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Abstract
BACKGROUND Patients with chronic kidney disease (CKD) represent a challenge for the dentist seeking to prescribe medications. Understanding the medical management of renal insufficiency and the pharmacokinetics of common dental drugs will aid clinicians in safely treating these patients. TYPES OF STUDIES REVIEWED The authors reviewed the literature concerning the medical and pharmacological management of CKD. They reviewed the pharmacokinetic effects of drugs described in case reports and research articles and obtained from them recommendations regarding the use of drugs and adjustment of dosages. CLINICAL IMPLICATIONS Because CKD is progressive, patients have varying levels of renal function but do not yet have end-stage renal disease. Some drugs that dentists prescribe commonly may worsen a patient's renal function, lead to drug toxicity or both. Managing the care of patients and prescribing medications tailored to their needs begin with a recognition of the patient with renal disease at risk of developing adverse effects. Clinicians can identify these patients from information obtained in their medical histories and from the drugs they may be taking. CONCLUSIONS To treat patients with kidney disease, clinicians must recognize those at risk, have knowledge of the pharmacokinetic changes that occur and recognize that adjustment of drug dosages often is needed.
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Kasuya F, Nishizawa R, Masuyama T, Kazumi M. Evaluation of a screening method by liquid chromatography-tandem mass spectrometry for estimating effect of drugs on the activation and β-oxidation of fatty acids in mitochondria. J Pharm Pharmacol 2010; 62:1697-703. [DOI: 10.1111/j.2042-7158.2010.01136.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abstract
Objectives
Fatty acid metabolism is controlled not only by the acyl-coenzyme A (CoA) synthetases but by some enzymes in the β-oxidation cycle. Medium-chain and long-chain acyl-CoA esters are key metabolites in fatty acid metabolism. We have developed an enzymatic assay method for determining chain shortening of the acyl-CoAs via β-oxidation from palmitic and octanoic acids in liver mitochondria. We have evaluated the assay method for detecting whether drugs influence the activation or the β-oxidation of fatty acids.
Methods
Liver mitochondria were used for investigating the effect of drugs on fatty acid metabolism. The drugs selected were salicylic acid, diclofenac, valproic acid and paracetamol. Each acyl-CoA formed was analysed by liquid chromatography–tandem mass spectrometry.
Key findings
After less than 5 min of incubation, the levels of acyl-CoAs reflected the acyl-CoA synthetase activity, whereas after 60-min incubation they reflected the activity of some enzymes in the β-oxidation cycle. Salicylic acid, diclofenac and valproic acid inhibited the medium-chain acyl-CoA synthetases, whereas valproic acid only exhibited a weak inhibitory activity toward the β-oxidation of the medium-chain fatty acids. In the case of long-chain fatty acid metabolism, salicylic acid and diclofenac inhibited both the activation and β-oxidation, whereas valproic acid was a weak inhibitor for only the β-oxidation activity. Paracetamol showed hardly any influence on the metabolism of medium-chain and long-chain fatty acids.
Conclusions
These findings suggest that salicylic acid, diclofenac, valproic acid and paracetamol exert a different influence on fatty acid metabolism depending on the length of the acyl chain. This assay allows sensitive and selective analysis for predicting the pathways by which drugs exert a greater influence over fatty acid metabolism.
