The authors would like to thank Hans-Joachim Schurek for invaluable scientific advice. The authors would like to thank Monique Carrel and Mich&#232;le Heidemeyer for excellent technical assistance, David Penton Ribas and Nourdine Faresse for a critical reading of the manuscript and Carsten Wagner and J&#252;rg Biber for the NaPi-2a antibody. This work was supported by the Swiss National Centre for Competence in Research "Kidney.CH" and by a project grant (310030_143929/1) from the Swiss National Science Foundation.

All procedures involving animals described in this manuscript were conducted according to Swiss law and approved by the veterinary administration of the Canton of Zurich, Switzerland.
1. Buffer Preparation
<ol>
	<li>Prepare solutions 1 - 4 and the antidiuretic hormone (ADH) solution (Table 1).</li>
	<li>Prepare the dialysis buffer (Table 1). 
	NOTE: This is the buffer used as the dialysis buffer during the perfusion. Later, the erythrocytes will be diluted in this buffer to form the final perfusate.</li>
	<li>Erythrocyte preparation.
	<ol>
		<li>Dilute 250 ml of human erythrocyte concentrate (tested material obtained from the local blood bank) to 500 ml with dialysis buffer. Centrifuge at 2,000 x g for 8 min. Remove the buffer, being careful not to remove any erythrocytes. Repeat 3x.</li>
	</ol>
	</li>
	<li>Prepare the albumin (bovine serum albumin; BSA) buffer.
	<ol>
		<li>In 200 ml of dialysis buffer, dissolve 44 g of BSA using a stir bar. Filter the solution with filter paper.</li>
	</ol>
	</li>
	<li>Prepare the perfusate.
	<ol>
		<li>Filter the erythrocytes from step 1.3.1 through filter paper into the BSA buffer. Fill up to a total volume of 800 ml with dialysis buffer. 
		NOTE: This is the final perfusate. The hematocrit should now be between 8 and 12%. The perfusate can be stored for up to 12 hr at 4 &#176;C.</li>
	</ol>
	</li>
</ol>
2. Initiating Dialysis and Oxygenation
<ol>
	<li>Turn on the water bath surrounding the larger buffer reservoir, smaller buffer reservoir, and the moist chamber (a small, double-walled chamber brought to 37 &#176;C and 100% humidity to later hold the kidney) to 37 &#176;C (Figure 2).</li>
	<li>Fill the larger buffer reservoir with the dialysis buffer and the smaller reservoir with the perfusate.</li>
	<li>Turn on the 5% CO2/95% O2 gas inflow to the dialysis buffer.</li>
	<li>Switch on continuous dialysis of the perfusate against the dialysis buffer. Take care to use low-flux dialysis tubing. Proceed to Step 3.</li>
</ol>
<img alt="Figure 2" src="/files/ftp_upload/54712/54712fig2.jpg" /> 
Figure 2: Schematic Drawing of the Perfusion Circuit. Scheme shows the main components of the perfusion circuit and the direction of buffer flow. All components surrounded by dark blue are kept at 37 &#176;C with a water bath/thermostat. 1: Dialysis buffer of at least 3 times the volume of the perfusion buffer is continuously bubbled with 95% O2/5% CO2. 2: Dialysis buffer and perfusion buffer are continuously dialyzed against each other in a dialysis tube by a roller pump. 3: Due to this dialysis, the perfusion buffer is enriched with 9% O2/5% CO2 and electrolyte levels are kept constant throughout perfusion. 4: A roller pump propels the perfusion buffer toward the kidney. 5: A windkessel removes peristaltic waves and acts as a bubble trap. 6: Pressure transducer (connected to 4. (roller pump) to keep continuous pressure while allowing freely alternating flow). 7: Throughout perfusion, the kidney remains in a moist chamber for 100% air humidity and 37 &#176;C kidney temperature. <a href="http://cloudfront.jove.com/files/ftp_upload/54712/54712fig2large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
3. Surgical Procedure Part 1 (for a diagram of all ligatures, see Figure 3)
Note: Perform all ligatures using 5-0 surgical thread.
<ol>
	<li>Anesthetize a mouse by intraperitoneal injection (10 &#181;l/g of body weight, 20 mg/ml ketamine and 1 mg/ml xylazine dissolved in 0.9% NaCl). Confirm sufficient depth of anesthesia by testing for absence of rear-foot reflexes.</li>
	<li>Fix the mouse in a supine position in the moist chamber. Protect the eyes with vet ointment. Place a 1 ml syringe below the spine to elevate the lumbar vessels.</li>
	<li>Perform a median laparotomy from the pubic crest to the sternum opening first the skin, then the abdominal muscles, with scissors.</li>
	<li>Remove the intestine and place it on the left side of the mouse lateral from the abdomen.</li>
	<li>Free the bladder from connective tissue and explore both ureters and the urethra.</li>
