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Claure-Del Granado R, Prudencio-Ribera VC, Gupta V, Yang J, Kashani K, Malhotra R. Bicarbonate-Based Solution for the Management of Established Acute Kidney Injury: A Pilot Open-Label Observation Study. Cureus 2023; 15:e42127. [PMID: 37476296 PMCID: PMC10355685 DOI: 10.7759/cureus.42127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 07/22/2023] Open
Abstract
Background Administration of intravenous (IV) solutions constitutes a key component of acute kidney injury (AKI) management. However, the optimal IV fluid solution in the setting of AKI remains uncertain. In this study, we assessed whether the use of bicarbonate-containing solution in patients with established AKI is associated with early renal recovery as compared to bicarbonate-free solutions. Methods We performed an open-label observational pilot study in 59 patients with established AKI. IV fluid solutions that were used include bicarbonate-based solution with low chloride content (80 mEq/L of 8% sodium bicarbonate in a solution that contains 77 mEq/L of sodium, 77 mEq/L of chloride and 25 g/L of glucose) or solutions without bicarbonate with high chloride content (0.9% normal saline, 0.45% half-saline, normal ringer, or 4% succinylated gelatine). We evaluated the association of IV fluids type with renal recovery. Results The median age of study participants was 66 years (inter-quartile range (IQR) 37-85), and 59% (n=35) were men. The prevalence of diabetes and chronic kidney disease (CKD) stages 1-3 were 34% (n=20) and 39% (n=23), respectively. Patients who received bicarbonate-based IV solutions had a greater reduction of serum creatinine (sCr) per day (delta sCr) as compared with patients who received bicarbonate-free solutions (-0.29±0.47 vs. 0.07±0.42; p=0.007). The renal recovery was faster in patients who received bicarbonate-based solutions as compared to the bicarbonate-free group (days from peak sCr to baseline sCr: 5.6±2.1 vs. 7.6±2.8; p < 0.001, respectively). Conclusions We observed faster renal recovery in patients with established AKI who received the bicarbonate-based solution with low chloride content. Our study findings require confirmation in larger cohorts.
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Affiliation(s)
- Rolando Claure-Del Granado
- Division of Nephrology, Department of Medicine, Hospital Obrero No. 2 - Caja Nacional de Salud (CNS) Universidad Mayor de San Simon, Cochabamba, BOL
| | | | - Vineet Gupta
- Medicine/Hospital Medicine, University of California San Diego School of Medicine, San Diego, USA
| | - Jason Yang
- Medicine, University of California San Diego School of Medicine, San Diego, USA
| | - Kianoush Kashani
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, USA
- Nephrology and Hypertension, Mayo Clinic, Rochester, USA
| | - Rakesh Malhotra
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego School of Medicine, San Diego, USA
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2
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Takahashi A, Maeda K, Sasaki K, Doi S, Nakashima A, Doi T, Masaki T. Relationships of hyperchloremia with hypertension and proteinuria in patients with chronic kidney disease. Clin Exp Nephrol 2022; 26:880-885. [PMID: 35524894 DOI: 10.1007/s10157-022-02229-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 04/07/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND A few previous clinical studies have shown that chloride (Cl) contributes to the progression and development of hypertension or proteinuria. Therefore, we aimed to determine whether hyperchloremia is associated with hypertension or proteinuria in patients with chronic kidney disease (CKD) and to define the relationships between the reduction in serum Cl concentration associated with CKD treatment and improvements in hypertension and/or proteinuria. METHODS We performed a retrospective observational study of new or referred patients with CKD who had hyperchloremia, moderate proteinuria, renal dysfunction, and hypertension. Patients taking medication for metabolic acidosis or with a history of dialysis were excluded. The participants' systolic and diastolic blood pressure (BP), serum sodium (Na) and Cl concentrations, and urinary protein (UP) concentration were measured at baseline and after 1 month of CKD treatment. RESULTS Fifty-one patients with CKD were included in the study. Their serum Cl concentration independently correlated with sBP and UP at baseline (P = 0.022 and P = 0.033, respectively). After 1 month's CKD treatment, their serum Na and Cl concentrations, sBP, and UP were significantly lower. The change in sBP during the month (ΔsBP) correlated with the change in serum Cl (ΔCl) (P = 0.012) but not with the change in serum Na. Multivariate analysis showed that ΔsBP was independently associated with ΔCl (P = 0.029). CONCLUSIONS Hyperchloremia is an independent predictor of hypertension and proteinuria for patients with CKD.
