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[Which biological parameters for volemic status estimation?]. Nephrol Ther 2018; 14 Suppl 1:S83-S88. [PMID: 29606267 DOI: 10.1016/j.nephro.2018.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 02/01/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Estimation of volemic status can be useful in the diagnosis of some hydro-electrolytic disorders such as hyponatremia and dyskalemia. As a matter of fact, clinical examination and classical biological parameters are not discriminant enough. The aim of this study was to determine the biological parameters that are better correlated to volemic status. METHOD Volemic status was established using extracellular fluid volume, measured by apparent distribution of inuline, in non-edematous patients and without cardiac or hepatic insufficiency. Patients were split in three groups according to their extracellular fluid volume: hypovolemic, normovolemic, and hypervolemic. Clinical and biological parameters were compared between the three groups and were correlated to extracellular fluid volume. RESULTS Data of 91 explorations were collected. There were no difference between groups regarding clinical parameters, plasma proteins, and urinary sodium excretion. Parameters better correlated to extracellular fluid volume were fasting calcium/creatinine ratio (r=0.51; P<0.0001), fasting urinary pH (r=0.43; P<0.0001), and plasma uric acid (r=-0.39; P=0.002). CONCLUSION In addition to uric acid, already proposed as a biological marker to estimate volemic status, fasting calciuria and fasting urinary pH could also be useful.
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Grellier J, Jaafar A, Martin A, El Alaoui M, Lebely C, Tack I, Vallet M. Syndrome of inappropriate anti-diuresis induces volume-dependent hypercalciuria. Osteoporos Int 2017; 28:3161-3168. [PMID: 28812111 DOI: 10.1007/s00198-017-4186-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 08/01/2017] [Indexed: 01/30/2023]
Abstract
UNLABELLED Hyponatremia is associated with bone demineralization. We hypothesized that, during hyponatremia, calciuria and calcium balance depend on volemic status. We evaluated calciuria in patients with hyponatremia, secondary to SIAD or hypovolemia. Patients with SIAD exhibited a volemic expansion that was associated with hypercalciuria. Calciuria was proportional to markers of volemia. INTRODUCTION Chronic mild hyponatremia has been associated with bone demineralization of unknown mechanisms. During chronic hyponatremia, arginine-vasopressin secretion can result from hypovolemia or from syndrome of inappropriate anti-diuresis (SIAD) that leads to a slightly volemic expansion. Since volemia determines renal calcium excretion and balance, we evaluated calcium homeostasis in patients with chronic hyponatremia, related to SIAD or to hypovolemia. METHODS We retrospectively included all patients referred to our Department between May 2006 and May 2014 for hyponatremia, resulting from SIAD or chronic hypovolemia. None had edema, cirrhosis, cardiac, or renal insufficiency. Exploration included estimation of volemia, extracellular fluid volume (ECFV) measurement with inulin, and calcium homeostasis. RESULTS In total, the SIAD and hypovolemic groups included 22 and 7 patients, respectively. The SIAD group exhibited signs of increased volemia: higher glomerular filtration rate, higher fractional excretion of uric acid, and lower plasma renin. ECFV exceeded that of the hypovolemic group and was above usual values. There was no difference between the two groups regarding plasma calcium, PTH, and vitamin D. However, in the SIAD group, calciuria was higher than in the hypovolemic group, reaching levels of hypercalciuria. Furthermore, there was a positive correlation between calciuria and markers of volemia. CONCLUSIONS Our results show that SIAD results in a volemic expansion tendency that is associated with a decrease in renal calcium reabsorption and thus hypercalciuria, whereas in the hypovolemic group, calciuria was not increased. Therefore, renal loss of calcium and bone demineralization in SIAD patients could be partly induced by volemic expansion.
