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Zhao P, Higashijima Y, Sonoda H, Morinaga R, Uema K, Oguchi A, Matsuzaki T, Ikeda M. Glucocorticoid-induced acute diuresis in rats in relation to the reduced renal expression of sodium-dependent cotransporter genes. J Pharmacol Sci 2024; 156:115-124. [PMID: 39179330 DOI: 10.1016/j.jphs.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/17/2024] [Accepted: 07/19/2024] [Indexed: 08/26/2024] Open
Abstract
Although several studies have shown that glucocorticoids exert diuretic effects in animals and humans, the underlying mechanism responsible for the acute diuretic effect remains obscure. Here we examined the mechanism in terms of gene-expression. We observed that glucocorticoids, including dexamethasone (Dex) and prednisolone (PSL), acutely induced diuresis in rats in a dose-dependent manner. Free water clearance values were negative after Dex or PSL treatment, similar to those observed after treatment with osmotic diuretics (furosemide and acetazolamide). Dex significantly increased the urinary excretion of sodium, potassium, chloride, glucose, and inorganic phosphorus. Renal microarray analysis revealed that Dex significantly altered the renal expression of genes related to transmembrane transport activity. The mRNA levels of sodium/phosphate (NaPi-2a/Slc34a1, NaPi-2b/Slc34a2, and NaPi-2c/Slc34a3) and sodium/glucose cotransporters (Sglt2/Slc5a2) were significantly reduced in the Dex-treated kidney, being negatively correlated with the urinary excretion of their corresponding solutes. Dex did not affect renal expression of the natriuretic peptide receptor 1 (Npr1) gene, or the expression, localization, and phosphorylation of aquaporin-2 (AQP2), a water channel protein. These findings suggest that the acute diuretic effects of glucocorticoids might be mediated by reduced expression of sodium-dependent cotransporter genes.
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Affiliation(s)
- Peiyan Zhao
- Department of Veterinary Pharmacology, University of Miyazaki, Miyazaki, 889-2192, Japan
| | - Yoshiki Higashijima
- Institute for Promotion of Tenure Track, University of Miyazaki, Miyazaki, 889-2192, Japan
| | - Hiroko Sonoda
- Department of Veterinary Pharmacology, University of Miyazaki, Miyazaki, 889-2192, Japan
| | - Rio Morinaga
- Department of Veterinary Pharmacology, University of Miyazaki, Miyazaki, 889-2192, Japan
| | - Keito Uema
- Department of Veterinary Pharmacology, University of Miyazaki, Miyazaki, 889-2192, Japan
| | - Akane Oguchi
- Department of Veterinary Pharmacology, University of Miyazaki, Miyazaki, 889-2192, Japan
| | - Toshiyuki Matsuzaki
- Department of Anatomy and Cell Biology, Gunma University Graduate School of Medicine, Gunma, 371-8511, Japan
| | - Masahiro Ikeda
- Department of Veterinary Pharmacology, University of Miyazaki, Miyazaki, 889-2192, Japan.
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Eid H, Al Awad E, Kamran Y. A case of neonatal diabetes insipidus following dexamethasone for bronchopulmonary dysplasia. J Neonatal Perinatal Med 2020; 14:597-600. [PMID: 33337391 DOI: 10.3233/npm-200525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Diabetes insipidus (DI) is a disease resulting from defects in the arginine vasopressin system responsible for regulating body water homeostasis. It is characterized by polyuria with increased serum osmolality and sodium and can result from congenital or acquired disorders. CLINICAL PRESENTATION A baby was admitted to NICU for extreme prematurity (25 weeks gestation), extreme low birth weight (900 grams) and respiratory distress. He received one dose of Surfactant and was ventilated using high frequency jet ventilation for development of pulmonary interstitial emphysema. After nine days, he still required high settings with development of early chronic lung changes in the form of atelectasis. Therefore, he was started on a course of dexamethasone following the DART study protocol (Dexamethasone: A Randomized Trial). However, after six days (cumulative dose of 0.75 mg/kg/day) he developed polyuria (7.4 ml/kg/h) with increased serum sodium (150 mmol/L) and osmolality (348 mmol/L). He lost 85 grams of his weight in 24 hours, which represented a 9.8 %weight loss. The findings were suggestive of DI and given there were no apparent causes other than dexamethasone, it was discontinued. Over the following 48 hours, polyuria and hypernatremia gradually resolved, reaching 3.5 ml/kg/h, and 140 mmol/L respectively. CONCLUSION The use of dexamethasone is not an uncommon practice in tertiary care neonatal units. To our knowledge, our case is the first report of neonatal DI secondary to the use of dexamethasone. We recommend closely monitoring urine output and serum electrolytes in preterm infants receiving dexamethasone.
