Rapamycin worsens renal function and intratubular cast formation in protein overload nephropathy

Kidney Int. 2005 Dec;68(6):2599-607. doi: 10.1111/j.1523-1755.2005.00732.x.


Background: Rapamycin (sirolimus) is associated with functional nephrotoxicity in some patients with nephrotic glomerular diseases but the pathophysiologic mechanisms are not known. This study investigated the effects of rapamycin on renal function and structure in protein overload nephropathy.

Methods: Rats with protein overload nephropathy [induced by bovine serum albumin (BSA), 2.1 g by daily intraperitoneal injection, day 0 to day 3] received daily intraperitoneal injections of either vehicle [dimethyl sulfoxide (DMSO)], rapamycin (0.2 mg/kg, an inhibitor of mammalian target of rapamycin), or roscovitine (3.5 mg/kg, a small molecule cyclin-dependent kinase inhibitor) (N= 9 each) from day -3 to day 3.

Results: In protein overload nephropathy, rapamycin caused severe acute renal failure and mild hypercholesterolemia (both P < 0.05). Rapamycin dramatically increased intratubular cast formation, and proximal tubular epithelial cells were swollen and engorged with increased cytoplasmic protein droplets. The number of 5-bromo-2'-deoxyuridine (BrdU)-positive tubular epithelial cells increased by more than 20-fold on day 3 in protein overload nephropathy, and this was attenuated by 65% with rapamycin (P < 0.05), whereas roscovitine was ineffective. Rapamycin increased the protein expression of p27(kip1) in tubular epithelial cells, but did not alter D-type cyclin expression or apoptosis.

Conclusion: Rapamycin caused a specific pattern of acute renal injury characterized by increased intratubular cast formation in protein overload nephropathy. This could be due to disruption of a potentially important compensatory mechanism in nephrotic glomerular diseases involving tubular epithelial cell protein endocytosis and proliferation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / chemically induced*
  • Acute Kidney Injury / pathology
  • Acute Kidney Injury / physiopathology*
  • Animals
  • Apoptosis / drug effects
  • Cell Division / drug effects
  • Cyclin D1 / metabolism
  • Cyclin D3
  • Cyclin-Dependent Kinase Inhibitor p27 / metabolism
  • Cyclins / metabolism
  • Cytoplasm / pathology
  • Epithelial Cells / pathology
  • Female
  • Growth Inhibitors / pharmacology
  • Immunosuppressive Agents / toxicity*
  • Kidney Cortex / pathology
  • Kidney Tubules / drug effects*
  • Kidney Tubules / pathology
  • Kidney Tubules / physiopathology
  • Monocytes / cytology
  • Proteinuria / pathology
  • Proteinuria / physiopathology*
  • Purines / pharmacology
  • Rats
  • Rats, Wistar
  • Roscovitine
  • Serum Albumin, Bovine / pharmacology
  • Sirolimus / toxicity*


  • Ccnd3 protein, rat
  • Cdkn1b protein, rat
  • Cyclin D3
  • Cyclins
  • Growth Inhibitors
  • Immunosuppressive Agents
  • Purines
  • Roscovitine
  • Cyclin D1
  • Cyclin-Dependent Kinase Inhibitor p27
  • Serum Albumin, Bovine
  • Sirolimus