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Affiliation(s)
- J Grellier
- CHU de Rangueil, Service des Explorations Fonctionnelles Physiologiques, 1, Avenue du Professeur Jean Poulhès-TSA 50032, 310599, Toulouse Cedex, France
| | - A Jaafar
- CHU de Rangueil, Service des Explorations Fonctionnelles Physiologiques, 1, Avenue du Professeur Jean Poulhès-TSA 50032, 310599, Toulouse Cedex, France
| | - A Martin
- CHU de Rangueil, Service des Explorations Fonctionnelles Physiologiques, 1, Avenue du Professeur Jean Poulhès-TSA 50032, 310599, Toulouse Cedex, France
| | - M El Alaoui
- CHU de Rangueil, Service des Explorations Fonctionnelles Physiologiques, 1, Avenue du Professeur Jean Poulhès-TSA 50032, 310599, Toulouse Cedex, France
| | - C Lebely
- CHU de Rangueil, Service des Explorations Fonctionnelles Physiologiques, 1, Avenue du Professeur Jean Poulhès-TSA 50032, 310599, Toulouse Cedex, France
| | - I Tack
- CHU de Rangueil, Service des Explorations Fonctionnelles Physiologiques, 1, Avenue du Professeur Jean Poulhès-TSA 50032, 310599, Toulouse Cedex, France
| | - M Vallet
- CHU de Rangueil, Service des Explorations Fonctionnelles Physiologiques, 1, Avenue du Professeur Jean Poulhès-TSA 50032, 310599, Toulouse Cedex, France.
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Abstract
1. Isolated cat kidneys perfused at constant pressure with blood from normal animals respond either to infusion or to injection of 0-9% NaCl (5-20 ml./150 ml. blood) by diuresis, natriuresis, a fall of the Na concentration in the urine, a fall followed by a rise in urinary Na/K and a rise in renal blood flow. The filtration fraction remains unchanged (Figs. 1, 2). 2. Kidneys perfused either with blood from intact donors at constant blood flow or with blood from hypophysectomized donors at constant pressure show no vascular response to dilution of the blood with 0 9% NaCl. Saline dilution still causes diuresis and natriuresis. The concentration of urinary Na rises, as does Na/K without an initial fall (Figs. 3, 4). 3. Kidneys perfused with blood from headless animals are unable to respond to saline loading (Fig. 6). 4. Extracts of posterior hypothalamus convert the modified response of the kidney perfused with blood from hypophysectomized animals an dilution of the blood with saline to the response given when blood from intact animals is used (Figs. 3-5). 5. Renal responses to saline loading are shown to be due to two hormones, and are dependent on the presence of an unidentified intracranial hormone, related to hypophysial hormones.
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Affiliation(s)
- M F Lockett
- Department of Pharmacology, University of Western Australia, Nedlands, Western Australia
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Haenggi MH, Pelet J, Guignard JP. [Estimation of glomerular filtration rate by the formula GFR = K x T/Pc]. Arch Pediatr 1999; 6:165-72. [PMID: 10079885 DOI: 10.1016/s0929-693x(99)80204-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Creatinine clearance is the most common method used to assess glomerular filtration rate (GFR). In children, GFR can also be estimated without urine collection, using the formula GFR (mL/min x 1.73 m2) = K x height [cm]/Pcr [mumol/L]), where Pcr represents the plasma creatinine concentration. K is usually calculated using creatinine clearance (Ccr) as an index of GFR. The aim of the present study was to evaluate the reliability of the formula, using the standard UV/P inulin clearance to calculate K. METHODS Clearance data obtained in 200 patients (1 month to 23 years) during the years 1988-1994 were used to calculate the factor K as a function of age. Forty-four additional patients were studied prospectively in conditions of either hydropenia or water diuresis in order to evaluate the possible variation of K as a function of urine flow rate. RESULTS When GFR was estimated by the standard inulin clearance, the calculated values of K was 39 (infants less than 6 months), 44 (1-2 years) and 47 (2-12 years). The correlation between the values of GFR, as estimated by the formula, and the values measured by the standard clearance of inulin was highly significant; the scatter of individual values was however substantial. When K was calculated using Ccr, the formula overestimated Cin at all urine flow rates. When calculated from Ccr, K varied as a function of urine flow rate (K = 50 at urine flow rates of 3.5 and K = 64 at urine flow rates of 8.5 mL/min x 1.73 m2). When calculated from Cin, in the same conditions, K remained constant with a value of 50. CONCLUSIONS The formula GFR = K x H/Pcr can be used to estimate GFR. The scatter of values precludes however the use of the formula to estimate GFR in pathophysiological studies. The formula should only be used when K is calculated from Cin, and the plasma creatinine concentration is measured in well defined conditions of hydration.
