Efficacy of orally administered montmorillonite in myoglobinuric acute renal failure model in male rats

Document Type : Original Article

Authors

1 School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran

2 School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran 2 Medical Toxicology Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Clinical Toxicology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

4 Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran

5 Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran

6 Department of Pharmacognosy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran

7 International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Objective(s): Acute kidney injury can be associated with serious consequences and therefore early treatment is critical to decreasing mortality and morbidity rate. We evaluated the effect of montmorillonite, the clay with strong cation exchange capacity, on the AKI model in rats.
Materials and Methods: Glycerol (50% solution, 10 ml/kg) was injected in the rat hind limbs to induce AKI. 24 hr after induction of acute kidney injury, the rats received oral doses of montmorillonite (0.5 g/kg or 1 g/kg), or sodium polystyrene sulfonate (1 g/kg) for three consecutive days. 
Results: Glycine induced acute kidney injury in rats with high levels of urea (336.60± 28.19 mg/dl), creatinine (4.10± 0.21 mg/dl), potassium (6.15 ± 0.28 mEq/L), and calcium (11.52 ± 0.19 mg/dl).  Both doses of montmorillonite (0.5 and 1 g/kg) improved the serum urea (222.66± 10.02 and 170.20±8.06, P<0.05), creatinine (1.86±0.1, 2.05± 0.11, P<0.05), potassium (4.68 ± 0.4, 4.73 ± 0.34, P<0.001) and calcium (11.15 ± 0.17, 10.75 ± 0.25, P<0.01) levels. Treatment with montmorillonite especially at a high dose reduced the kidney pathological findings including, tubular necrosis, amorphous protein aggregation, and cell shedding into the distal and proximal tubule lumen. However, administration of SPS could not significantly decrease the severity of damages.
Conclusion: According to the results of this study, as well as the physicochemical properties of montmorillonite, such as high ion exchange capacity and low side effects, montmorillonite can be a low-cost and effective treatment option to reduce and improve the complications of acute kidney injury. However, the efficacy of this compound in human and clinical studies needs to be investigated.