	<li>Place a ligature around the left ureter (ligature I). Close it.</li>
	<li>Place a ligature around the urethra (ligature II). Close it.</li>
	<li>Place a &#34;lasso&#34; ligature around the whole bladder (ligature III).</li>
	<li>Incise the bladder 1 mm.</li>
	<li>Cannulate the opening with 2 cm PE 50 tubing.</li>
	<li>Close ligature III around the tubing.</li>
	<li>Cut the left ureter and urethra distal from the ligatures. The bladder is now attached to the right ureter only and freely moving.</li>
	<li>Clear the abdominal aorta of connective tissue and fat.</li>
	<li>Place an abdominal mid-aorta ligature (ligature IV).</li>
	<li>Place a ligature around the aorta below the diaphragm between the superior mesenteric artery and the coeliac trunk (ligature V).</li>
	<li>Place a ligature around the superior mesenteric artery (ligature VI).</li>
	<li>Place an aortic ligature directly below the right and above the left renal artery (ligature VII).</li>
	<li>Place a ligature around the caudal vein package (cava) (ligature VIII). Proceed to Step 4.</li>
</ol>
<img alt="Figure 3" src="/files/ftp_upload/54712/54712fig3.jpg" /> 
Figure 3: Schematic Drawing of the Ligatures placed during Surgery. View of the open abdomen after the laparotomy. The intestine is moved out to the left. L and R indicate the left and right kidney. The black lines show the area of the respective ligature. Ligatures are first placed and then closed, in the sequence given in the text. X marks the location of the incision for aorta cannulation. <a href="http://cloudfront.jove.com/files/ftp_upload/54712/54712fig3large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
4. Priming of the Perfusion Circuit
<ol>
	<li>Start the rotary pump and fill the tubing with perfusate. Take care to empty all air bubbles from it.</li>
	<li>Fill the windkessel device to approximately mid-level with perfusate.</li>
	<li>Calibrate the pressure transducer to 0 mm Hg when all tubing is filled and flow is 0. Keep the perfusion needle at kidney level during this time.</li>
	<li>Keep flow at a constant minimal level (0.6 ml/min) and proceed to Step 5.</li>
</ol>
5. Surgical Procedure Part 2
<ol>
	<li>Place a clamp between ligature IV and the branching of the left renal artery.</li>
	<li>Make a small incision in the aorta caudal of ligature IV, taking care to not cut the dorsal wall.</li>
	<li>Dilate the opening in the aorta with a vessel dilator.</li>
	<li>Cannulate the aorta with a needle (2 cm long, pulled PE 50), pushing the tip just to the clamp.</li>
	<li>Open the clamp.</li>
	<li>Push the tip of the needle cranially until it reaches the junction of the right kidney artery and the aorta.</li>
	<li>Close ligature VII.</li>
	<li>Close ligature IV.</li>
	<li>Open the chest with scissors by dissecting the diaphragm. With a single cut, separate the aorta, vena cava, heart and vegetative nerves.&#160;&#160;With this step, the animal is sacrificed via rapid exsanguination under continuous deep anesthesia.</li>
	<li>Start pressure control of the perfusion pump. Maintain the mean pressure between 80 and 100 mmHg.</li>
	<li>Close ligature V.</li>
	<li>Close ligature VI.</li>
	<li>Close ligature VIII.</li>
	<li>Free the right kidney from connective tissue and its embedding into the adipose capsule with scissors.</li>
	<li>Cut the aorta proximally to ligature V.</li>
	<li>Cut the superior mesenteric artery distally to ligature VI.</li>
	<li>Cut the kidney-supporting vessel bundle out, taking care to not cut into the vessels themselves.</li>
	<li>Cut the liver at the connection to the kidney. Take care to free the kidney, but leave a small part of the liver adherent to it, so that the vena cava is kept open by it.</li>
	<li>Take the kidney bundle out of the mouse. Remove the mouse from the moist chamber.</li>
	<li>Place a &#34;lasso&#34; ligature around the connection of liver and kidney (ligature IX).</li>
	<li>Cannulate the vena cava with a venous line (2 cm PE 50).</li>
	<li>Close ligature IX. Venous outflow through the venous line should immediately start.</li>
	<li>Close the moist chamber.</li>
</ol>
6. Downstream Analyses
<ol>
	<li>During the following hour, continuously monitor blood flow and intravascular pressure15. Collect venous outflow, which can be used for analysis of, for example, renal renin release7. Collect urine for analysis of electrolyte concentration and glomerular filtration rate 14. After 1 hr of perfusion, kidneys can be snap-frozen for western blotting or be fixed for imaging approaches16.</li>
</ol>

