FURTHER STUDIES ON RENAL TUBULAR CONSERVATION OF FREE AMINO ACIDS IN EARLY INFANCY

Assessment of tubular reabsorption of sodium, glucose, phosphate and amino acids based on spot urine samples

Reference values for tubular transport of sodium, phosphate, glucose and amino acids are generally based on inulin or creatinine short-term clearances, which are difficult to obtain in children. Hence, quantitative assessment of tubular transport capacities is rarely performed. For a simplified procedure, reference values for fractional sodium excretion, phosphate reabsorption related to glomerular filtration rate, percent glucose and percent amino acid reabsorption were established in 62 children from spot urine and simultaneously obtained blood samples. Sodium excretion, and glucose and amino acid reabsorption were significantly lower in infants than children, whereas phosphate reabsorption decreased during the first year of life. Results using the proposed protocol and those obtained from timed urine specimens correlated well; the phenomenon of renal adaptation during childhood could equally well be demonstrated. Renal tubular dysfunction can be diagnosed without timed urine specimens.

Uptake of gentamicin in foetal and newborn rats after a single intraperitoneal injection

The aim of the present investigation has been to examine 1) the placental passage and uptake of gentamicin in foetal rat tissues and 2) uptake and organ distribution of this drug in neonatal rats with special reference to the kidney. After a single intraperitoneal injection of tritium-labelled gentamicin to the mother, we found a rapid passage of radioactivity across the rat placenta, but no pronounced tendency to accumulation in the foetus. After administration of 10 micrograms or 100 mg gentamicin per kg body weight to pregnant rats at day 11 or 13, respectively, of gestation, the maximal concentrations of the drug recovered in individual foetuses were 0.05 and 300 ng per mg wet weight. Ten and 90 min. after administration the uptake of gentamicin in the kidney cortex of the mother was 25 and 118 fold higher, respectively, than the corresponding uptake in the foetal kidney after 19 days of gestation. After a single intraperitoneal injection, gentamicin uptake in the kidney cortex of neonatal rats resembled that seen in adult animals, with a rapid initial phase followed by a relatively stable plateau, although the maximal uptake was only about 10% as large in the neonates.

Changes in urinary amino acid fractional excretion in neonates undergoing total parenteral nutrition

The paper examines the possible reasons why there was a different weight gain pattern in two groups of sick neonates fed two different amino acid solutions during a prospective double-blind trial of otherwise identical total parenteral nutrition. During the 13-month study period, 14 neonates (eight less than 32 weeks gestation) received Vamin as their amino acid source, and 18 (eight less than 32 weeks gestation) received a new amino acid solution, Paedmin. The older group of neonates gained weight far better when fed Vamin (P less than 0.003), neonates of less than 32 weeks gestation gained weight better when fed Paedmin (P less than 0.004). These differences in weight gain were reflected in differences in plasma amino acid concentration in that the levels were lower in the groups gaining weight less well; and in urinary fractional excretion where the groups gaining weight less well had a markedly higher fractional excretion and total urinary loss of amino acids (P less than 0.001). It is suggested that these differences in amino acid handling of two different amino acid solutions may lead to differences in weight gain.

Paper chromatography of urinary amino acids. A 30 year survey of dietary influences on the normal pattern, and patients' results

In the clinical laboratory, paper chromatography is still the most useful, simple, inexpensive procedure for initial identification of abnormalities of amino acid excretion. The results of its use for more than 8000 paediatric and adult renal patients is surveyed. Nonspecific generalized aminoaciduria was the most frequent abnormality found, comprising some 70% of abnormal results, with cystine-lysinuria the next most common. The identification of the abnormal excretory pattern of amino acids as distinct from the normal was complicated by the effects of the New Zealand diet. In particular, valine, citrulline, hydroxyproline and glutamic acid are found in considerable amounts as part of the normal pattern. Their dietary origin is discussed. Varying mixtures of monosaccharides and disaccharides occurred in association with a range of amino acid patterns.