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Main Subjects


1. Rahman M, Shad F, Smith MC. Acute kidney injury: A guide to diagnosis and management. Am Fam Physician 2012; 86:631-639.
2. Kellum JA. Diagnostic criteria for acute kidney injury: Present and future. Critical Care Clinics 2015; 31:621-632.
3. Yang F, Zhang L, Wu H, Zou H, Du Y. Clinical analysis of cause, treatment and prognosis in acute kidney injury patients. PLoS One 2014; 9:e85214.
4. Molitoris BA. Measuring glomerular filtration rate in acute kidney injury: Yes, but not yet. Crit Care 2012; 16:1-2.
5. Allen JC, Gardner DS, Skinner H, Harvey D, Sharman A, Devonald MA. Definition of hourly urine output influences reported incidence and staging of acute kidney injury. BMC Nephrol 2020; 21:1-8.
6. Yoshida M, Honma S. Regeneration of injured renal tubules. J Pharmacol Sci 2014; 124:117-122.
7. listed Na. Section 2: AKI definition. Kidney Int 2012:19-36.
8. Luo M, Yang Y, Xu J, Cheng W, Li X-W, Tang M-M, et al. A new scoring model for the prediction of mortality in patients with acute kidney injury. Scientific Reports 2017; 7:1-11.
9. Wiersema R, Eck RJ, Haapio M, Koeze J, Poukkanen M, Keus F, et al. Burden of acute kidney injury and 90-day mortality in critically ill patients. BMC Nephrol 2020; 21:1-8.
10. Chen H, Busse LW. Novel therapies for acute kidney injury. Kidney Int Rep 2017; 2:785-799.
11. Lobo VA. Renal Replacement Therapy in Acute Kidney Injury: Which Mode and When? IIndian J Crit Care Med 2020; 24:S102.
12. Selby NM, Fluck RJ, Kolhe NV, Taal MW. International criteria for acute kidney injury: Advantages and remaining challenges. PLoS Med 2016; 13:e1002122.
13. Petejova N, Martinek A. Acute kidney injury due to rhabdomyolysis and renal replacement therapy: A critical review. Crit Care 2014; 18:1-8.
14. Singh AP, Junemann A, Muthuraman A, Jaggi AS, Singh N, Grover K, et al. Animal models of acute renal failure. Pharmacol Rep 2012; 64:31-44.
15. Reis NG, Francescato HDC, de Almeida LF, Silva C, Costa RS, Coimbra TM. Protective effect of calcitriol on rhabdomyolysis-induced acute kidney injury in rats. Sci Rep 2019; 9:7090.
16. A. Emam E. Clays as catalysts in petroleum refining industry. ARPN J Sci Tech 2013; 3:356-375.
17. Yang Z, Wang W, Wang G, Tai X. Optimization of low-energy Pickering nanoemulsion stabilized with montmorillonite and nonionic surfactants. Colloids Surf A Physicochem Eng Asp 2020; 585:124098.
18. Moosavi PM, Astaraei AR, Karimi A, Moshiri M, Etemad L, Zeinali M, et al. Efficacy of orally administered montmorillonite for acute iron poisoning detoxification in rat. Appl Clay Sci 2015; 103:62-66.
19. Król-Morkisz K, Pielichowska K. Thermal decomposition of polymer nanocomposites with functionalized nanoparticles.  Polymer Composites with Functionalized Nanoparticles: Elsevier; 2019. p. 405-435.
20. Han Z, Li J, Zhang M, Lv C. Effect of montmorillonite on arsenic accumulation in common carp. Afr J Mycol Biotechnol 2012; 11:6160-6168.
21. Park JH, Shin HJ, Kim MH, Kim JS, Kang N, Lee JY, et al. Application of montmorillonite in bentonite as a pharmaceutical excipient in drug delivery systems. J Pharm Investig 2016; 46:363-375.
22. Moshiri M, Imenshahidi M, Moallem S, Ghadirie A, Nyasmand A, Mirhoseini Moosavi P, et al. Montmorillonite, a promising new material for acute lithium intoxication in rats. Iran J Pharm Res 2021; 17:71-82.
23. Mirhoseini Moosavi P, Astaraei AR, Moshiri M, Etemad L, Zeinali M, Karimi GR. Efficacy of orally administered montmorillonite for acute iron poisoning detoxification in rat. Appl Clay Sci 2015; 103:62–66.
24. Zhang Yt, Wang Xf, Long Lh, Liu T, Cao Yx. Montmorillonite adsorbs creatinine and accelerates creatinine excretion from the intestine. J Pharm Pharmacol 2009; 61:459-464.
25. Gaba S, Jesrani G, Gupta S, Gupta M. Acute kidney injury and hyperkalemia with precarious electrocardiographic changes caused by concurrent use of telmisartan and diclofenac. Cureus 2020; 12:e9858.
26. GARY NE, EISINGER RP. Clay ingestion and hypokalemia. Ann Intern Med 1982; 97:622-622.
27. Gonzalez JJ, Owens W, Ungaro PC, Werk Jr EE, Wentz PW. Clay ingestion: A rare cause of hypokalemia. Ann Intern Med 1982; 97:65-66.
28. Setime MA, Sesay S, Cainelli F, Vento S. A case of severe hypokalemic myopathy due to clay ingestion. Isr Med Assoc J 2013; 15:524-525.
29. Rezaee-Khorasany A, Razavi BM, Taghiabadi E, Tabatabaei Yazdi A, Hosseinzadeh H. Effect of crocin, an active saffron constituent, on ethanol toxicity in the rat: histopathological and biochemical studies. Iran J Basic Med Sci 2020; 23:51-62.
30. Liu P, Zhang L. Adsorption of dyes from aqueous solutions or suspensions with clay nano-adsorbents. Sep Purif Technol 2007; 58:32-39.
31. Ma Y-L, Xu Z-R, Guo T, You P. Adsorption of methylene blue on Cu (II)-exchanged montmorillonite. J Colloid Interface Sci 2004; 280:283-288.