<ol><li>Carrel, A., Lindbergh, C. A. The culture of whole organs. <a target="_blank" href="http://scholar.google.com/scholar?hl=en&safe=off&q=author%3aCarrel%2C+A+%22Science+%28New+York%2C+N.Y.%29%22">Science (New York, N.Y.)</a>. 81 (2112), 621-623 (1935).</li>
<li>Skutul, K. <a target="_blank" href="http://scholar.google.com/scholar?hl=en&safe=off&q=author%3aSkutul%2C+K+%22%C3%9Cber+Durchstr%C3%B6mungsapparate+Pfl%C3%BCger%27s+Archiv%22">Über Durchströmungsapparate Pflüger's Archiv</a>. 123 (4-6), 249-273 (1908).</li>
<li>Nizet, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+isolated+perfused+kidney%3A+possibilities%2C+limitations+and+results%5BTitle%5D)+AND+%22Kidney+Int%22%5BJournal%5D)">The isolated perfused kidney: possibilities, limitations and results.</a> Kidney Int. 7 (1), 1-11 (1975).</li>
<li>Weiss, C., Passow, H., Rothstein, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Autoregulation+of+flow+in+isolated+rat+kidney+in+the+absence+of+red+cells%5BTitle%5D)+AND+%22Am+J+Physiol%22%5BJournal%5D)">Autoregulation of flow in isolated rat kidney in the absence of red cells.</a> Am J Physiol. 196 (5), 1115-1118 (1959).</li>
<li>Schurek, H. J., Kriz, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Morphologic+and+functional+evidence+for+oxygen+deficiency+in+the+isolated+perfused+rat+kidney%5BTitle%5D)+AND+%22Lab+Invest%22%5BJournal%5D)">Morphologic and functional evidence for oxygen deficiency in the isolated perfused rat kidney.</a> Lab Invest. 53 (2), 145-155 (1985).</li>
<li>Stolte, H., Schurek, H. J., Alt, J. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Glomerular+albumin+filtration%3A+a+comparison+of+micropuncture+studies+in+the+isolated+perfused+rat+kidney+with+in+vivo+experimental+conditions%5BTitle%5D)+AND+%22Kidney+Int%22%5BJournal%5D)">Glomerular albumin filtration: a comparison of micropuncture studies in the isolated perfused rat kidney with in vivo experimental conditions.</a> Kidney Int. 16 (3), 377-384 (1979).</li>
<li>Schweda, F., Wagner, C., Krämer, B. K., Schnermann, J., Kurtz, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Preserved+macula+densa-dependent+renin+secretion+in+A1+adenosine+receptor+knockout+mice%5BTitle%5D)+AND+%22AJP+Renal+Physiol%22%5BJournal%5D)">Preserved macula densa-dependent renin secretion in A1 adenosine receptor knockout mice.</a> AJP Renal Physiol. 284 (4), F770-F777 (2003).</li>
<li>Moers, C., Smits, J. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Machine+perfusion+or+cold+storage+in+deceased-donor+kidney+transplantation%5BTitle%5D)+AND+%22N+Engl+J+Med%22%5BJournal%5D)">Machine perfusion or cold storage in deceased-donor kidney transplantation.</a> N Engl J Med. 360 (1), 7-19 (2009).</li>
<li>Nicholson, M. L., Hosgood, S. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Renal+transplantation+after+ex+vivo+normothermic+perfusion%3A+the+first+clinical+study%5BTitle%5D)+AND+%22Am+J+Transplant%22%5BJournal%5D)">Renal transplantation after ex vivo normothermic perfusion: the first clinical study.</a> Am J Transplant. 13 (5), 1246-1252 (2013).</li>
<li>Worner, M., Poore, S., Tilkorn, D., Lokmic, Z., Penington, A. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((A+low-cost%2C+small+volume+circuit+for+autologous+blood+normothermic+perfusion+of+rabbit+organs%5BTitle%5D)+AND+%22Art+Org%22%5BJournal%5D)">A low-cost, small volume circuit for autologous blood normothermic perfusion of rabbit organs.</a> Art Org. 38 (4), 352-361 (2014).</li>
<li>Kaths, J. M., Spetzler, V. N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Normothermic+Ex+Vivo+Kidney+Perfusion+for+the+Preservation+of+Kidney+Grafts+prior+to+Transplantation%5BTitle%5D)+AND+%22J+Vis+Exp%22%5BJournal%5D)">Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation.</a> J Vis Exp. (101), e52909(2015).</li>
<li>Song, J. J., Guyette, J. P., Gilpin, S. E., Gonzalez, G., Vacanti, J. P., Ott, H. C. Regeneration and experimental orthotopic transplantation of a bioengineered kidney. <a target="_blank" href="http://scholar.google.com/scholar?hl=en&safe=off&q=author%3aSong%2C+JJ+%22Nature+Med%22">Nature Med</a>. 19 (5), 646-651 (2013).</li>
<li>Hall, A. M., Crawford, C., Unwin, R. J., Duchen, M. R., Peppiatt-Wildman, C. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Multiphoton+imaging+of+the+functioning+kidney%5BTitle%5D)+AND+%22JASN%22%5BJournal%5D)">Multiphoton imaging of the functioning kidney.</a> JASN. 22 (7), 1297-1304 (2011).</li>
<li>Lindell, S. L., Williams, N., Brusilovsky, I., Mangino, M. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Mouse+IPK%3A+A+Powerful+Tool+to+Partially+Characterize+Renal+Reperfusion+and+Preservation+Injury%5BTitle%5D)+AND+%22Open+Transplant+J%22%5BJournal%5D)">Mouse IPK: A Powerful Tool to Partially Characterize Renal Reperfusion and Preservation Injury.</a> Open Transplant J. 5, 15-22 (2011).</li>
<li>Wagner, C., De Wit, C., Kurtz, L., Grünberger, C., Kurtz, A., Schweda, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Connexin40+is+essential+for+the+pressure+control+of+renin+synthesis+and+secretion%5BTitle%5D)+AND+%22Circ+Res%22%5BJournal%5D)">Connexin40 is essential for the pressure control of renin synthesis and secretion.</a> Circ Res. 100 (4), 556-563 (2007).</li>
<li>Czogalla, J., Vohra, T., Penton, D., Kirschmann, M., Craigie, E., Loffing, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+mineralocorticoid+receptor+%28MR%29+regulates+ENaC+but+not+NCC+in+mice+with+random+MR+deletion%5BTitle%5D)+AND+%22Pfl%C3%BCger%27s+Archiv%22%5BJournal%5D)">The mineralocorticoid receptor (MR) regulates ENaC but not NCC in mice with random MR deletion.</a> Pflüger's Archiv. , (2016).</li>
<li>Poosti, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Precision-cut+kidney+slices+%28PCKS%29+to+study+development+of+renal+fibrosis+and+efficacy+of+drug+targeting+ex+vivo%5BTitle%5D)+AND+%22Dis+Model+Mech%22%5BJournal%5D)">Precision-cut kidney slices (PCKS) to study development of renal fibrosis and efficacy of drug targeting ex vivo.</a> Dis Model Mech. 8 (10), 1227-1236 (2015).</li>
<li>Rahgozar, M., Guan, Z., Matthias, A., Gobé, G. C., Endre, Z. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Angiotensin+II+facilitates+autoregulation+in+the+perfused+mouse+kidney%3A+An+optimized+in+vitro+model+for+assessment+of+renal+vascular+and+tubular+function%5BTitle%5D)+AND+%22Nephrology%22%5BJournal%5D)">Angiotensin II facilitates autoregulation in the perfused mouse kidney: An optimized in vitro model for assessment of renal vascular and tubular function.</a> Nephrology. 9 (5), 288-296 (2004).</li>
</ol>