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Affiliation(s)
- M H Haenggi
- Unité de néphrologie, centre hospitalier universitaire Vaudois, Lausanne, VD, Suisse
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Kikuchi M, Sato M, Chiba A, Chiba Y, Nagao K, Suzuki T, Fujigaki Y, Hoshino H. Studies on the site of renal tubular defect in Bartter's syndrome. ACTA PAEDIATRICA JAPONICA : OVERSEAS EDITION 1997; 39:358-61. [PMID: 9241901 DOI: 10.1111/j.1442-200x.1997.tb03753.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Renal tubular function was studied in an 8-month-old male infant with Bartter's syndrome, which is characterized by hypokalemic metabolic alkalosis, normotensive hyperreninemic hyperaldosteronism, and reduced pressor response to angiotensin II. Chloride transport along the diluting segment (CH2O/CH2O + CCl) was impaired. Furthermore, furosemide did not elicit normal natriuresis, which suggested impaired chloride reabsorptive capacity at the furosemide-sensitive ascending limb of Henle's loop. Loss of antidiuretic hormone-mediated urinary concentration was in support of this. These findings pointed to the thick ascending limb of Henle's loop as the site of the primary defect in this child.
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Affiliation(s)
- M Kikuchi
- Department of Pediatrics, Hitachi General Hospital, Japan
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DIRKS JH, CIRKSENA WJ, BERLINER RW. THE EFFECTS OF SALINE INFUSION ON SODIUM REABSORPTION BY THE PROXIMAL TUBULE OF THE DOG. J Clin Invest 1996; 44:1160-70. [PMID: 14328393 PMCID: PMC292591 DOI: 10.1172/jci105223] [Citation(s) in RCA: 256] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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EARLY LE, FRIEDLER RM. OBSERVATIONS ON THE MECHANISM OF DECREASED TUBULAR REABSORPTION OF SODIUM AND WATER DURING SALINE LOADING. J Clin Invest 1996; 43:1928-37. [PMID: 14236217 PMCID: PMC289638 DOI: 10.1172/jci105067] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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KAMM DE, LEVINSKY NG. INHIBITION OF RENAL TUBULAR SODIUM REABSORPTION BY HYPERNATREMIA. J Clin Invest 1996; 44:1144-50. [PMID: 14328391 PMCID: PMC292589 DOI: 10.1172/jci105221] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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LEVINSKY NG, LALONE RC. SODIUM EXCRETION DURING ACUTE SALINE LOADING IN DOGS WITH VENA CAVAL CONSTRICTION. J Clin Invest 1996; 44:565-73. [PMID: 14278172 PMCID: PMC292526 DOI: 10.1172/jci105169] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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COELHO JB, BRADLEY SE. FUNCTION OF THE NEPHRON POPULATION DURING HEMORRHAGIC HYPOTENSION IN THE DOG, WITH SPECIAL REFERENCE TO THE EFFECTS OF OSMOTIC DIURESIS. J Clin Invest 1996; 43:386-400. [PMID: 14135489 PMCID: PMC441931 DOI: 10.1172/jci104923] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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EARLEY LE, FRIEDLER RM. CHANGES IN RENAL BLOOD FLOW AND POSSIBLY THE INTRARENAL DISTRIBUTION OF BLOOD DURING THE NATRIURESIS ACCOMPANYING SALINE LOADING IN THE DOG. J Clin Invest 1996; 44:929-41. [PMID: 14322027 PMCID: PMC292573 DOI: 10.1172/jci105210] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Pitts TO, McGowan JA, Chen TC, Silverman M, Rose ME, Puschett JB. Inhibitory effects of volume expansion performed in vivo on transport in the isolated rabbit proximal tubule perfused in vitro. J Clin Invest 1988; 81:997-1003. [PMID: 3350975 PMCID: PMC329623 DOI: 10.1172/jci113454] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
To examine the renal tubular sites and mechanisms involved in the effects of hypooncotic volume expansion (VE) on renal electrolyte excretion, we performed clearance and isolated tubular perfusion studies using intact and thyroparathyroidectomized (TPTX) rabbits. We also examined the effect of VE on luminal brush border transport. In the microperfusion studies, proximal convoluted (PCT) and straight (PST) tubules were taken from rabbits without prior VE or after 30 min of 6% (body wt) VE. Acute VE increased the percentage excretion of Na, Ca, and P in TPTX animals and the percentage and absolute excretions of these ions in intact rabbits. In PST from VE animals, fluid flux (Jv) was depressed compared with Jv in PST from nonVE rabbits: Jv = 0.18 +/- 0.03, (VE) vs. 0.31 +/- 0.03 nl/mm.min, (nonVE) P less than 0.02. Phosphate transport (Jp) in the PST from VE animals was also depressed: JP = 1.58 +/- 0.10 (VE) vs. 2.62 +/- 0.47 pmol/mm.min, (nonVE) P less than 0.05. Similar results were obtained with TPTX animals. In the PCT from VE animals, Jv was decreased (0.49 +/- 0.10 (VE) vs. 0.97 +/- 0.14 nl/mm.min, (nonVE) P less than 0.02), but JP was not affected significantly. Transport inhibition was stable over approximately 90 min of perfusion. In the brush border vesicle studies, sodium-dependent phosphate transport was inhibited compared with that in control animals, at the 9-, 30-, and 60-s time points. These findings indicate that the inhibition of renal ionic transport by VE occurs in both PCT and PST and is, in part, the result of a direct effect of VE on tubular transport mechanisms.