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Affiliation(s)
- Akira Takahashi
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi Minami-ward, Hiroshima, 734-8551, Japan
| | - Kazuya Maeda
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi Minami-ward, Hiroshima, 734-8551, Japan. .,Department of Nephrology, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, 1-9-6 Sendamachi Naka-ward, Hiroshima, 730-8619, Japan.
| | - Kensuke Sasaki
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi Minami-ward, Hiroshima, 734-8551, Japan
| | - Shigehiro Doi
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi Minami-ward, Hiroshima, 734-8551, Japan
| | - Ayumu Nakashima
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi Minami-ward, Hiroshima, 734-8551, Japan
| | - Toshiki Doi
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi Minami-ward, Hiroshima, 734-8551, Japan.,Division of Nephrology, Ichiyokai Harada Hospital, Hiroshima, 731-5134, Japan
| | - Takao Masaki
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi Minami-ward, Hiroshima, 734-8551, Japan.
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3
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Saini V, Samra T, Naik B N, Ganesh V, Garg K, Sethi S, Kanwar DB, Singh S, Rawat N, Gorla D. Normal Saline Versus Balanced Crystalloids in Renal Transplant Surgery: A Double-Blind Randomized Controlled Study. Cureus 2021; 13:e18247. [PMID: 34722040 PMCID: PMC8544908 DOI: 10.7759/cureus.18247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 11/21/2022] Open
Abstract
Background The importance of optimal acid-base balance during renal transplant surgeries cannot be stressed enough. Optimal preload and electrolyte balance is important in maintaining this. There has been a debate on the choice of perioperative crystalloids in renal transplant surgeries over the past decades. Normal saline (0.9% saline) is more likely to cause hyperchloremic acidosis when compared to balanced salt solutions (BSS) with low chloride content whereas BSS may cause hyperkalemia. We aim to compare the safety and efficacy of normal saline (NS), Ringer’s lactate (RL) and Plasmalyte (PL) on acid-base balance and electrolytes during living donor kidney transplantation. Materials and methods Patients were randomized to NS group (n = 60), RL group (n = 60) and Plasmalyte group (n = 60). Arterial blood samples were collected for acid-base analysis after induction of anaesthesia (T0), prior to clamping the iliac vein (T1), 10 minutes after reperfusion of the donated kidney (T2) and at the end of surgery (T3). In addition, serum creatinine and 24-hour urine output were recorded on postoperative days one, two and seven. Results There was a statistically significant difference (p < 0.001) in the pH at the end of surgery between the three groups with the NS group being more acidotic (pH 7.29 ± 0.06, 95% CI 7.27-7.32), although this was not clinically relevant. This was explainable by the parallel increase in chloride in the NS group. Early postoperative graft functions in terms of serum creatinine, urine output and graft failure requiring dialysis were not significantly different between the groups. Conclusion Balanced salt solutions such as Plasmalyte and Ringer’s lactate are associated with better pH and chloride levels compared to normal saline when used intraoperatively in renal transplant patients. This difference, however, does not appear to have any bearing on graft function. Plasmalyte seems to maintain a better acid-base and electrolyte balance, especially during the postreperfusion period.
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Affiliation(s)
- Vikas Saini
- Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Tanvir Samra
- Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Naveen Naik B
- Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Venkata Ganesh
- Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Kashish Garg
- Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Sameer Sethi
- Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Deepesh B Kanwar
- Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Sarbpreet Singh
- Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Neha Rawat
- Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Deepkanth Gorla
- Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
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4
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Maoka T, Kawata T, Koike T, Mochizuki T, Schnermann J, Hashimoto S. Defective renal autoregulation in the chronic bile duct ligation model of liver failure. Clin Exp Nephrol 2018. [DOI: 10.1007/s10157-018-1551-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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5
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Weinberg L, Collins N, Van Mourik K, Tan C, Bellomo R. Plasma-Lyte 148: A clinical review. World J Crit Care Med 2016; 5:235-250. [PMID: 27896148 PMCID: PMC5109922 DOI: 10.5492/wjccm.v5.i4.235] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 07/06/2016] [Accepted: 10/09/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To outline the physiochemical properties and specific clinical uses of Plasma-Lyte 148 as choice of solution for fluid intervention in critical illness, surgery and perioperative medicine.