A comparison of the uptake of 3-hydroxy-3-methyl-glutaric acid in newborn and adult rat kidney

The developmental aspects of the renal uptake of 3-OH-3-CH3-glutaric acid (HMG) was examined using isolated renal tubules prepared from both newborn and adult rats and isolated renal brush border membranes vesicles from adult rats. The accumulation of 70 microM HMG by both newborn and adult tubules reached a steady state and achieved a distribution ratio (DR) of 4.9 and 6.5, respectively; decreased DR's at higher substrate concentrations suggest concentration-dependent uptake. Lineweaver-Burk analysis of the 5 min calculated velocities of HMG uptake by newborn and adult tubules indicate a single transport system with the same apparent Km of 0.2 mM in both age groups. The Vmax in adult rats was twofold greater than in newborn (0.95 versus 0.44 mM/1/5 min). The carrier system for HMG is assumed to be distinct from those of amino acids and sugars because tubule uptake of HMG is not affected by the presence of alpha-NH2-isobutyric acid and alpha-methyl-D-glucoside. Sodium maleate and acetoacetate significantly decreased HMG uptake in tubules of both age groups. HMG uptake by isolated renal brush border membrane vesicles from adult rats suggests that uptake is both carrier-mediated and Na+-dependent. These observations are consistent with renal tubular HMG uptake by an energy-dependent, carrier-mediated system.

Changes in plasma amino acid distribution and urine amino acids excretion during prolonged heavy exercise

Venous plasma and urine amino acids and urea were measured in ten well-trained men, aged 23--45 years, in connection with a 70 km cross-country ski race, lasting 4.39--6.04 h, leading to slight dehydration. The estimated urea production rate during the race was of the order 7.6 mumol/min, kg b.wt, i.e. twice the rate for such men on ordinary protein intake, during ordinary activity, thus suggesting increased protein catabolism. The race led to a fall of the total plasma amino acid concentration to about 60% of the pre-race level. In particular, the branched chain amino acids (valine, iso-leucine, leucine) and alanine were markedly reduced, whereas the S-containing amino acids (taurine, cystine, methionine) and the aromatic (phenylalanine, tyrosine, trytophan, histidine) and glutamine/glutamate were increased, unchanged or only moderately reduced. It is concluded that prolonged heavy exercise is accompanied by increased protein catabolism and changes in the plasma amino acid concentrations similar to those observed during prolonged starvation, but differing from those seen at heavy exercise of less than 2 h duration or prolonged exercise of moderate intensity.

Free amino-acid concentrations in fetal fluids

The pattern of free amino-acid concentrations in maternal venous plasma, fetal umbilical arterial plasma, fetal urine, and amniotic fluid at 15 to 20 weeks' gestation has been determined. Free amino-acid concentrations were greater in fetal plasma than in maternal plasma, amniotic fluid, or fetal urine.The ratios of amino-acid concentrations in fetal umbilical arterial plasma and urine indicate that the fetal kidney can effectively conserve amino-acids, possibly reaching an adult level of competence in this respect.There was little correlation between amino-acid concentrations in the fluids analysed with the exception of that between amniotic fluid and fetal urine.

Amino acid excretion patterns in developing rats

Amino acid excretion patterns were studied in rats 2 to 12 weeks old. In general there was a decline in amino acid excretion over this period which paralleled that reported in human infants by other workers. The decrease was most marked for certain amino acids (glycine, histidine, and arginine). These changes in excretion are not explicable in terms of changes in plasma amino acid concentrations, nor is it likely that they result from differences in filtered load. They may reflect a progressive development of transport mechanisms for some amino acids over the period studied, in which case similar changes in the concentrating ability of rat kidney cortex slices would be predicted. Other possible explanations which are less readily tested include changes in permeability of the tubular cell membranes and differences in the glomerular filtering capacity relative to the amount of tubular tissue which has developed.

Hyper-beta-alaninemia associated with beta-aminoaciduria and gamma-aminobutyricaciduria, somnolence and seizures

Hyper-beta-alaninemia was found in a somnolent, convulsing infant. Hyper-beta-aminoaciduria (beta-ala, betaAIB and taurine) was also observed, varying directly with plasma beta-alanine concentration. The beta-aminoaciduria is explained by the interaction between beta-alanine and a specific cellular-transport system with preference for beta-amino compounds. Gamma-aminobutyricaciduria was also observed, its excretion being independent of beta-alanine levels. Dietary modifications, pyridoxine, pantothenic acid and antibiotic therapy were not beneficial. Post-mortem tissues had elevated levels of beta-alanine and carnosine; GABA levels in brain were probably elevated for the age of the patient. A proposed block in beta-alanine-alpha-ketoglutarate transaminase would expand the free beta-alanine pool, thus increasing tissue carnosine. beta-Alanine is a central-nervous-system depressant. Associated inhibition of GABA transaminase and displacement of GABA from central-nervous-system binding sites would produce GABAuria and convulsions.