia due to β-cell hypersecretion and reduction in insulin clearance. J Steroid Biochem Mol Biol. 2019;190:54-63. https://doi.org/10.1016/j.jsbmb.2019.03.018
14. Freitas GC, Carregaro AB. Aplicabilidade da extrapolação alométrica em protocolos terapêuticos para animais selvagens. Cienc Rural. 2013;43(2):297-304. https://doi.org/10.1590/S0103-84782013000200017
15. Pereira RO, Muller CR, Nascimento NRF, Fonteles MC, Evangelista FSA, Fiorino P, et al. Early consumption of a high-fat diet worsens renal damage in spontaneously hypertensive rats in adulthood. Int J Physiol Pathophysiol Pharmacol. 2019;11(6):258-66.
16. Garcia IJP, Cézar JS, Lemos BS, Silva LN, Ribeiro RIMA, Santana CC, et al. Effects of high-fat diet on kidney lipid content and the Na, K-ATPase activity. Braz J Pharm Sci. 2018;54(1). https://doi.org/10.1590/s2175-97902018000117165
17. Rangan GK, Tesch GH. Quantification of renal pathology by image analysis. Nephrology (Carlton). 2007;12(6):553-8. https://doi.org/10.1111/j.1440-1797.2007.00855.x
18. Kudose S, Hoshi M, Jain S, Gaut JP. Renal Histopathologic Findings Associated with the Severity of Clinical Acute Kidney Injury. Am J Surg Pathol. 2018;42(5):625-35. https://doi.org/10.1097/PAS.0000000000001028
19. Gonsalez SR, Cortes AL, Romanelli MA, Mattos-Silva P, Curnow AC, Prieto MC, et al. Lysophosphatidic Acid Prevents Ischemia-Reperfusion Injury but Does Not Prevent Tubular Dysfunction. J Nephrol Sci. 2020;2(2):5-19.
20. Zhu BT, Han GZ, Shim JY, Wen Y, Jiang XR. Quantitative Structure-Activity Relationship of Various Endogenous Estrogen Metabolites for Human Estrogen Receptor α and β Subtypes: Insights into the Structural Determinants Favoring a Differential Subtype Binding. Endocrinology. 2006;147(9):4132-50. https://doi.org/10.1210/en.2006-0113
21. Cheema MU, Irsik DL, Wang Y, Miller-Little W, Hyndman KA, Marks ES, et al. Estradiol regulates AQP2 expression in the collecting duct: a novel inhibitory role for estrogen receptor α. Am J Physiol Renal Physiol. 2015;309(4):F305-17. https://doi.org/10.1152/ajprenal.00685.2014
22. Muhn P, Krattenmacher R, Beier S, Elger W, Schillinger E. Drospirenone: A novel progestogen with antimineralocorticoid and antiandrogenic activity. Contraception. 1995;51(2):99-110. https://doi.org/10.1016/0010-7824(94)00015-O
23. Losert W, Casals-Stenzel J, Buse M. Progestogens with antimineralocorticoid activity. Arzneimittelforschung. 1985;35(9):459-71.
24. Sitruk-Ware R, Nath A. The use of newer progestins for contraception. Int Repr Health J Contraception. 2010;82(5):410-17.
25. Aizawa N, Homma Y, Igawa Y. Influence of High Fat Diet Feeding for 20 Weeks on Lower Urinary Tract Function in Mice. Low Urinary Tract Symptoms. 2013;5(2):101-8. https://doi.org/10.1111/j.1757-5672.2012.00172.x
26. Quadri SS, Culver S, Ramkumar N, Kohan DE, Siragy HM. (Pro)Renin receptor mediates obesity-induced antinatriuresis and elevated blood pressure via upregulation of the renal epithelial sodium channel. PLoS One. 2018;13(8):e0202419. https://doi.org/10.1371/journal.pone.0202419
27. Volcko KL, Carroll QE, Brakey DJ, Daniels D. High-fat diet alters fluid intake without reducing sensitivity to glucagon-like peptide-1 receptor agonist effects. Physiol Behav. 2020;221:112910. https://doi.org/10.1016/j.physbeh.2020.112910
28. Prior LJ, Eikelis N, Armitage JA, Davern PJ, Burke SL, Montani JP, et al. Exposure to a High-Fat Diet Alters Leptin Sensitivity and Elevates Renal Sympathetic Nerve Activity and Arterial Pressure in Rabbits. Hypertension. 2010;55(4):862-8. https://doi.org/10.1161/HYPERTENSIONAHA.109.141119
29. Nizar JM, Dong W, McClellan RB, Labarca M, Zhou Y, Wong J, et al. Na + -sensitive elevation in blood pressure is ENaC independent in diet-induced obesity and insulin resistance. Ame J Physiol Renal Physiol. 2016;310(9):F812-20. https://doi.org/10.1152/ajprenal.00265.2015
30. Lee J, Yoo K, Kim SW, Jung KH, Ma SK, Lee YK, et al. Decreased Expression of Aquaporin Water Channels in Denervated Rat Kidney. Nephron Physiol. 2006;103(4):170-8. https://doi.org/10.1159/000092918
31. Salman IM, Sattar MA, Abdullah NA, Ameer OZ, Basri F, Hussain NM, et al. Role of renal sympathetic nervous system in the control of renal potassium handling. J Nephrol. 2010;23(3):291-6.
32. Türk S, Cernomorcenco A, Kirimlioğlu E. Effect on Endoplasmic Reticulum Stress of the Combined Oral Contraceptives in the Liver. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi. 2024;10(1):1-7. https://doi.org/10.30934/kusbed.1281214
33. Esquinas P, Rios R, Raya AI, Pineda C, Rodriguez M, Aguilera-Tejero E, et al. Structural and ultrastructural renal lesions in rats fed high-fat and high-phosphorus diets. Clin Kidney J. 2021;14(3):847-54. https://doi.org/10.1093/ckj/sfaa009
34. Matsumoto A, Matsui I, Katsuma Y, Yasuda S, Shimada K, Namba-Hamano T, et al. Quantitative Analyses of Foot Processes, Mitochondria, and Basement Membranes by Structured Illumination. Kidney Int Rep. 2021;6(7):1923-38. https://doi.org/10.1016/j.ekir.2021.04.021
35. Cortinovis M, Perico N, Ruggenenti P, Remuzzi A, Remuzzi G. Glomerular hyperfiltration. Nat Rev Nephrol. 2022;18(7):435-51. https://doi.org/10.1038/s41581-022-00559-y
36. Armani A, Cinti F, Marzolla V, Morgan J, Cranston GA, Antelmi A, et al. Mineralocorticoid receptor antagonism induces browning of white adipose tissue through impairment of autophagy and prevents adipocyte dysfunction in high‐fat‐diet‐fed mice. FASEB J. 2014;28(8):3745-57. https://doi.org/10.1096/fj.13-245415
37. Acharya KD, Graham M, Raman H, Parakoyi AER, Corcoran A, Belete M, et al. Estradiol-mediated protection against high-fat diet-induced anxiety and obesity is associated with changes in the gut microbiota in female mice. Sci Rep. 2023;13(1):4776. https://doi.org/10.1038/s41598-023-31783-6