32. Zhang SQ, Hou WG. Adsorption behavior of Pb (II) on montmorillonite. Colloids Surf A: Physicochem Eng Asp 2008; 320:92-97.
33. Barbier F, Duc G, Petit-Ramel M. Adsorption of lead and cadmium ions from aqueous solution to the montmorillonite/water interface. Colloids Surf A Physicochem Eng Asp 2000; 166:153-159.
34. Puls RW, Bohn HL. Sorption of cadmium, nickel, and zinc by kaolinite and montmorillonite suspensions. Soil Sci Soc Am J 1988; 52:1289-1292.
35. Akar ST, Yetimoglu Y, Gedikbey T. Removal of chromium (VI) ions from aqueous solutions by using Turkish montmorillonite clay: Effect of activation and modification. Desalination 2009; 244:97-108.
36. Ren X, Zhang Z, Luo H, Hu B, Dang Z, Yang C, et al. Adsorption of arsenic on modified montmorillonite. Appl Clay Sci 2014; 97:17-23.
37. Hu X, Lu G, Chen L, Gu J, Zhang Y. Study on the mechanism of the interaction between montmorillonite and bacterium. Yao Xue Xue Bao. Acta pharm Sin 2002; 37:718-720.
38. Wang Z, Cui M, Tang L, Li W, Wei Y, Zhu Z, et al. Oral activated charcoal suppresses hyperphosphataemia in haemodialysis patients. Nephrology 2012; 17:616-620.
39. Musso CG, Michelangelo H, Reynaldi J, Martinez B, Vidal F, Quevedo M, et al. Combination of oral activated charcoal plus low protein diet as a new alternative for handling in the old end-stage renal disease patients. Saudi J Kidney Dis Transpl 2010; 21:102-104.
40. Andreoli SP. Acute kidney injury in children. Pediatr Nephrol 2009; 24:253-263.
41. Kim HY, Yokozawa T, Nakagawa T, Sasaki S. Protective effect of γ-aminobutyric acid against glycerol-induced acute renal failure in rats. Food Chem Toxicol 2004; 42:2009-2014.
42. Cao Y, Long L, Ma Z, Tao X, Liu J, Zhou L. Effect of montmorillonite on diffussion of urea between blood and intestine and on absorption of intestine in rats. Zhong Yao Cai 2009; 32:249-253.
43. Kim KS, Park M, Lim WT, Komarneni S. Massive intercalation of urea in montmorillonite. Soil Sci Soc Am J 2011; 75:2361-2366.
44. James D, Harward M. Mechanism of NH3 adsorption by montmorillonite and kaolinite. Clays Clay Miner 1962; 11:301-320.
45. Yun Y, Gao T, Li Y, Gao Z, Duan J, Yin H, et al. Corrigendum to excretory function of intestinal tract enhanced in kidney impaired rats caused by adenine. ScientificWorldJournal 2020; 2020:8273196.
46. Yun Y, Gao T, Li Y, Gao Z, Duan J, Yin H, et al. Excretory function of intestinal tract enhanced in kidney impaired rats caused by adenine. ScientificWorldJournal 2016; 2016:2695718.
47. Khan FY. Rhabdomyolysis: A review of the literature. Neth J Med 2009; 67:272-283.
48. Long B, Targonsky E, Koyfman A. Just the Facts: Diagnosis and management of rhabdomyolysis. CJEM 2020; 22:745-748.
49. Madkour AH, Helal MG, Said E, Salem HA. Dose-dependent renoprotective impact of Lactoferrin against glycerol-induced rhabdomyolysis and acute kidney injury. Life Sci 2022; 302:120646.
50. Severance Jr H, Holt T, Patrone NA, Chapman L. Profound muscle weakness and hypokalemia due to clay ingestion. South Med J 1988; 81:272-274.
51. Ukaonu C, Hill DA, Christensen F. Hypokalemic myopathy in pregnancy caused by clay ingestion. Obstet Gynecol 2003; 102:1169-1171.
52. Bennett A, Stryjewski G. Severe hypokalemia caused by oral and rectal administration of bentonite in a pediatric patient. Pediatr Emerg Care 2006; 22:500-502.
53. Samuel HU, Balasubramaniyan T, Thirumavalavan S, Vasudevan C, Kumar RS, Murugesan V, et al. Rhabdomyolysis with myoglobin-induced acute kidney injury: A case series of four cases. Indian J Pathol Microbiol 2021; 64:382.
54. Loehry C, Axon A, Hilton P, Hider R, Creamer B. Permeability of the small intestine to substances of different molecular weight. Gut 1970; 11:466-470.
55. Kalakonda A, Jenkins BA, John S.  Physiology, bilirubin. 2021. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2022.
56. Kröning S, Scheller FW, Wollenberger U, Lisdat F. Myoglobin‐clay electrode for nitric oxide (NO) detection in solution. Electroanalysis 2004; 16:253-259.
57. McLaren AD, Peterson GH, Barshad I. The adsorption and reactions of enzymes and proteins on clay minerals: IV. Kaolinite and montmorillonite. Soil Sci Soc Am J 1958; 22:239-244.
58. Hunt TV, DeMott JM, Ackerbauer KA, Whittier WL, Peksa GD. Single-dose sodium polystyrene sulfonate for hyperkalemia in chronic kidney disease or end-stage renal disease. Clin Kidney J 2019; 12:408-413.
59. McGowan C, Saha S, Chu G, Resnick M, Moss S. Intestinal necrosis due to sodium polystyrene sulfonate (Kayexalate) in sorbitol. South Med J 2009; 102:493-497.
60. Sandle G, Gaiger E, Tapster S, Goodshep T. Enhanced rectal potassium secretion in chronic renal insufficiency: Evidence for large intestinal potassium adaptation in man. Clin Sci 1986; 71:393-401.
61. Batlle D, Boobés K, Manjee KG. The colon as the potassium target: Entering the colonic age of hyperkalemia treatment? EBioMedicine 2015; 2:1562-1563.