The authors have no competing financial interests and nothing else to disclose.

The mouse isolated perfused kidney is a tool for studying kidney function in a controlled environment ex vivo for 1 hr, bridging the gap between in vivo experiments in intact animals, which may be flawed by the impact of numerous systemic factors, and in vitro experiments in isolated nephron segments or cultured cells, which necessarily neglect the impact of intact organ structure on function. There is, to the authors&#39; knowledge, no alternative technique with which to perform this specific ...

The isolated perfusion of organs has been the subject of an ongoing effort among physiologists for many decades1. The technique enables the function of the organ, without systemic influences such as blood pressure, hormones, or nerves, to be studied. Carl Eduard Loebell is considered to be the first to have described the successful perfusion of an isolated kidney, in 18492. Since then, the perfusion apparatus has undergone significant refinement. Frey and Gruber introduced an artificial lung for oxygenation and pulsatile pumps for continuous perfusion2. While early researchers mainly studied the kidneys of large mammals-namely, pigs2 and dogs3-the first report of the use of rat kidneys, by Weiss et al., was a milestone in the study of small-mammal-organ perfusion4. Schurek et al. reported the necessity of adding mammalian erythrocytes to the perfusate if sufficient renal tubular oxygenation was to be achieved5. Critical for long-term experiments was the introduction of continuous dialysis of the buffer by the same research group6. In 2003, Schweda et al. were the first to report a functional mouse isolated perfused kidney (MIPK)7, later refined by Rahgozar et al.18 and Lindell et al.14.
While technically more challenging than the rat isolated perfused kidney, the use of the MIPK bears the advantage of enabling the use of a wide array of genetically altered mice. This paper presents the details of the authors&#39; method for perfusing isolated mouse kidneys for 1 hr. The method allows for the continuous assessment of renal flow rate, vascular resistance, hormone release, blood gas analysis, urine analysis, and the application of drugs. Following the procedure, kidneys could be processed for molecular and biochemical analysis, be fixed for microscopy, or transplanted into a recipient mouse (Figure 1).
<img alt="Figure 1" src="/files/ftp_upload/54712/54712fig1.jpg" /> 
Figure 1: Overview of Possible Input/Output to the Isolated Perfused Kidney. BGA: Blood gas analysis. <a href="http://cloudflare.jove.com/files/ftp_upload/54712/54712fig1large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
This technique likely will receive increasing attention over coming years, as many innovative applications are being discussed with the dawn of prolonged normothermic kidney perfusion prior to transplantation (with or without the application of anti-rejection or genome-editing drugs)8,9, 10, 11, the bioengineering of whole kidneys from decellularized scaffolds12, and the application of high doses of fluorescent dyes for multiphoton imaging13. It is also an ideal model with which to study the role of specific genes during acute kidney injury14.
A step-by-step protocol is given to allow other laboratories to perform isolated mouse kidney perfusion successfully. First, the composition and preparation of the buffer is specified. Then, the surgery is described in detail and the critical steps are shown. Third, data is presented that are representative of a successful preparation: renal blood flow, vascular resistance, glomerular filtration rate , and fractional electrolyte excretion-all as functional measurements of viability-and transmission electron micrographs of the morphology of different nephron segments of perfused kidneys fixed after 1 hr of perfusion.