METHODS We performed an electronic literature search from Medline and PubMed (via Ovid), anesthesia and pharmacology textbooks, and online sources including studies that compared Plasma-Lyte 148 to other crystalloid solutions. The following keywords were used: “surgery”, “anaesthesia”, “anesthesia”, “anesthesiology”, “anaesthesiology”, “fluids”, “fluid therapy”, “crystalloid”, “saline”, “plasma-Lyte”, “plasmalyte”, “hartmann’s”, “ringers”“acetate”, “gluconate”, “malate”, “lactate”. All relevant articles were accessed in full. We summarized the data and reported the data in tables and text.
RESULTS We retrieved 104 articles relevant to the choice of Plasma-Lyte 148 for fluid intervention in critical illness, surgery and perioperative medicine. We analyzed the data and reported the results in tables and text.
CONCLUSION Plasma-Lyte 148 is an isotonic, buffered intravenous crystalloid solution with a physiochemical composition that closely reflects human plasma. Emerging data supports the use of buffered crystalloid solutions in preference to saline in improving physicochemical outcomes. Further large randomized controlled trials assessing the comparative effectiveness of Plasma-Lyte 148 and other crystalloid solutions in measuring clinically important outcomes such as morbidity and mortality are needed.
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6
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Solutés balancés en réanimation. MEDECINE INTENSIVE REANIMATION 2016. [DOI: 10.1007/s13546-016-1171-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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7
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Schnermann J. Concurrent activation of multiple vasoactive signaling pathways in vasoconstriction caused by tubuloglomerular feedback: a quantitative assessment. Annu Rev Physiol 2015; 77:301-22. [PMID: 25668021 DOI: 10.1146/annurev-physiol-021014-071829] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Tubuloglomerular feedback (TGF) describes the negative relationship between (a) NaCl concentration at the macula densa and (b) glomerular filtration rate or glomerular capillary pressure. TGF-induced vasoconstriction of the afferent arteriole results from the enhanced effect of several vasoconstrictors with an effect size sequence of adenosine = 20-HETE > angiotensin II > thromboxane = superoxide > renal nerves > ATP. TGF-mediated vasoconstriction is limited by the simultaneous release of several vasodilators with an effect size sequence of nitric oxide > carbon monoxide = kinins > adenosine. The sum of the constrictor effects exceeds that of the dilator effects by the magnitude of the TGF response. The validity of the additive model used in this analysis can be tested by determining the effect of combined inhibition of some or all agents contributing to TGF. Multiple independent contributors to TGF are consistent with the variability of TGF and of the factors contributing to TGF resetting.
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Affiliation(s)
- Jurgen Schnermann
- Kidney Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892;
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8
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Effects of fluid resuscitation with 0.9% saline versus a balanced electrolyte solution on acute kidney injury in a rat model of sepsis*. Crit Care Med 2014; 42:e270-8. [PMID: 24335444 DOI: 10.1097/ccm.0000000000000145] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To compare the acute effects of 0.9% saline versus a balanced electrolyte solution on acute kidney injury in a rat model of sepsis. DESIGN Controlled laboratory experiment. SETTING University laboratory. SUBJECTS Sixty adult, male Sprague-Dawley rats. INTERVENTIONS We induced sepsis by cecal ligation and puncture and randomized animals to receive fluid resuscitation with either 0.9% saline or Plasma-Lyte solution for 4 hours after 18 hours of cecal ligation and puncture (10 mL/kg in the first hour and 5 mL/kg in the next 3 hr). Blood and urine specimens were obtained from baseline, 18 hours after cecal ligation and puncture, immediately after 4 hours fluid resuscitation, and 24 hours later. We measured blood gas, plasma electrolytes, creatinine, interleukin-6, cystatin C, and neutrophil gelatinase-associated lipocalin concentrations. We also analyzed urine for cystatin C and neutrophil gelatinase-associated lipocalin. We used Risk, Injury, Failure, Loss and End-stage criteria for creatinine to assess severity of acute kidney injury. We observed all animals for survival up to 1 day after resuscitation. Surviving animals were killed for kidney histology. Finally, we carried out an identical study in 12 healthy animals. MEASUREMENTS AND MAIN RESULTS Compared with Plasma-Lyte, 0.9% saline resuscitation resulted in significantly greater blood chloride concentrations (p < 0.05) and significantly decreased pH and base excess. Acute kidney injury severity measured by RIFLE criteria was increased with 0.9% saline compared with Plasma-Lyte resuscitation (p < 0.05), and these results were consistent with kidney histology and biomarkers of acute kidney injury. Twenty-four-hour survival favored Plasma-Lyte resuscitation (76.6% vs 53.3%; p = 0.03). Finally, in healthy animals, we found no differences between fluids and no evidence of acute kidney injury. CONCLUSION Volume resuscitation with Plasma-Lyte resulted in less acidosis and less kidney injury and improved short-term survival when compared with 0.9% saline in this experimental animal model of sepsis.