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Affiliation(s)
- H Eid
- Foothills Medical Centre, University of Calgary and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - E Al Awad
- Peter Lougheed Centre, University of Calgary, Calgary, Canada
| | - Y Kamran
- Foothills Medical Centre, University of Calgary and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
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Basatac C, Sağlam S, Aktepe F, Akpinar H. Primary large cell prostate neuroendocrine carcinoma with central and nephrogenic diabetes insipidus. Int Braz J Urol 2020; 46:859-863. [PMID: 32648432 PMCID: PMC7822364 DOI: 10.1590/s1677-5538.ibju.2019.0180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/06/2019] [Indexed: 02/08/2023] Open
Affiliation(s)
- Cem Basatac
- Department of Urology, Istanbul Bilim University, Istanbul, Turkey.,Department of Surgery University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Sezer Sağlam
- Department of Medical Oncology, Istanbul Bilim University, Istanbul, Turkey
| | - Fatma Aktepe
- Department of Pathology, Group Florence Nightingale Hospitals, Istanbul, Turkey
| | - Haluk Akpinar
- Department of Urology, Istanbul Bilim University, Istanbul, Turkey
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Yang LY, Lin S, Xie QB, Yin G. Central diabetes insipidus unveiled by glucocorticoid therapy in a patient with an empty sella: A case report and literature review. Medicine (Baltimore) 2020; 99:e22939. [PMID: 33120853 PMCID: PMC7581106 DOI: 10.1097/md.0000000000022939] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Some diseases contribute to hypopituitarism without clinical manifestations and the glucocorticoid therapy may unveil central diabetes insipidus. The condition is rare and usually causes problems for clinical physicians. PATIENT CONCERNS A 59-year-old woman presented to our hospital due to facial numbness and persistent eyelid heaviness. DIAGNOSIS Physical examination and cerebrospinal fluid examination supported a diagnosis of Guillain-Barre[Combining Acute Accent] syndrome. Magnetic resonance imaging showed an empty sella. Hormone test indicated hypopituitarism. INTERVENTIONS The patient received intravenous immunoglobulin and glucocorticoid. Central diabetes insipidus appeared after 20 days. Subsequently, the patient was prescribed 1-desamino-8-D-arginine vasopressin and prednisone. OUTCOMES During 6 months' follow-up, the patient's urine output was gradually reduced to normal level. LESSONS This case indicated that hypopituitarism may be caused by an empty sella and be masked by adrenal insufficiency. Central diabetes insipidus may present after glucocorticoid therapy.