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Affiliation(s)
- T O Pitts
- Department of Medicine, Presbyterian-University, Pittsburgh, Pennsylvania
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Tulassay T, Ruskoaho H, Tòth M, Rascher W. Atrial natriuretic peptide in volume expansion-induced natriuresis in man. CLINICAL AND EXPERIMENTAL HYPERTENSION. PART A, THEORY AND PRACTICE 1988; 10:363-80. [PMID: 2966021 DOI: 10.3109/10641968809033898] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The role of atrial natriuretic peptide (ANP) in the extracellular volume expansion (ECVE) induced natriuresis was examined in normal man under basal conditions and following dopamine blockage. Hypotonic ECVE was induced by drinking of 20 ml/kg tap water and subsequent intravenous infusion of 2 1 0, 9% saline over a period of 4 hours. This maneuver caused an increase in the plasma concentrations of ANP from 25.8 +/- 3.4 (means +/- SEM) to 59.7 +/- 6.7 fmol/ml. There was a dissociation between ANP response and urinary sodium excretion. A transient rise in glomerular filtration rate (GFR), plasma dopamine and a continuous decrease in plasma renin activity, aldosterone, vasopressin, and noradrenaline were observed. The natriuretic response to ECVE was blunted during dopamine blockade by metoclopramide, but plasma ANP, renin activity, catecholamine and vasopressin levels were not affected. However, plasma aldosterone rose. Our data are compatible with the concept that intrarenal dopamine and raised plasma concentration of ANP contribute to the natriuretic response to ECVE, but these hormonal changes do not completely explain the underlying mechanisms.
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Affiliation(s)
- T Tulassay
- Department of Pediatrics, University of Heidelberg, F.R.G
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Kelly TM, Nelson DH. Sodium excretion and atrial natriuretic peptide levels during mineralocorticoid administration. A mechanism for the escape from hyperaldosteronism. Endocr Res 1987; 13:363-83. [PMID: 2966064 DOI: 10.3109/07435808709035463] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Urinary sodium excretion initially decreases when mineralocorticoid levels are increased, but if high plasma levels of hormone are maintained, sodium excretion rises to again equal sodium intake. To ascertain if atrial natriuretic peptide (ANP) plays a role in reestablishing sodium balance during mineralocorticoid ingestion, 0.3 to 0.5 mg per day of fludrocortisone were administered for 18 days to four healthy male subjects. The average daily intake of sodium was regulated at 180 +/- 2 meq. ANP levels rose from a mean of 91.7 +/- 13.0 pg/ml during the control week to 179.7 +/- 39.2 pg/ml during the final week on fludrocortisone (p less than 0.05). Urinary sodium excretion fell 27% immediately after fludrocortisone administration was initiated but returned to baseline levels in an average of 5 days. Levels of ANP, normalized for each subject to the mean of his control week values, correlated with the amount of sodium excreted in the subsequent 24 hours (p less than 0.05). Simultaneous with the rise in ANP values, levels of plasma renin activity (PRA) and aldosterone decreased. ANP concentrations throughout the study were inversely correlated with PRA and aldosterone levels (p less than 0.001 for both correlations). Values of serum osmolality and plasma arginine vasopressin did not change significantly during the study. The results obtained demonstrate that increased secretion of ANP is associated with escape from the sodium retaining effect of chronically high mineralocorticoid levels in man and suggest that ANP plays a prominent role in the mechanism of this escape.