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9
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Morrell ED, Kellum JA, Hallows KR, Pastor-Soler NM. Epithelial transport during septic acute kidney injury. Nephrol Dial Transplant 2013; 29:1312-9. [PMID: 24378526 DOI: 10.1093/ndt/gft503] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A goal for scientists studying septic acute kidney injury (AKI) should be to formulate a conceptual model of disease that is able to coherently reconcile the molecular and inflammatory consequences of sepsis with impaired epithelial tubular function, diminished glomerular filtration rate (GFR) and ultimately kidney failure. Recent evidence has shed light on how sepsis modulates the tubular regulation of ion, glucose, urea and water transport and acid-base homeostasis in the kidney. The present review summarizes recent discoveries on changes in epithelial transport under septic and endotoxemic conditions as well as the mechanisms that link inflammation with impaired tubular membrane transport. This paper also proposes that the tubular dysfunction that is mediated by inflammation in sepsis ultimately leads to increased sodium and chloride delivery to the distal tubule and macula densa, contributing to tubuloglomerular feedback and impaired GFR. We feel that this conceptual model resolves many of the physiologic and clinical paradoxes that septic AKI presents to practicing researchers and clinicians.
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Affiliation(s)
- Eric D Morrell
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, S976.1 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA
| | - John A Kellum
- The Center for Critical Care Nephrology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA CRISMA (Clinical Research Systems Modeling of Acute Illness) Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kenneth R Hallows
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, S976.1 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA The Center for Critical Care Nephrology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Department of Cell Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Núria M Pastor-Soler
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, S976.1 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA The Center for Critical Care Nephrology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Department of Cell Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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10
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Lang F, Capasso G, Schwab M, Waldegger S. Renal tubular transport and the genetic basis of hypertensive disease. Clin Exp Nephrol 2005; 9:91-9. [PMID: 15980941 DOI: 10.1007/s10157-005-0355-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2004] [Accepted: 03/11/2005] [Indexed: 10/25/2022]
Abstract
Several monogenic hypertensive disorders are caused by genetic mutations leading to the deranged function and/or regulation of renal tubular NaCl transport, such as mutations of the renal epithelial Na+ channel (ENaC) in Liddle syndrome, of the kinase WNK1 (with no K) in Gordon syndrome, and of the mineralocorticoid receptor, or of 11beta-hydroxysteroid dehydrogenase. Moreover, excessive formation of aldosterone in glucocorticoid-remediable hypertension leads to severe hypertension. Conversely, impaired function of the Na+,K+,2Cl- cotransporter (NKCC2), the renal outer medullary K+ channel (ROMK1), and the renal epithelial Cl- channel ClCKb/Barttin causes Bartter syndrome and defective Na+,Cl+ cotransporter (NCCT) Gitelman syndrome, salt-wasting disorders with hypotension. These monogenic disorders are rare, but illustrate the significance of renal tubular transport in blood pressure regulation. There is little doubt, however, that deranged renal salt reabsorption significantly contributes to essential hypertension polymorphisms of several genes participating in the regulation of renal Na+ transport have been shown to be associated with blood pressure and prevalence of hypertension. Two common genes will be discussed in more detail. The first encodes the renal Cl- channel ClCKb. A gain-of-function mutation of ClCKb, increasing channel activity by 7- to 20-fold is found in approximately 20% of unselected Caucasians and 40% of an unselected African population. The second common gene variant (prevalence, 3%-5% in unselected Caucasians), to be discussed in more detail, affects the serum and glucocorticoid inducible kinase SGK1, a kinase upregulated by mineralocorticoids and enhancing the activity of ENaC, ROMK, and Na+/K+ATPase. Both gene variants are associated with slightly increased blood pressure. SGK1 further stimulates the glucose transporter SGLT1, and the SGK1 gene variant correlates, in addition, with increased body mass index.