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Veldhuijzen van Zanten SEM, Cruz O, Kaspers GJL, Hargrave DR, van Vuurden DG. State of affairs in use of steroids in diffuse intrinsic pontine glioma: an international survey and a review of the literature. J Neurooncol 2016; 128:387-94. [PMID: 27177627 PMCID: PMC4901114 DOI: 10.1007/s11060-016-2141-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 05/04/2016] [Indexed: 11/25/2022]
Abstract
Children diagnosed with diffuse intrinsic pontine glioma (DIPG) face a dismal prognosis, with severe neurologic deterioration and inevitable death at a median of 9 months from diagnosis. Steroids are widely prescribed as supportive or palliative treatment although they are known to cause severe side effects that may reduce the quality of life. This study aims to review the current knowledge on, and use of, steroids in DIPG patients. A global questionnaire-study among health care professionals was performed to ascertain information on the current (multi-)institutional and (multi-)national use of steroids, the availability of clinical guidelines, and the need for improvements in prescribing steroids to DIPG patients. In addition, an extensive literature search was performed to review studies investigating steroids in pediatric brain tumor patients. From 150 responding health care professionals, only 7 % had clinical guidelines. The use of steroids was heterogeneous and over 85 % of respondents reported serious side effects. Fourteen articles, with low level of evidence, described the use of steroids in pediatric brain tumor patients. Clinical trials investigating optimal dose or regimen were lacking. This study is a first inventory of the availability of evidence-based information and clinical guidelines, and the current attitude towards the use of steroids in DIPG patients. To date, the risk–benefit ratio of steroids in this disease is yet to be determined. We emphasize the need for clinical trials resulting in guidelines on steroids, and possibly alternative drugs, to optimize the quality of care and quality of life of DIPG patients.
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Affiliation(s)
- Sophie E M Veldhuijzen van Zanten
- Division of Oncology/Haematology, Department of Paediatrics, VU University Medical Center (VUmc), De Boelelaan 1118, Room KTC4.027, 1081 HZ, Amsterdam, The Netherlands.
| | - Ofelia Cruz
- Department of Paediatric Oncology, Hospital Sant Joan de Déu (HSJD), Passeig Sant Joan de Déu, 2, Esplugues De Llobregat, 08950, Barcelona, Spain
| | - Gertjan J L Kaspers
- Division of Oncology/Haematology, Department of Paediatrics, VU University Medical Center (VUmc), De Boelelaan 1118, Room KTC4.027, 1081 HZ, Amsterdam, The Netherlands
- Princess Máxima Center of Pediatric Oncology, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - Darren R Hargrave
- Paediatric Oncology Unit, Great Ormond Street Hospital (GOSH), Great Ormond Street, London, WC1N 3JH, UK
| | - Dannis G van Vuurden
- Division of Oncology/Haematology, Department of Paediatrics, VU University Medical Center (VUmc), De Boelelaan 1118, Room KTC4.027, 1081 HZ, Amsterdam, The Netherlands
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Chen M, Cai H, Klein JD, Laur O, Chen G. Dexamethasone increases aquaporin-2 protein expression in ex vivo inner medullary collecting duct suspensions. Front Physiol 2015; 6:310. [PMID: 26578982 PMCID: PMC4630297 DOI: 10.3389/fphys.2015.00310] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/14/2015] [Indexed: 12/25/2022] Open
Abstract
Aquaporin-2 (AQP2) is the vasopressin-regulated water channel that controls renal water reabsorption and plays an important role in the maintenance of body water homeostasis. Excessive glucocorticoid as often seen in Cushing's syndrome causes water retention. However, whether and how glucocorticoid regulates AQP2 remains unclear. In this study, we examined the direct effect of dexamethasone on AQP2 protein expression and activity. Dexamethasone increased AQP2 protein abundance in rat inner medullary collecting duct (IMCD) suspensions. This was confirmed in HEK293 cells transfected with AQP2 cDNA. Cell surface protein biotinylation showed an increase of dexamethasone-induced cell membrane AQP2 expression and this effect was blocked by glucocorticoid receptor antagonist RU486. Functionally, dexamethasone treatment of oocytes injected with an AQP2 cRNA increased water transport activity as judged by cell rupture time in a hypo-osmotic solution (66 ± 13 s in dexamethasone vs. 101 ± 11 s in control, n = 15). We further found that dexamethasone treatment reduced AQP2 protein degradation, which could result in an increase of AQP2 protein. Interestingly, dexamethasone promoted cell membrane AQP2 moving to less buoyant lipid raft submicrodomains. Taken together, our data demonstrate that dexamethasone promotes AQP2 protein expression and increases water permeability mainly via inhibition of AQP2 protein degradation. The increase in AQP2 activity promotes water reabsorption, which may contribute to glucocorticoid-induced water retention and hypertension.