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Affiliation(s)
- T M Kelly
- Department of Medicine, University of Utah School of Medicine, Salt Lake City 84132
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Abstract
The incidence of congestive heart failure (CHF) in the elderly increases with age as 80% of patients hospitalised with CHF are older than 60 years of age. In this age group CHF may result from several factors such as coronary artery disease, hypertension, valvular disease or intrinsic myocardiopathies. Important alterations of renal physiology have been observed in this condition: decreases in renal plasma flow and glomerular filtration rate, and increases in renal venous pressure. Natriuretic hormone inhibition occurs and renin-angiotensin-aldosterone system activation and antidiuretic hormone secretion increase, resulting in positive water and sodium balances that contribute to the manifestations of congestive heart failure. The treatment of CHF in the elderly is similar to that in younger patients; the difference in management is determined by the severity of the disease and the side effects of the drugs used. Diuretics increase water and sodium elimination by the kidney and increase the systolic volume of the left ventricle, probably by the reduction of preload and afterload. Diuretic therapy must be pursued carefully in patients receiving digitalis, especially in those elderly individuals who may be on restricted diets: the most common adverse effects of diuretics in this age group are hypovolaemia, hyponatraemia, hypokalaemia and hypomagnesaemia.
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Györy AZ, Beck F, Rick R, Thurau K. Electron microprobe analysis of proximal tubule cellular Na, Cl and K element concentrations during acute mannitol-saline volume expansion in rats: evidence for inhibition of the Na pump. Pflugers Arch 1985; 403:205-9. [PMID: 2580272 DOI: 10.1007/bf00584101] [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: 01/01/2023]
Abstract
It has previously been shown that during mannitol-saline volume expansion (VE) Na transport was inhibited 50% by harvested proximal tubular fluid without a change in paracellular shunt pathway permeability to Na. To determine whether this inhibition was due to changes in cellular entry step or an effect on the pump itself, intracellular element concentrations were measured by electron microprobe X-ray ranalysis in proximal tubular cells of control (non-expanded, NE) and VE rats. Nai, Cli and phosphorusi were increased (mean +/- S.E.) from 19.3 +/- 0.8 to 23.4 +/- 0.6, 15.8 +/- 0.4 to 21.3 +/- 0.4 and 124.3 +/- 2.6 to 138.0 +/- 1.8 mmol . kg-1 wet weight (P less than 0.001) respectively while Ki remained unchanged: 122.9 +/- 2.2 and 124.2 +/- 1.3 mmol . kg-1 wet weight. The increases in Nai and Cli were in excess of cell shrinkage produced by the hyperosmolal peritubular environment while the unchanged Ki in the face of cell shrinkage indicates and actual loss. It is concluded that mannitol-saline VE inhibits the Na pump producing a rise in Nai and a fall in Ki.
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Langberg H, Hartmann A, Holdaas H, Kiil F. Site and magnitude of the tubular inhibitory effect of expanding the extracellular volume in dogs. ACTA PHYSIOLOGICA SCANDINAVICA 1984; 122:285-98. [PMID: 6516881 DOI: 10.1111/j.1748-1716.1984.tb07512.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Ethacrynic acid inhibits energy-requiring transcellular NaCl reabsorption without affecting NaHCO3 reabsorption. Acetazolamide inhibits NaHCO3 and most of the remaining NaCl reabsorption in the proximal tubules (bicarbonate-dependent reabsorption) but raises distal transcellular NaCl reabsorption. After administration of both diuretics, the remaining bicarbonate-dependent and transcellular reabsorptions become constant until glomerular filtration rate (GFR) is almost halved. The inhibitory effect of expanding the extracellular volume (ECV) until plasma volume and GFR increased 30-40% was examined in anesthetized dogs. Examinations at comparable GFR obtained by altering arterial perfusion pressure showed that the inhibitory effect of ECV expansion was attenuated by administering acetazolamide. Ethacrynic acid amplified the inhibitory effect which for sodium and chloride reabsorption amounted to 6-7% of the filtered load at comparable GFR. An inhibitory effect of ECV expansion of bicarbonate reabsorption was disclosed only after raising plasma bicarbonate concentration. Thus, the small inhibitory effect of massive ECV expansion is confined to proximal tubular bicarbonate-dependent reabsorption and is of the same magnitude as previously demonstrated in experiments of similar design by raising plasma pH by only 0.07 unit. Since ouabain inhibits transcellular NaCl reabsorption, a natriuretic hormone is more likely to be an inhibitor of carbonic anhydrase than of Na,K-ATPase.