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Affiliation(s)
- Fumiyo Kasuya
- Biochemical Toxicology Laboratory, Faculty of Pharmaceutical Sciences, Kobegakuin University, Kobe, Japan
| | - Ryota Nishizawa
- Biochemical Toxicology Laboratory, Faculty of Pharmaceutical Sciences, Kobegakuin University, Kobe, Japan
| | - Teiichi Masuyama
- Biochemical Toxicology Laboratory, Faculty of Pharmaceutical Sciences, Kobegakuin University, Kobe, Japan
| | - Maya Kazumi
- Biochemical Toxicology Laboratory, Faculty of Pharmaceutical Sciences, Kobegakuin University, Kobe, Japan
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Kasuya F, Kazumi M, Tatsuki T, Suzuki R. Effect of salicylic acid and diclofenac on the medium-chain and long-chain acyl-CoA formation in the liver and brain of mouse. J Appl Toxicol 2010; 29:435-45. [PMID: 19391105 DOI: 10.1002/jat.1431] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Medium-chain and long-chain acyl-CoA esters are key metabolites in fatty acid metabolism. Effects of salicylic acid on the in vivo formation of acyl-CoAs in mouse liver and brain were investigated. Further, inhibition of the medium-chain and long-chain acyl-CoA synthetases by salicylic acid and diclofenac was determined in mouse liver and brain mitochondria. Acyl-CoA esters were analyzed by liquid chromatography-tandem mass spectrometry. The amounts of medium-chain acyl-CoAs (C(6), C(8) and C(10)) were less than long-chain acyl-CoAs (C(16:0), C(18:0), C(18:1) and C(20:4)) in both liver and brain. The administration of salicylic acid decreased the levels of both the medium-chain (C(6), C(8) and C(10)) and long-chain acyl-CoAs (C(16:0), C(18:0), C(18:1) and C(20:4)) in liver. In brain, however, only long-chain acyl-CoAs were decreased. The level of salicylyl-CoA detected in brain was about 12% of that in liver. Salicylic acid had a strong inhibitory activity (IC(50) = 0.1 mm) for the liver mitochondrial formation of hexanoyl-CoA from hexanoic acid, whereas diclofenac was weak (IC(50) = 4.4 mm). In contrast, diclofenac (IC(50) = 1.4 mm) inhibited the liver mitochondrial long-chain acyl-CoA synthetases more potently than salicylic acid (IC(50) = 25.5 mm). Similar inhibitory activities for the acyl-CoA synthetases were obtained in the case of the brain and liver mitochondria, except for the weak inhibition of brain medium-chain acyl-CoA synthetases by salicylic acid (IC(50) = 1.8 mm). These findings suggest that salicylic acid and diclofenac exhibit different mechanisms of inhibition of fatty acid metabolism depending on the length of the acyl chain and tissues, and they may contribute to the further understanding of the toxic effects associated with these drugs.
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Affiliation(s)
- Fumiyo Kasuya
- Kobegakuin University, Minatojima, chuo-ku, Kobe, Japan.
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Kasuya F, Yamaoka Y, Osawa E, Igarashi K, Fukui M. Difference of the liver and kidney in glycine conjugation of ortho-substituted benzoic acids. Chem Biol Interact 2000; 125:39-50. [PMID: 10724365 DOI: 10.1016/s0009-2797(99)00163-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The relative importance of the liver and kidney for glycine conjugation of ortho-substituted benzoic acids was investigated. Glycine conjugation of ortho-substituted benzoic acids was investigated in mouse liver and kidney mitochondria. The extent of glycine conjugation of benzoic acids with the halogen group decreased in the order F > Cl > Br > I. The conjugation of salicylic acid with glycine took place in only the kidney. 2-Methoxybenzoic acid exhibited no activity in the liver and kidney. The difference in glycine conjugation of ortho-substituted benzoic acids was observed between liver and kidney. The kidney was more active in glycine conjugation of ortho-substituted acids than the liver. In addition, the relationship between glycine conjugation and the chemical structure of ortho-substituted acids was examined in the liver and kidney. The size of the substituent had a far greater influence over glycine conjugation in the liver and kidney. Glycine conjugation was also dependent on the substituent electronegativity. It may be important that the substrates undergoing glycine conjugation contain a flat region coplanar to the carboxylate group.
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Affiliation(s)
- F Kasuya
- Faculty of Pharmaceutical Sciences, Kobe-gakuin University, Japan
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Kasuya F, Igarashi K, Fukui M. Characterization of a renal medium chain acyl-CoA synthetase responsible for glycine conjugation in mouse kidney mitochondria. Chem Biol Interact 1999; 118:233-46. [PMID: 10362229 DOI: 10.1016/s0009-2797(99)00084-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Glycine conjugation of a series of benzoic acid derivatives was investigated in mouse kidney mitochondria. The chlorine and methyl substitutions in the para- and meta-positions of the benzene ring yielded an increase in glycine conjugation. The acids with a methoxy group showed a low degree of glycine conjugation. In addition, the acids with nitro or amino groups were conjugated to a slight extent with glycine. The in vitro conjugation of salicylic acid with glycine occurred not in liver but in kidney. The specificity of the renal medium chain acyl-CoA synthetase catalyzing the first reaction of glycine conjugation was also examined. The enzyme accepted not only medium chain fatty acids but also aromatic and arylacetic acids. The highest activity was shown with hexanoic acid. High activities were observed for benzoic acid derivatives with alkyl and alkoxyl groups in the para- and meta-positions of the benzene ring. An ortho-substituted acid exhibited no activity. In addition, the enzyme was less active with valproic acid, tranexamic acid, indomethacin and ketoprofen. The enzyme was inhibited by diflunisal, 2-hydroxydodecanoic acid and salicylic acid, which did not act as substrates. There was a poor correlation between the activity of the medium chain acyl-CoA synthetase and glycine conjugation of eleven substituted benzoic acids. These findings suggest that the present medium chain acyl-CoA synthetase is involved in glycine conjugation of the substituted acids in mouse kidney mitochondria, but there may be a larger contribution of another isoenzyme.
