Volume 82, Issue 10, Pages 1121-1129 (November 2012) Autosomal dominant polycystic kidney disease is associated with central and nephrogenic defects in osmoregulation  Thien Anh Ho, Nathalie Godefroid, Damien Gruzon, Jean-Philippe Haymann, Céline Maréchal, Xueqi Wang, Andreas Serra, Yves Pirson, Olivier Devuyst  Kidney International  Volume 82, Issue 10, Pages 1121-1129 (November 2012) DOI: 10.1038/ki.2012.225 Copyright © 2012 International Society of Nephrology Terms and Conditions

Figure 1 Relationship between plasma osmolality and vasopressin levels in autosomal dominant polycystic kidney disease (ADPKD) and controls (CTRLs). The correlation of individual parameters at baseline and after water deprivation shows that the positive relationship between plasma osmolality and plasma vasopressin (AVP), as observed in (a) controls, is blunted in (b) ADPKD patients. Kidney International 2012 82, 1121-1129DOI: (10.1038/ki.2012.225) Copyright © 2012 International Society of Nephrology Terms and Conditions

Figure 2 Correlation beween total renal volume and urinary concentrating ability in autosomal dominant polycystic kidney disease (ADPKD) patients. There is an inverse correlation between maximal urine concentration (Umax) and total renal volume measured by magnetic resonance imaging (MRI). The correlation is illustrated by MRI images of the kidneys of two representative patients: a 42-year-old man with few renal cysts shows a high urinary concentrating ability (959mOsm/kg), whereas a 40-year-old woman with large cystic kidneys shows a low urinary concentrating ability (464mOsm/kg). Kidney International 2012 82, 1121-1129DOI: (10.1038/ki.2012.225) Copyright © 2012 International Society of Nephrology Terms and Conditions

Figure 3 Relationship between plasma vasopressin and maximal urine osmolality in autosomal dominant polycystic kidney disease (ADPKD) patients and controls (CTRLs). The peripheral response to vasopressin was assessed by analyzing maximal urine concentration (Umax, after overnight water deprivation) as a function of plasma AVP. The dotted line represents the expected Umax in these conditions (800mOsm/kg). Black squares represent ADPKD patients, and open squares represent CTRL subjects. The two significant regression lines in CTRL (r2: 0.58; P=0.01) and ADPKD (r2: 0.46; P=0.03) are shown, with a displacement to the right indicating that a higher plasma AVP level is needed to achieve the same Umax in ADPKD vs. CTRL. For a similar range of plasma AVP, only 4/10 ADPKD patients vs. 9/10 CTRL subjects reached a Umax >800mOsm/kg (P=0.019). Kidney International 2012 82, 1121-1129DOI: (10.1038/ki.2012.225) Copyright © 2012 International Society of Nephrology Terms and Conditions

Figure 4 Acute water loading in autosomal dominant polycystic kidney disease (ADPKD) patients and controls (CTRLs). A similar response to acute water loading—(a) increased urine output and (b) decreased urine osmolality (Uosm)—is observed in both groups. Both the timing and magnitude of changes are similar in ADPKD vs. controls. Kidney International 2012 82, 1121-1129DOI: (10.1038/ki.2012.225) Copyright © 2012 International Society of Nephrology Terms and Conditions

Figure 5 Urine osmolality after overnight water deprivation in children with autosomal dominant polycystic kidney disease (ADPKD) and controls (CTRLs). Urine osmolality was obtained in 10 pairs of children with ADPKD vs. age- and gender-matched controls. The maximal urine osmolality (Umax) is significantly higher in CTRL than in ADPKD children (P=0.029). *P<0.05, CTRL vs. ADPKD. Kidney International 2012 82, 1121-1129DOI: (10.1038/ki.2012.225) Copyright © 2012 International Society of Nephrology Terms and Conditions

Figure 6 Expression of polycystic kidney disease (PKD) genes in the hypothalamus. (a) Expression of Pkd1, Pkd2, and Avp genes (in situ hybridization) in the hypothalamic nuclei of the adult mouse. Data compiled from the Mouse Allen Brain Atlas (http://mouse.brain-map.org/). (b) Expression of PKD1, PKD2, and AVP in human brain. The expression profiles for AVP, PKD1, and PKD2 (microarray) in paraventricular nucleus (PVN) and supraoptic nucleus (SON) were obtained from Allen Brain Atlas (http://human.brain-map.org). The microarray data sets are presented as a matrix with brain structure, using a ‘heat map’ format in which the colors correspond to a normalized (z-score) expression level of each probe in coronal sections of magnetic resonance imaging (MRI) space around the hypothalamus. z is negative when the raw score is below the population mean and positive when above. The data shown in the Table are log2 expression values of each probe in each brain area. Expression data of AVP: donor=10021 and probes=1058921; expression data of PKD1: donor=10021 and probes=1053025; expression data of PKD2: donor=10021 and probes=1053021. PVN, paraventricular nucleus; SCN, suprachiasmatic nucleus; SON, supraoptic nucleus. Kidney International 2012 82, 1121-1129DOI: (10.1038/ki.2012.225) Copyright © 2012 International Society of Nephrology Terms and Conditions