Name: assessing urinary tract junction obstruction defects by methylene blue dye injection
Uploaded: 2017-10-12T12:30:00
Description: Watch this Scientific Journal Video about Assessing Urinary Tract Junction Obstruction Defects by Methylene Blue Dye Injection at JoVE.com

I thank Dr. Alan O. Perantoni (CDBL/NCI/NIH) for supporting the submission of this manuscript. I also thank Dr. Michael Hall (CDBL/NCI/NIH) and Nirmala Sharma (CDBL/NCI/NIH) for editing this manuscript. I am grateful to Lai Thang (SAIC) for his excellent mouse husbandry. This work was supported by the National Institutes of Health, National Cancer Institute and Center for Cancer Research.

Mice (Wnt5a flox/flox mice (Wnt5atm1.1Tpy) and Dll1Cre line, UVJO mouse model)7 were managed according to NIH guidelines for the care and use of laboratory animals and studied under a protocol approved by the NCI-Frederick Animal Care and Use Committee.
1. Preparation of Methylene Blue Dye Solution
<ol>
	<li>Measure 0.1 g methylene blue powder.</li>
	<li>Dissolve the methylene blue in 10 mL normal saline or 1x phosphate buffered s...

<ol>
	<li>Rasouly, H. M., Lu, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lower+urinary+tract+development+and+disease.">Lower urinary tract development and disease.</a> Wiley Interdiscip Rev Syst Biol Med. 5, 307-342 (2013).</li><li>Kispert, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=T-Box+Genes+in+the+Kidney+and+Urinary+Tract.">T-Box Genes in the Kidney and Urinary Tract.</a> Curr Top Dev Biol. 122, 245-278 (2017).</li><li>Bohnenpoll, T., Kispert, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ureter+growth+and+differentiation.">Ureter growth and differentiation.</a> Semin Cell Dev Biol. 36, 21-30 (2014).</li><li>Nicolaou, N., Renkema, K. Y., Bongers, E. M., Giles, R. H., Knoers, N. V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Genetic,+environmental,+and+epigenetic+factors+involved+in+CAKUT.">Genetic, environmental, and epigenetic factors involved in CAKUT.</a> Nat Rev Nephrol. 11, 720-731 (2015).</li><li>Tripathi, P., Wang, Y., Casey, A. M., Chen, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Absence+of+canonical+Smad+signaling+in+ureteral+and+bladder+mesenchyme+causes+ureteropelvic+junction+obstruction.">Absence of canonical Smad signaling in ureteral and bladder mesenchyme causes ureteropelvic junction obstruction.</a> J Am Soc Nephrol. 23, 618-628 (2012).</li><li>Aoki, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Id2+haploinsufficiency+in+mice+leads+to+congenital+hydronephrosis+resembling+that+in+humans.">Id2 haploinsufficiency in mice leads to congenital hydronephrosis resembling that in humans.</a> Genes Cells. 9, 1287-1296 (2004).</li><li>Yun, K., Perantoni, A. O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hydronephrosis+in+the+Wnt5a-ablated+kidney+is+caused+by+an+abnormal+ureter-bladder+connection.">Hydronephrosis in the Wnt5a-ablated kidney is caused by an abnormal ureter-bladder connection.</a> Differentiation. 94, 1-7 (2017).</li><li>Uetani, N., Bouchard, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Plumbing+in+the+embryo:+developmental+defects+of+the+urinary+tracts.">Plumbing in the embryo: developmental defects of the urinary tracts.</a> Clin Genet. 75, 307-317 (2009).</li><li>Murawski, I. J., Watt, C. L., Gupta, I. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessing+urinary+tract+defects+in+mice:+methods+to+detect+the+presence+of+vesicoureteric+reflux+and+urinary+tract+obstruction.">Assessing urinary tract defects in mice: methods to detect the presence of vesicoureteric reflux and urinary tract obstruction.</a> Methods Mol Biol. 886, 351-362 (2012).</li><li>Weiss, A. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Nephric+duct+insertion+requires+EphA4/EphA7+signaling+from+the+pericloacal+mesenchyme.">Nephric duct insertion requires EphA4/EphA7 signaling from the pericloacal mesenchyme.</a> Development. 141, 3420-3430 (2014).</li></ol>

Mouse kidneys are functional beginning at E16.5 and a dye injection test is theoretically possible from this time point. However, the kidney is too small to be injected with the dye solution and phenotypes such as hydronephrosis and hydroureter are not clearly observed since these phenotypes are a secondary effect of urine built up due to abnormal urine transport. These phenotypes, from the obstructions such as UPJO or UVJO, are evident at E18.5 by distended kidneys and ureters. Larger kidneys of embryos at E19.5 or neon...