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Affiliation(s)
- F Kasuya
- Faculty of Pharmaceutical Sciences, Kobe-gakuin University, Kobe, Japan
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Shetty BV, Badr M, Melethil S. Evaluation of hepatic metabolism of salicylic acid in perfused rat liver. J Pharm Sci 1994; 83:607-8. [PMID: 8046624 DOI: 10.1002/jps.2600830433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Hepatic metabolism of salicylic acid was studied using a single-pass liver perfusion technique. Livers obtained from male, Sprague-Dawley rats (200-300 g) were perfused with Krebs-Henseleit bicarbonate buffer containing the drug (50-100 micrograms/mL) and glycine (0.5 or 5 mM) or glucose (5.5 mM) or bovine serum albumin (0.33%). Effluent samples over a 30-50 min interval were analyzed for salicylic acid and its metabolites (gentisic acid, salicyluric acid, and salicyl acyl and salicyl phenolic glucuronides). Effluent concentrations of salicylic acid did not differ from those in the perfusate, indicating that the liver is not a site for the metabolism of this drug. Hepatic uptake studies are needed to confirm this finding.
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Affiliation(s)
- B V Shetty
- University of Missouri-Kansas City, School of Pharmacy 64108-2792
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Vree TB, Hekster YA, Anderson PG. Contribution of the human kidney to the metabolic clearance of drugs. Ann Pharmacother 1992; 26:1421-8. [PMID: 1477449 DOI: 10.1177/106002809202601116] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To demonstrate that the human kidney is capable not only of filtering and secreting drugs and their metabolites, but also of carrying out conjugation reactions such as acyl glucuronidation, N-glucuronidation, and glycination. DATA SOURCES Plasma concentrations and renal excretion rates of drugs are measured and renal clearance is calculated in a series of selected pharmacokinetic studies in healthy human volunteers (some studies were conducted in the authors' laboratory and others were reported in the literature). BACKGROUND THEORY: It is generally agreed that the liver plays the dominant role in drug metabolism, and that the function of the kidneys is limited to excretion of parent drug and metabolites. This can be easily understood when a metabolite is present in both plasma and urine. When the metabolite is present in urine but is not measurable in plasma, then the possibility exists that the metabolite is formed by the kidneys. RESULTS "Simple" excretion by the kidneys is demonstrated for sulfatroxazole/sulfamethoxazole. Ether glucuronides of codeine are formed in the liver, and the resulting glucuronide is excreted by the kidneys. Possible formation of N1- and N2-glucuronides by the kidneys is demonstrated for sulfadimethoxine, sulfametomidine, and sulfaphenazole. Acyl glucuronidation of probenecid and nalidixic acid is carried out by the kidneys. The acyl glucuronidation of probenecid shows a capacity-limited formation/excretion rate of 46 mg/h, which is subject dependent. During this process, the acyl glucuronidation of co-administered nalidixic acid is reduced from 53 to 16 percent compared with that of nalidixic acid alone. Probenecid and its acyl glucuronidation do not inhibit the ether glucuronidation of codeine in the liver, but only interfere with the active tubular secretion process. The acyl glucuronidation of the nonsteroidal antiinflammatory drug naproxen and its metabolite, O-desmethylnaproxen, may be carried out by the liver and kidneys. Glycination of benzoic acid and salicylic acid is carried out in both the liver and kidneys. CONCLUSIONS It is difficult to recognize renal drug metabolism in the intact human body (in vivo); the glucuronides or conjugates must be measured via direct HPLC analysis. In cases where the metabolite is present in high concentrations in urine but not in blood, there may be an indication that the kidneys are responsible for the formation of the metabolite. Impaired kidney function not only affects renal excretion but may also affect renal metabolism.