<table><tbody><tr><td>&lt;strong&gt;Perfusion Circuit:&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Moist chamber 834/8</td><td>Harvard Apparatus/Hugo Sachs Elektronik GmbH</td><td>73-2901</td><td></td></tr><tr><td>Cannular with basket and side port</td><td>Harvard Apparatus/Hugo Sachs Elektronik GmbH</td><td>73-2947</td><td></td></tr><tr><td>Thermostat TC120-ST5&amp;nbsp;</td><td>Harvard Apparatus/Hugo Sachs Elektronik GmbH</td><td>73-4544</td><td></td></tr><tr><td>ISM 827/230V Roller Pump Reglo Analogue</td><td>Harvard Apparatus/Hugo Sachs Elektronik GmbH</td><td>73-0114</td><td></td></tr><tr><td>Reservoir jacketed for buffer solution 1 L</td><td>Harvard Apparatus/Hugo Sachs Elektronik GmbH</td><td>73-3438</td><td></td></tr><tr><td>Reservoir jacketed for buffer solution 0.5 L</td><td>Harvard Apparatus/Hugo Sachs Elektronik GmbH</td><td>73-3436</td><td></td></tr><tr><td>Pressure Transducer APT300&amp;nbsp;</td><td>Harvard Apparatus/Hugo Sachs Elektronik GmbH</td><td>73-3862</td><td></td></tr><tr><td>TAM-D Plugsys Transducer</td><td>Harvard Apparatus/Hugo Sachs Elektronik GmbH</td><td>73-1793</td><td></td></tr><tr><td>SCP Plugsys servo controller</td><td>Harvard Apparatus/Hugo Sachs Elektronik GmbH</td><td>73-2806</td><td></td></tr><tr><td>Windkessel&amp;nbsp;</td><td>Harvard Apparatus/Hugo Sachs Elektronik GmbH</td><td>73-3717</td><td></td></tr><tr><td>HSE-USB data acquisition</td><td>Harvard Apparatus/Hugo Sachs Elektronik GmbH</td><td>73-3330</td><td></td></tr><tr><td>Low-Flux Dialysator Diacap Polysulfone</td><td>B.Braun</td><td>7203525</td><td></td></tr><tr><td>PE-Tubing for aorta cannulation 1.19 mm I.D. x 1.70 mm O.D.</td><td>Scientific Commodities Inc.</td><td>BB31695-PE/8</td><td></td></tr><tr><td>&lt;strong&gt;Name&lt;/strong&gt;</td><td>&lt;strong&gt;Company&lt;/strong&gt;</td><td>&lt;strong&gt;Catalog Number&lt;/strong&gt;</td><td>&lt;strong&gt;Comments&lt;/strong&gt;</td></tr><tr><td>&lt;strong&gt;Buffer reagents:&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Aminoplasmal 10%</td><td>B.Braun</td><td>134518064</td><td></td></tr><tr><td>Sodium pyruvate</td><td>Sigma-Aldrich</td><td>P2256-25G</td><td></td></tr><tr><td>L-Glutamic acid monosodium salt hydrate</td><td>Sigma-Aldrich</td><td>G1626-100G</td><td></td></tr><tr><td>L-(-)-Malic acid sodium salt</td><td>Sigma-Aldrich</td><td>M1125-25G</td><td></td></tr><tr><td>Sodium-L-Lactate</td><td>Sigma-Aldrich</td><td>L7022-10G</td><td></td></tr><tr><td>alpha-Ketoglutaric acid sodium salt</td><td>Sigma-Aldrich</td><td>K1875-25G</td><td></td></tr><tr><td>NaCl</td><td>Sigma-Aldrich</td><td>31434-1KG-R</td><td></td></tr><tr><td>NaHCO&lt;sub&gt;3&lt;/sub&gt;</td><td>Sigma-Aldrich</td><td>S5761-5KG</td><td></td></tr><tr><td>KCl</td><td>Sigma-Aldrich</td><td>60130-1KG</td><td></td></tr><tr><td>Urea</td><td>Sigma-Aldrich</td><td>U5378-500G</td><td></td></tr><tr><td>Creatinine</td><td>Sigma-Aldrich</td><td>C4255-10G</td><td></td></tr><tr><td>Ampicillin</td><td>Roche</td><td>10835242001</td><td></td></tr><tr><td>MgCl&lt;sub&gt;2&lt;/sub&gt; * 6H&lt;sub&gt;2&lt;/sub&gt;O</td><td>Sigma-Aldrich</td><td>M2393-500G</td><td></td></tr><tr><td>D-Glucose</td><td>Sigma-Aldrich</td><td>G8270-1KG</td><td></td></tr><tr><td>CaCl&lt;sub&gt;2&lt;/sub&gt; * 6H&lt;sub&gt;2&lt;/sub&gt;O&amp;nbsp;</td><td>Riedel-de-Ha&amp;euml;n</td><td>12074</td><td></td></tr><tr><td>NaH&lt;sub&gt;2&lt;/sub&gt;PO&lt;sub&gt;4&lt;/sub&gt;</td><td>Sigma-Aldrich</td><td>S9638-500G</td><td></td></tr><tr><td>Na&lt;sub&gt;2&lt;/sub&gt;HPO&lt;sub&gt;4&lt;/sub&gt;</td><td>Sigma-Aldrich</td><td>S0876-500G</td><td></td></tr><tr><td>Antidiuretic Hormone dDAVP</td><td>Sigma-Aldrich</td><td>V2013-1MG</td><td></td></tr><tr><td>FITC-Inulin</td><td>Sigma-Aldrich</td><td></td><td></td></tr><tr><td>Filter used for erythrocyte filtration</td><td>Macherey-Nagel</td><td>MN 615</td><td></td></tr><tr><td>BGA Analysis:</td><td></td><td></td><td></td></tr><tr><td>ABL 80 flex</td><td>Radiometer Medical ApS</td><td></td><td></td></tr><tr><td>Electron Microscope:</td><td></td><td></td><td></td></tr><tr><td>Philips CM100 TEM</td><td>FEI</td><td></td><td></td></tr></tbody></table>

the mouse isolated perfused kidney technique

The mouse isolated perfused kidney (MIPK) is a technique for keeping a mouse kidney under ex vivo conditions perfused and functional for 1 hr. This is a prerequisite for studying the physiology of the isolated organ and for many innovative applications that may be possible in the future, including perfusion decellularization for kidney bioengineering or the administration of anti-rejection or genome-editing drugs in high doses to prime the kidney for transplantation. During the time of the perfusion, the kidney can be manipulated, renal function can be assessed, and various pharmaceuticals administered. After the procedure, the kidney can be transplanted or processed for molecular biology, biochemical analysis, or microscopy.
This paper describes the perfusate and the surgical technique needed for the ex vivo perfusion of mouse kidneys. Details of the perfusion apparatus are given and data are presented showing the viability of the kidney&#39;s preparation: renal blood flow, vascular resistance, and urine data as functional, transmission electron micrographs of different nephron segments as morphological readouts, and western blots of transport proteins of different nephron segments as molecular readout.

With the method described, isolated mouse kidneys can remain viable for at least 1 hr. We tested the tissue viability after 1 hr of continuous perfusion with functional (renal blood flow and vascular resistance, blood gas analysis of venous outflow, glomerular filtration rate, urinary fractional Na+ and K+ excretion, and urine osmolality) and morphological (transmission electron microscopy, TEM) methods in four kidneys of wildtype C57Bl/6 mice. Additionally, western ...