The urinary system consists of a pair of kidneys and ureters and a common bladder and urethra. The main function of the urinary system is to maintain body homeostasis by managing the water and electrolyte balance of the blood. The kidneys filter the blood to control electrolyte concentrations and acid-base balance,and produce urine to excrete excess water and waste including solutes and metabolites. Urine is then transported through the ureter from the renal pelvis of the kidney to the bladderin a unidirectional manner where it is stored and ultimately eliminated via the urethra1.
The ureters are straight tubes originating from the nephric duct. After budding from the nephric duct at embryonic day 10.5 (E10.5) in the mouse, the ureter stalk elongates and differentiates into a multilayered structure called urothelium which is impermeable between mouse E12.5 and E16.5. The mesenchymal cells surrounding the ureter stalk are also differentiated into three layers consisting of inner stromal cells, intermediate thick smooth muscle cells, and outer adventitial fibroblasts. Ureteral peristaltic waves initiating in the renal pelvis are propagated through the smooth muscle layer of the ureter wall to the bladder to transport urine2,3, which is produced starting at E16.5 in the mouse1.
Congenital anomalies of the kidney and urinary tract (CAKUT) are among the most frequent genetic diseases, present in around 1% of human fetuses1,4, and composed of a variety of phenotypes including hydronephrosis and hydroureter. The abnormal accumulation of urine in the kidney and ureter results in hydronephrotic kidney and hydroureter formation. One cause of hydronephrosis and/or hydroureter formation is an obstruction of the urinary tract. Ureteropelvic junction obstruction (UPJO) is caused by aberrant urine flow due to a blockage between the proximal ureter and the renal pelvis, resulting in hydronephrosis and proximal hydroureter narrowing with angulation or persistent folding5,6. In addition, the ectopic insertion of the distal ureter into either the bladder wall or the reproductive tract is called ureterovesical junction obstruction (UVJO). UVJO can also induce hydronephrosis and hydromegaureter formation7,8. An additional ureterovesical junction (UVJ) defect is vesicoureteric reflux (VUR). VUR is characterized by retrograde urine flow from the bladder toward the kidney at UVJ. Compared to UVJO, perinatal embryos with VUR do not distinctly show a distended hydronephrotic kidney or severe hydroureter phenotype9.
In the laboratory mouse, urine flow can be examined by injection of a dye, such as methylene blue, into the renal pelvis9. The injectedmethylene blue solution will trace the urine trajectory from the renal pelvis through the ureter and into the bladder. Hydronephrosis can be recognized by an expansion of the dye in the kidney. UPJO can be detected as a blockage of dye flow at the proximal ureter with distended renal pelvis5. Any dilation of the ureter indicated by a widened diameter demonstrates an example of hydroureter. Finally, dye accumulation at the bladder wall or at the site of the reproductive tract indicates UVJO with distended hydronephrotic kidney and dilated hydromegaureter7,10. To detect VUR, the dye solution is injected into the bladder and subsequent retrograde flow is monitored in the kidney9.
Here, a protocol for methylene blue dye injection into the renal pelvis of a perinatal embryo is presented. This protocol allows the tracing of urine flow from the renal pelvis through the ureter and into the bladder and verifies potential urinary tract junction obstructions such as UPJO or UVJO.

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assessing urinary tract junction obstruction defects by methylene blue dye injection

Urinary tract junction obstruction defects are congenital anomalies inducing hydronephrosis and hydroureter. Murine urinary tract junction obstruction defects can be assessed by tracking methylene blue dye flow within the urinary system. Methylene blue dye is injected into the renal pelvis of perinatal embryonic kidneys and dye flow is monitored from the renal pelvis of the kidney through the ureter and into the bladder lumen after applying hydrostatic pressure. Dye accumulation will be evident in the bladder lumen of the normal perinatal urinary tract, but will be constrained between the renal pelvis and the end point of an abnormal ureter, if urinary tract obstructions occur. This method facilitates the confirmation of urinary tract junction obstructions and visualization of hydronephrosis and hydroureter. This manuscript describes a protocol for methylene blue dye injection into the renal pelvis to confirm urinary tract junction obstructions.

The kidneys and lower urinary system are located dorsal to most other internal organs such as the liver and intestine. After removing these other internal organs, a pair of kidneys and ureters and a single bladder are visible (Figure 1A). Upon successful dissection, the dye injected into the renal pelvis will flow from the kidney into the bladder via the ureter. The renal pelvis is the funnel-like dilated proximal part of the ureter in the kidney. Therefore, ...

Watch this Scientific Journal Video about Assessing Urinary Tract Junction Obstruction Defects by Methylene Blue Dye Injection at JoVE.com

Assessing Urinary Tract Junction Obstruction Defects by Methylene Blue Dye Injection

Methylene blue dye injection into the renal pelvis facilitates the assessment of urinary tract junction obstruction defects during mouse embryonic urinary tract development. Here, a protocol for methylene blue dye injection into the renal pelvis is described.

Urinary tract junction obstruction defects are congenital anomalies inducing hydronephrosis and hydroureter. Murine urinary tract junction obstruction ...

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