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Affiliation(s)
- Florian Lang
- Department of Physiology, University of Tübingen, Gmelinstr. 5, D-72076 Tübingen, Germany.
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11
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Oriowo MA. Chloride channels and α1-adrenoceptor-mediated pulmonary artery smooth muscle contraction: effect of pulmonary hypertension. Eur J Pharmacol 2004; 506:157-63. [PMID: 15588736 DOI: 10.1016/j.ejphar.2004.11.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2004] [Revised: 10/28/2004] [Accepted: 11/02/2004] [Indexed: 11/21/2022]
Abstract
Noradrenaline induced concentration-dependent contractions of pulmonary artery segments from control and monocrotaline-treated rats. There was a significant decrease in the maximum response but not sensitivity in artery segments from monocrotaline-treated rats. At a concentration (10(-6) M) that abolished KCl-induced contraction, nifedipine attenuated but did not abolish, noradrenaline-induced contraction in both groups. However, noradrenaline-induced contraction in artery segments from pulmonary hypertensive rats was more susceptible to inhibition by nifedipine. Bumetanide (10(-4) M), a chloride transport inhibitor and niflumic acid, a chloride channel inhibitor, reduced noradrenaline-induced contraction of the pulmonary artery in control and pulmonary hypertensive groups. These compounds were more effective in ring segments from pulmonary hypertensive rats. It was concluded that activation of chloride channels was involved in noradrenaline-induced contraction and that the contribution of chloride channels was enhanced in pulmonary hypertensive rats.
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Affiliation(s)
- Mabayoje A Oriowo
- Department of Pharmacology and Toxicology, Faculty of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait.
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12
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Jeck N, Waldegger S, Lampert A, Boehmer C, Waldegger P, Lang PA, Wissinger B, Friedrich B, Risler T, Moehle R, Lang UE, Zill P, Bondy B, Schaeffeler E, Asante-Poku S, Seyberth H, Schwab M, Lang F. Activating Mutation of the Renal Epithelial Chloride Channel ClC-Kb Predisposing to Hypertension. Hypertension 2004; 43:1175-81. [PMID: 15148291 DOI: 10.1161/01.hyp.0000129824.12959.f0] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The chloride channel ClC-Kb is expressed in the basolateral cell membrane of the distal nephron and participates in renal NaCl reabsorption. Loss-of-function mutations of ClC-Kb lead to classic Bartter syndrome, a rare salt-wasting disorder. Recently, we identified the ClC-Kb
T481S
polymorphism, which confers a strong gain-of-function effect on the ClC-Kb chloride channel. The present study has been performed to explore the prevalence of the mutation and its functional significance in renal salt handling and blood pressure regulation. As evident from electrophysiological analysis with the 2-electrode voltage-clamp technique, heterologous expression of ClC-Kb
T481S
in Xenopus oocytes gave rise to a current that was 7-fold larger than the current produced by wild-type ClC-Kb. The prevalence of the mutant allele was significantly higher in an African population from Ghana (22%) than in whites (12%). As tested in 1 white population, carriers of ClC-Kb
T481S
were associated with significantly higher systolic (by ≈6.0 mm Hg) and diastolic (by ≈4.2 mm Hg) blood pressures and significantly higher prevalence (45% versus 25%) of hypertensive (≥140/90 mm Hg) blood pressure levels. Individuals carrying ClC-Kb
T481S
had significantly higher plasma Na
+
concentrations and significantly decreased glomerular filtration rate. In conclusion, the mutation ClC-Kb
T481S
of the renal epithelial Cl
−
channel ClC-Kb strongly activates ClC-Kb chloride channel function in vitro and may predispose to the development of essential hypertension in vivo.
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Affiliation(s)
- Nikola Jeck
- Department of Pediatrics, University of Marburg, Germany
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