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Affiliation(s)
- Minguang Chen
- Division of Nephrology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University Wenzhou, China ; Department of Physiology, Emory University School of Medicine Atlanta, GA, USA
| | - Hui Cai
- Department of Physiology, Emory University School of Medicine Atlanta, GA, USA ; Renal Division, Department of Medicine, Emory University School of Medicine Atlanta, GA, USA
| | - Janet D Klein
- Department of Physiology, Emory University School of Medicine Atlanta, GA, USA ; Renal Division, Department of Medicine, Emory University School of Medicine Atlanta, GA, USA
| | - Oskar Laur
- Department of Microbiology and Immunology, Emory University School of Medicine Atlanta, GA, USA
| | - Guangping Chen
- Department of Physiology, Emory University School of Medicine Atlanta, GA, USA ; Renal Division, Department of Medicine, Emory University School of Medicine Atlanta, GA, USA
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Habib G. Polyuria and polydipsia following an intra-articular steroid injection. Eur J Intern Med 2009; 20:e75. [PMID: 19393485 DOI: 10.1016/j.ejim.2008.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 09/07/2008] [Accepted: 09/24/2008] [Indexed: 10/21/2022]
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Garofeanu CG, Weir M, Rosas-Arellano MP, Henson G, Garg AX, Clark WF. Causes of reversible nephrogenic diabetes insipidus: A systematic review. Am J Kidney Dis 2005; 45:626-37. [PMID: 15806465 DOI: 10.1053/j.ajkd.2005.01.008] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND In nephrogenic diabetes insipidus (NDI), the kidney is unable to produce concentrated urine because of the insensitivity of the distal nephron to antidiuretic hormone (arginine vasopressin). In settings in which fluid intake cannot be maintained, this may result in severe dehydration and electrolyte imbalances. The risk for conversion of reversible to irreversible NDI seems to be a potential complication. This review summarizes the reversible causes of acquired NDI to facilitate earlier recognition and more effective treatment by clinicians. METHODS Two reviewers independently searched MEDLINE, Experta Medica (EMBASE), and ISI bibliographic databases. Human studies that described NDI caused by drugs, substances, or metabolic disturbances were included. To evaluate the causal role of the risk factor, data were abstracted according to Koch's postulates. RESULTS One hundred fifty-five studies published between 1957 and March 2004 described 30 risk factors. Of 155 studies, 58 studies provided a "definite" diagnosis of NDI; 83 studies, a "probable" diagnosis; and 14 studies, a "possible" diagnosis. Nine factors were considered "definite" causes of NDI; 15 factors, "probable" causes; and 6 factors, "possible" causes. The most reported risk factors were lithium (84 studies), antibiotics (16 studies), antifungals (11 studies), antineoplastic agents (9 studies), antivirals (8 studies), and metabolic disturbances (8 studies). Duration of NDI reversal, as well as conversion to irreversible symptoms, seemed to depend on the duration of exposure. CONCLUSION Most risk factors for reversible NDI were medications, and their identification and removal resulted in resolution of the condition. Long-term treatment with lithium seemed to result in irreversible NDI.
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Affiliation(s)
- Camelia G Garofeanu
- Division of Nephrology, Walkerton Health Study, London Health Science Centre, Westminster Campus, Canada
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Neff SPW, Stapelberg F, Warmington A. Excruciating perineal pain after intravenous dexamethasone. Anaesth Intensive Care 2002; 30:370-1. [PMID: 12075649 DOI: 10.1177/0310057x0203000319] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We describe two cases of unexpected perineal pain immediately after intravenous injection of fentanyl and dexamethasone (100 microg and 8 mg respectively) during induction of general anaesthesia. In both cases the pain was immediate (onset within 30 seconds), severe, localized to the genital region and of shooting and burning character No other clinical signs or symptoms were observed in either case and both patients made an uneventful recovery without neurological sequelae. We review the existing literature on perineal pain as an adverse effect of intravenous corticosteroid esters and recommend their administration either in diluted form or after induction of general anaesthesia.
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Affiliation(s)
- S P W Neff
- Department of Anaesthesia, National Women's Hospital, Auckland, New Zealand
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