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The Mouse Isolated Perfused Kidney Technique

The mouse isolated perfused kidney (MIPK) is a technique for keeping a mouse kidney under ex vivo conditions perfused and functional for 1 hr. The buffers and surgical technique are described in detail.

The mouse isolated perfused kidney (MIPK) is a technique for keeping a mouse kidney under ex vivo conditions perfused and functional for 1 hr. This is a ...

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Research

JoVE Journal

Biology

21.7K Views.  University of Zürich.  De muis die geperfuseerde nier (MIPK) is een techniek voor het houden van een muizennier onder ex vivo omstandigheden geperfuseerd en functioneel voor 1 uur. De buffers en operatietechniek worden beschreven. 

Video: The Mouse Isolated Perfused Kidney Technique

Use of a Hanging-weight System for Isolated Renal Artery Occlusion

In hospitalized patients, over 50% of cases of acute kidney injury (AKI) are caused by renal ischemia 1-3. A recent study of hospitalized patients revealed that only a mild increase in serum creatinine levels (0.3 to 0.4 mg/dl) is associated with a 70% greater risk of death than in persons without any increase 1. Along these lines, surgical procedures requiring cross-clamping of the aorta and renal vessels are associated with a renal failure rates of up to 30% 4. Similarly, AKI after cardiac surgery occurs in over 10% of patients under normal circumstances and is associated with dramatic increases in mortality. AKI are also common complications after liver transplantation. At least 8-17% of patients end up requiring renal replacement therapy 5. Moreover, delayed graft function due to tubule cell injury during kidney transplantation is frequently related to ischemia-associated AKI 6. Moreover, AKI occurs in approximately 20% of patients suffering from sepsis 6.The occurrence of AKI is associated with dramatic increases of morbidity and mortality 1. Therapeutic approaches are very limited and the majority of interventional trials in AKI have failed in humans. Therefore, additional therapeutic modalities to prevent renal injury from ischemia are urgently needed 3, 7-9. 
To elucidate mechanisms of renal injury due to ischemia and possible therapeutic strategies murine models are intensively required 7-13. Mouse models provide the possibility of utilizing different genetic models including gene-targeted mice and tissue specific gene-targeted mice (cre-flox system). However, murine renal ischemia is technically challenging and experimental details significantly influence results. We performed a systematic evaluation of a novel model for isolated renal artery occlusion in mice, which specifically avoids the use of clamping or suturing the renal pedicle 14. This model requires a nephrectomy of the right kidney since ischemia can be only performed in one kidney due to the experimental setting. In fact, by using a hanging-weight system, the renal artery is only instrumented once throughout the surgical procedure. In addition, no venous or urethral obstruction occurs with this technique. We could demonstrate time-dose-dependent and highly reproducible renal injury with ischemia by measuring serum creatinine. Moreover, when comparing this new model with conventional clamping of the whole pedicle, renal protection by ischemic preconditioning is more profound and more reliable. Therefore his new technique might be useful for other researchers who are working in the field of acute kidney injury.

A precise murine model for acute kidney injury (AKI) due to ischemia is an important tool to investigate acute kidney injury and possibly find therapeutic tools to treat renal injury. The hanging weight system offers a tool for immediate and reliable renal artery occlusion and reperfusion without causing renal congestion.

In hospitalized patients, over 50% of cases of acute kidney injury (AKI) are caused by renal ischemia 1-3. A recent study of hospitalized patients ...

Medicine

Isolation of Glomeruli and In Vivo Labeling of Glomerular Cell Surface Proteins

Proteinuria results from the disruption of the glomerular filter that is composed of the fenestrated endothelium, glomerular basement membrane, and podocytes with their slit diaphragms. The delicate structure of the glomerular filter, especially the slit diaphragm, relies on the interplay of diverse cell surface proteins. Studying these cell surface proteins has so far been limited to in vitro studies or histologic analysis. Here, we present a murine in vivo biotinylation labeling method, which enables the study of glomerular cell surface proteins under physiologic and pathophysiologic conditions. This protocol contains information on how to perfuse mouse kidneys, isolate glomeruli, and perform endogenous immunoprecipitation of a protein of interest. Semi-quantitation of glomerular cell surface abundance is readily available with this novel method, and all proteins accessible to biotin perfusion and immunoprecipitation can be studied. In addition, isolation of glomeruli with or without biotinylation enables further analysis of glomerular RNA and protein as well as primary glomerular cell culture (i.e., primary podocyte cell culture).

Isolation of Glomeruli and In Vivo Labeling of Glomerular Cell Surface Proteins

Here we present a protocol for murine in vivo labeling of glomerular cell surface proteins with biotin. This protocol contains information on how to perfuse mouse kidneys, isolate glomeruli, and perform endogenous immunoprecipitation of the protein of interest.

Proteinuria results from the disruption of the glomerular filter that is composed of the fenestrated endothelium, glomerular basement membrane, and ...