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Affiliation(s)
- T B Vree
- Department of Clinical Pharmacy, Sint Radboud Hospital, Nijmegen, The Netherlands
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de Lannoy IA, Hirayama H, Pang KS. A physiological model for renal drug metabolism: enalapril esterolysis to enalaprilat in the isolated perfused rat kidney. JOURNAL OF PHARMACOKINETICS AND BIOPHARMACEUTICS 1990; 18:561-87. [PMID: 2177788 DOI: 10.1007/bf01073939] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A physiologically based kidney model was developed to describe the metabolism of enalapril and explain the observed discrepancies between generated and preformed enalaprilat (metabolite) elimination in the constant flow single-pass and recirculating isolated perfused rat kidney preparations (IPKs) as a result of the differing points of origin of the metabolite within the kidney, subsequent to the simultaneous delivery of 14C-enalapril and 3H-enalaprilat. The model incorporated clearances for diffusion/transport of drug and metabolite across the basolateral and luminal membranes of the renal cells, an intrinsic clearance for renal drug metabolism, in addition to physiological variables such as perfusate flow rate, glomerular filtration rate, and urine flow rate. Nonlinear curve fitting of single-pass and recirculating data was performed to estimate the rate-limiting step in the renal elimination of enalaprilat. Through fitting and simulation procedures, we were able to predict metabolic and excretory events for enalapril (renal extraction ratio approximately equal to 0.25-0.3; fractional excretion, FE, was less than unity) and the relatively constant pattern of urinary excretion of preformed enalaprilat (extraction ratio approximately equal to 0.07; FE approximately equal to 1). The extraction ratio of the intrarenally formed enalaprilat in single-pass IPK was about twofold that for the preformed metabolite, whereas the FEs of generated enalaprilat in recirculating IPKs were greater than 1, and tended to increase, then decrease with perfusion time. These observations were explained by the optimized parameters which indicated that efflux from cell to lumen was rate-controlling in the excretion of enalaprilat, and another small transport barrier also existed at the basolateral membrane; the lower extraction ratio of preformed enalaprilat was due to its poor transmembrane clearance at the basolateral membrane. The variable FEs for generated enalaprilat vs. the relatively constant FE for preformed metabolite in the recirculating IPK was explained by the changing contributions of both circulating and intrarenal metabolite to metabolite excretion.
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Affiliation(s)
- I A de Lannoy
- Faculty of Pharmacy, University of Toronto, Ontario, Canada
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Abstract
This review informs clinicians about current clinical usage and pharmacokinetics of newer NSAIDs and aspirin. To understand the effects of these drugs, a review of prostaglandin synthesis and actions is provided.
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Affiliation(s)
- M E Mortensen
- Section of Clinical Pharmacology/Toxicology, Ohio State University, Columbus
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Tremaine LM, Diamond GL, Quebbemann AJ. Quantitative determination of organ contribution to excretory metabolism. JOURNAL OF PHARMACOLOGICAL METHODS 1985; 13:9-35. [PMID: 3974258 DOI: 10.1016/0160-5402(85)90064-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A method for the quantitative determination of organ contribution to in vivo excretory metabolism is described. By excretory metabolism, we mean metabolism of a compound by an organ with direct excretion. The technique separately and simultaneously quantifies clearance of circulating metabolite and clearance of circulating precursor by excretory metabolism. For xenobiotics, the method involves the simultaneous infusion of radiolabeled precursor and unlabeled metabolite. The method is dependent upon the achievement of steady-state plasma concentrations of precursor and metabolite and on the ability to accurately analyze, both chemically and radioactively, the precursor in plasma, and the metabolite in both plasma and excretory fluid. The technique is not compromised by in vivo conversion of metabolite to precursor. This method is suitable for the simultaneous quantitative determination of the contribution of several organs to the formation of any number of metabolites present in excretory fluids. The simultaneous contribution of excretory metabolism to the urinary and biliary elimination of 1-naphthol in the rat is presented.
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Tremaine LM, Diamond GL, Quebbemann AJ. In vivo quantification of renal glucuronide and sulfate conjugation of 1-naphthol and p-nitrophenol in the rat. Biochem Pharmacol 1984; 33:419-27. [PMID: 6704161 DOI: 10.1016/0006-2952(84)90235-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The simultaneous in vivo renal sulfate and glucuronide conjugations of 1-naphthol (1-N) and p-nitrophenol (PNP) were determined in the rat. In mammals, 1-N and PNP are excreted almost entirely in the urine, mainly as the glucuronide and sulfate conjugates. In male Sprague-Dawley rats, greater than 98% of the infused [14C]1-N (1.0 mumole X min-1 X kg-1) or [14C]PNP (2.0 mumoles X min-1 X kg-1) recovered in urine was identified as the sulfate and glucuronide conjugates. Renal metabolism accounted for a minimum of 20% of the endogenously formed conjugates of either substrate excreted in the urine. The rat kidney formed the glucuronide and sulfate conjugates of PNP at equal rates, whereas the glucuronide: sulfate conjugate ratio for renally formed 1-N conjugates was 3:1. When the conjugates of either 1-N or PNP were infused systemically, in vivo hydrolysis contributed significantly to the amount of circulating parent phenol.