Biochemistry

Quantifying Glomerular Permeability of Fluorescent Macromolecules Using 2-Photon Microscopy in Munich Wistar Rats

Kidney diseases involving urinary loss of large essential macromolecules, such as serum albumin, have long been thought to be caused by alterations in the permeability barrier comprised of podocytes, vascular endothelial cells, and a basement membrane working in unison. Data from our laboratory using intravital 2-photon microscopy revealed a more permeable glomerular filtration barrier (GFB) than previously thought under physiologic conditions, with retrieval of filtered albumin occurring in an early subset of cells called proximal tubule cells (PTC)1,2,3.
Previous techniques used to study renal filtration and establishing the characteristic of the filtration barrier involved micropuncture of the lumen of these early tubular segments with sampling of the fluid content and analysis4. These studies determined albumin concentration in the luminal fluid to be virtually non-existent; corresponding closely to what is normally detected in the urine. However, characterization of dextran polymers with defined sizes by this technique revealed those of a size similar to serum albumin had higher levels in the tubular lumen and urine; suggesting increased permeability5.
Herein is a detailed outline of the technique used to directly visualize and quantify glomerular fluorescent albumin permeability in vivo. This method allows for detection of filtered albumin across the filtration barrier into Bowman's space (the initial chamber of urinary filtration); and also allows quantification of albumin reabsorption by proximal tubules and visualization of subsequent albumin transcytosis6. The absence of fluorescent albumin along later tubular segments en route to the bladder highlights the efficiency of the retrieval pathway in the earlier proximal tubule segments. Moreover, when this technique was applied to determine permeability of dextrans having a similar size to albumin virtually identical permeability values were reported2. These observations directly support the need to expand the focus of many proteinuric renal diseases to included alterations in proximal tubule cell reclamation.

A technique utilizing high resolution intavital 2-photon microscopy to directly visualize and quantify gloemrular filtration in surface glomeruli. This method allows for direct determination of permeability characteristics of macromolecules in both normal and diseased states.

Kidney  diseases involving urinary loss of large essential macromolecules, such as  serum albumin, have long been thought to be caused by alterations in ...

Reliable and High Efficiency Extraction of Kidney Immune Cells

Immune system activation occurs in multiple kidney diseases and pathophysiological processes. The immune system consists of both adaptive and innate components and multiple cell types. Sometimes, the cell type of interest is present in very low numbers among the large numbers of total cells isolated from the kidney. Hence, reliable and efficient isolation of kidney mononuclear cell populations is important in order to study the immunological problems associated with kidney diseases. Traditionally, tissue isolation of kidney mononuclear cells have been performed via enzymatic digestions using different varieties and strengths of collagenases/DNAses yielding varying numbers of viable immune cells. Recently, with the development of the mechanical tissue disruptors for single cell isolation, the collagenase digestion step is avoided and replaced by a simple mechanical disruption of the kidneys after extraction from the mouse. Herein, we demonstrate a simple yet efficient method for the isolation of kidney mononuclear cells for every day immune cell extractions. We further demonstrate an example of subset analysis of immune cells in the kidney. Importantly, this technique can be adapted to other soft and non-fibrous tissues such as the liver and brain.

Techniques that are reliable and efficient for the isolation of kidney immune cells are needed for downstream applications. This requires surface antibody labeling of a small number of kidney immune cells. Herein, we describe a concise method for isolation of kidney immune cells that seemingly achieves this goal.

Immune system activation occurs in multiple kidney diseases and pathophysiological processes.  The immune system consists of both adaptive and innate ...

Immunology and Infection

Microdissection of Primary Renal Tissue Segments and Incorporation with Novel Scaffold-free Construct Technology

Kidney transplantation is now a mainstream therapy for end-stage renal disease. However, with approximately 96,000 people on the waiting list and only one-fourth of these patients achieving transplantation, there is a dire need for alternatives for those with failing organs. In order to decrease the harmful consequences of dialysis along with the overall healthcare costs it incurs, active investigation is ongoing in search of alternative solutions to organ transplantation. Implantable tissue-engineered renal cellular constructs are one such feasible approach to replacing lost renal functionality. Here, described for the first time, is the microdissection of murine kidneys for isolation of living corticomedullary renal segments. These segments are capable of rapid incorporation within scaffold-free endothelial-fibroblast constructs which may enable rapid connection with host vasculature once implanted. Adult mouse kidneys were procured from living donors, followed by stereoscope microdissection to obtain renal segments 200 - 300 &#181;m in diameter. Multiple renal constructs were fabricated using primary renal segments harvested from only one kidney. This method demonstrates a procedure which could salvage functional renal tissue from organs that would otherwise be discarded.

Tissue-engineered renal constructs provide a solution for the organ shortage and deleterious effects of dialysis. Here, we describe a protocol to micro dissect murine kidneys for isolation of cortico-medullary segments. These segments are implanted into scaffold-free cellular constructs, forming renal organoids.

Kidney transplantation is now a mainstream therapy for end-stage renal disease. However, with approximately 96,000 people on the waiting list and only ...

Bioengineering

Optical Clearing and Imaging of Immunolabeled Kidney Tissue

Optical clearing techniques render tissue transparent by equilibrating the refractive index throughout a sample for subsequent three-dimensional (3-D) imaging. They have received great attention in all research areas for the potential to analyze microscopic multicellular structures that extend over macroscopic distances. Given that kidney tubules, vasculature, nerves, and glomeruli extend in many directions, which have been only partially captured by traditional two-dimensional techniques so far, tissue clearing also opened up many new areas of kidney research. The list of optical clearing methods is rapidly growing, but it remains difficult for beginners in this field to choose the best method for a given research question. Provided here is a simple method that combines antibody labeling of thick mouse kidney slices; optical clearing with cheap, non-toxic and ready-to-use chemical ethyl cinnamate; and confocal imaging. This protocol describes how to perfuse kidneys and use an antigen-retrieval step to increase antibody- binding without requiring specialized equipment. Its application is presented in imaging different multicellular structures within the kidney, and how to troubleshoot poor antibody penetration into tissue is addressed. We also discuss the potential difficulties of imaging endogenous fluorophores and acquiring very large samples and how to overcome them. This simple protocol provides an easy-to-setup and comprehensive tool to study tissue in three dimensions.

The combination of antibody labeling, optical clearing, and advanced light microscopy allows three-dimensional analysis of complete structures or organs. Described here is a simple method to combine immunolabeling of thick kidney slices, optical clearing with ethyl cinnamate, and confocal imaging that enables visualization and quantification of three-dimensional kidney structures.

Optical clearing techniques render tissue transparent by equilibrating the refractive index throughout a sample for subsequent three-dimensional (3-D) ...

A Quantitative Detection Method for MicroRNAs in the Kidney of an Ischemic Kidney Injury Mouse Model

MicroRNAs (miRNAs) are involved in various disease states and are effective biomarkers for the early diagnosis of diseases and treatment in mice. However, standard protocols for the purification of miRNAs and detection of their expression in the kidneys of acute kidney injury (AKI) mice have not been well established. This study developed an effective and simple protocol to purify and quantify miRNAs in the kidneys of an AKI mouse model induced by renal ischemia-reperfusion using quantitative real-time reverse-transcription polymerase chain reaction (qRT-PCR). This protocol comprises five steps: 1) induction of AKI by renal ischemia-reperfusion, 2) harvesting of kidneys, 3) purification of total RNA, including miRNAs, from kidneys, 4) cDNA synthesis by reverse transcription of miRNA, and 5) qRT-PCR to detect miRNA expression. Using this protocol, the renal ischemia-reperfusion injury model can be generated with mild to severe forms of AKI. Additionally, if the procedure is followed properly, a consistent AKI model with minimal individual differences can be obtained. This qRT-PCR assay shows a very wide dynamic range and enables the discrimination of mature miRNAs, which can be accurately quantified with high specificity. This protocol can be used to study the miRNA expression profile in AKI kidneys.

This article presents a protocol for detecting microRNA expression in the kidneys of an acute kidney injury mouse model using quantitative real-time reverse-transcription polymerase chain reaction. This protocol emphasizes an ischemic kidney injury mouse model and the careful extraction of microRNA samples.

MicroRNAs (miRNAs) are involved in various disease states and are effective biomarkers for the early diagnosis of diseases and treatment in mice. However, ...

Isolating and Imaging Live, Intact Pacemaker Regions of Mouse Renal Pelvis by Vibratome Sectioning

The renal pelvis (RP) is a funnel-shaped, smooth muscle structure that facilitates normal urine transport from the kidney to the ureter by regular, propulsive contractions. Regular RP contractions rely on pacemaker activity, which originates from the most proximal region of the RP at the pelvis-kidney junction (PKJ). Due to the difficulty in accessing and preserving intact preparations of the PKJ, most investigations on RP pacemaking have focused on single-cell electrophysiology and Ca2+ imaging experiments. Although important revelations on RP pacemaking have emerged from such work, these experiments have several intrinsic limitations, including the inability to accurately determine cellular identity in mixed suspensions and the lack of in situ imaging of RP pacemaker activity. These factors have resulted in a limited understanding of the mechanisms that underlie normal rhythmic RP contractions. In this paper, a protocol is described to prepare intact segments of mouse PKJ using a vibratome sectioning technique. By combining this approach with mice expressing cell-specific reporters and genetically encoded Ca2+ indicators, investigators may be able to more accurately study the specific cell types and mechanisms responsible for peristaltic RP contractions that are vital for normal urine transport.

The goal of this protocol is to isolate intact pacemaker regions of the mouse renal pelvis using vibratome sectioning. These sections can then be used for in situ Ca2+ imaging to elucidate Ca2+ transient properties of pacemaker cells and other interstitial cells in vibratome slices.

The renal pelvis (RP) is a funnel-shaped, smooth muscle structure that facilitates normal urine transport from the kidney to the ureter by regular, ...

Glomeruli Isolation: A Technique to Obtain Intact Glomeruli from Murine Kidney

Source: Eymael, J. et al. <a href="https://www.jove.com/video/60324" target="_blank">Glomerular Outgrowth as an Ex Vivo Assay to Analyze Pathways Involved in Parietal Epithelial Cell Activation.</a> J. Vis. Exp. (2020)
This video describes the method to isolate intact glomeruli from mouse kidneys. The encapsulated and decapsulated glomeruli thus obtained can further be used for culturing parietal epithelial cell outgrowths from the murine kidney.

Source: Eymael, J. et al. Glomerular Outgrowth as an Ex Vivo Assay to Analyze Pathways Involved in Parietal Epithelial Cell Activation. J. Vis. Exp. ...

JoVE Encyclopedia of Experiments

Cancer Research

Urinary Tract Cancer

In vitro studies

A Whole-Mount Organ Staining Technique for Three-Dimensional Imaging of the Kidney

Source: Hasegawa, S., et al. <a href="https://app.jove.com/v/63986">Whole-Kidney Three-Dimensional Staining with CUBIC.</a> J. Vis. Exp. (2022).
This video demonstrates an assay for the whole-mount staining of murine kidneys using a tissue-clearing method called CUBIC (clear, unobstructed brain/body imaging cocktails and computational analysis) and immunofluorescent staining. The kidney is subjected to tissue clearing, wherein the kidney is delipidated, decolorized, and treated with a refractive index matching solution to make the tissue transparent for optimum three-dimensional imaging. The tissue is stained with fluorescently labeled antibodies to reveal sympathetic nerves and arteries in the tissue under a light-sheet microscope.

All procedures involving animal models have been reviewed by the local institutional animal care committee and the JoVE veterinary review board.
1. Animal ...

The Mouse Isolated Perfused Kidney Technique

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