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Abstract
1. [carboxyl-14C]Aspirin has been orally administered to four male volunteers and the urinary metabolites examined by paper chromatography, t.l.c., h.p.l.c. and mass spectrometry. 2. 14C Radioactivity was eliminated rapidly in the urine, 94 to 98% of the dose in the first 24 h and approx. 1% in 24-48 h. 3. The major urinary metabolite was salicyluric acid (56-68% dose). In addition, free salicylic and gentisic acids were also detected as were both the acyl and phenolic glucuronides of salicylate. 4. A phenolic glucuronide of salicyluric acid has also been identified. The importance of this metabolite in relation to analytical methods for salicylphenolic glucuronide determination is discussed. 5. The presence of other di- and tri-hydroxybenzoic acids or gentisuric acid could not be demonstrated.
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James MO, Bend JR. Perinatal development of, and effect of chemical pretreatment on, glycine N-acyltransferase activities in liver and kidney of rabbit and rat. Biochem J 1978; 172:293-9. [PMID: 666746 PMCID: PMC1185695 DOI: 10.1042/bj1720293] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The ontogenic development of glycine N-acyltransferase activity was studied in preparations of hepatic and renal mitochondria from the New Zealand White rabbit and the Sprague-Dawley rat. Preparations of hepatic mitochondria from the rat and the rabbit attain adult glycine N-acyltransferase specific activities by birth and 4 weeks of age respectively, whereas mitochondrial preparations from rabbit kidney do not attain adult activity until 4 months of age. Pretreatment of adult rats or immature rabbits with salicylic acid, benzoic acid or phenobarbital had little effect on glycine N-acyltransferase activity in vitro in liver or kidney.
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Caldwell J, Moffatt JR, Smith RL. Post-mortem survival of hippuric acid formation in rat and human cadaver tissue samples. Xenobiotica 1976; 6:275-80. [PMID: 936647 DOI: 10.3109/00498257609151639] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
1. A rapid and sensitive semi-micro method for the determination of hippuric acid formation by tissue samples in vitro is described and applied to the determination of the post-mortem survival of hippuric acid formation in rat and human cadaver tissue samples. 2. Hippuric acid formation survived in rat and human cadaver liver for at least 72 h when corpses were stored at 4 degrees. 3. Hippuric acid formation was detected in human cadaver liver and kidney samples and was absent from brain, intestine, heart and lung. 4. Post-mortem liver samples from a case of acute pancreatitis failed to form hippuric acid as did kidney samples from a case of systemic lupus erythematosus with renal involvement.
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Lowenthal DT, Briggs WA, Levy G. Kinetics of salicylate elimination by anephric patients. J Clin Invest 1974; 54:1221-6. [PMID: 4424666 PMCID: PMC301669 DOI: 10.1172/jci107865] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The objectives of this research were to determine the kinetics of salicylate elimination in anephric patients and particularly to establish if these patients form the major metabolite of salicylic acid, salicyluric acid, at a normal rate. This investigation was initiated because of conflicting reports concerning the contribution of the kidneys to the formation of salicyluric acid in man. Six patients, 20-44 yr old, three of whom were anatomically anephric while the other three were physiologically anephric, received an intravenous injection of 500 mg salicylic acid (as sodium salicylate)/1.73 m(2) body surface area on an interdialysis day. Serial blood samples were obtained for 12 or 16 h after injection and the plasma was assayed for salicylic acid, salicyluric acid, total protein, albumin, and creatinine. Detailed pharmacokinetic analysis based on an open, two-compartment linear model revealed no significant differences in apparent volume of distribution and apparent first-order distribution and elimination rate constants between the anephric patients and normal adult subjects. An estimate of salicyluric acid formation rate by the anephric patients, based on the initial rate of increase of salicylurate concentrations in plasma, indicates that the metabolite is formed at a normal rate. These results suggest that the kidneys do not contribute significantly to the formation of salicyluric acid from salicylic acid in man.
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Herd AK, Haleblian JK. Pharmaceutical sciences--1973: literature review of pharmaceutics. J Pharm Sci 1974; 63:995-1055. [PMID: 4604899 DOI: 10.1002/jps.2600630704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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