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Sewell RB, Poston L, Wilkinson SP. Sodium and fluid retention in hepatic cirrhosis: a role for circulating hormones? AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1984; 14:297-304. [PMID: 6594125 DOI: 10.1111/j.1445-5994.1984.tb03776.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Morgan T, Ray C. The permeability of collecting ducts to 22Na+ and 36Cl- in rat isolated papillae. Clin Exp Pharmacol Physiol 1982; 9:657-63. [PMID: 7166010 DOI: 10.1111/j.1440-1681.1982.tb00837.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
1. The diffusional permeability of collecting ducts to 22Na+ and 36Cl- was measured in rat papillae in vitro. 2. The permeability of the collecting duct to 36Cl- was 0.72 (s.e.m. = 0.01; n = 356) microns/sec which was significantly higher than the value of 0.51 (s.e.m. = 0.01; n = 356) microns/sec measured for 22Na+. 3. Collecting ducts in papillae taken from rats on a high sodium intake had a 22Na+ permeability of 0.63 (s.e.m. = 0.04; n = 53) microns/sec which was significantly higher than the value on a normal salt intake (0.50, s.e.m. = 0.04; n = 46 microns/sec). 4. When papillae from normal rats were studied in plasma taken from salt loaded rats, the 22Na+ permeability of 0.59 (s.e.m. = 0.04; n = 18) microns/sec was significantly higher than when incubated in plasma from normal rats (0.44, s.e.m. = 0.05; n = 12) microns/sec. 5. An extract of urine with natriuretic activity had no effect on 22Na+ permeability when tested in this system. 6. Adrenalectomy, PGE2, indomethacin and antidiuretic hormone had no significant effect on 22Na+ and 36Cl- permeability. 7. A substance exists in plasma from salt loaded animals that increases the permeability of collecting ducts to sodium. This effect could explain the component of the natriuresis that follows saline infusion which is independent of changes in glomerular filtration rate, aldosterone, or proximal tubule reabsorption.
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Knox FG, Haas JA. Factors influencing renal sodium reabsorption in volume expansion. Rev Physiol Biochem Pharmacol 1982; 92:75-113. [PMID: 7038823 DOI: 10.1007/bfb0030503] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Abstract
In the steady state, urinary excretion of sodium is closely matched to dietary salt intake. Given rigorous defense of extracellular fluid osmolality, it is the quantity of sodium in the extracellular fluid that determines the volume of this compartment. Changes in extracellular fluid volume are detected by volume sensors located in the intrathoracic vascular bed, kidney and other organs. These mechanoreceptors gauge the adequacy of intravascular volume, relative to capacitance, at various sites within the circulation. The perception of a change in the normal relationship between intravascular volume and circulatory capacity evokes a host of renal effector mechanisms that lead ultimately to physiologically appropriate changes in urinary sodium excretion. These effector mechanisms involve physical adjustments in the glomerular filtration rate, renal microvascular hemodynamics and peritubular capillary Starling forces, tubule fluid composition, flow rate and transtubular ion gradients. Neural and humoral pathways are also involved and, among the latter, angiotensin II, aldosterone, prostaglandins and kinins have been studied extensively. The continuous interaction between these sensor and effector mechanisms serves to ensure near-constancy of the extracellular fluid volume, a condition essential for optimal circulatory performance.
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Knox FG, Burnett JC, Kohan DE, Spielman WS, Strand JC. Escape from the sodium-retaining effects of mineralocorticoids. Kidney Int 1980; 17:263-76. [PMID: 6995687 DOI: 10.1038/ki.1980.32] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Heuer LJ, Knue-Beestermüller E. [Comparison of the effects of gastroenteric and parenteral saline loading on kidney function after inhibition of prostaglandin synthesis (author's transl)]. RESEARCH IN EXPERIMENTAL MEDICINE. ZEITSCHRIFT FUR DIE GESAMTE EXPERIMENTELLE MEDIZIN EINSCHLIESSLICH EXPERIMENTELLER CHIRURGIE 1980; 178:43-54. [PMID: 7209134 DOI: 10.1007/bf01856757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
UNLABELLED We inhibited the prostaglandin synthesis with indomethacin in rats during a 7-h (periods: 1--4h; 4--5.5h; 5.5--7h) gastroenteric and parenteral infusion of isotonic saline. Indomethacin was given in a dosis of 10 mg/kg of b. wt. by stomach tube after 5.5-h infusion of saline. We studied how far prostaglandins are involved in the different function of the kidney by measuring the water and sodium excretion and the cortico-medullary osmotic and albumin concentrations of the kidney. RESULTS 1. a) Studies Without Indomethacin. As compared to infusion of isotonic saline into the stomach water excretion is decreased by 30% (P less than 0.02) and 35% (P = n.s.) in the second and third 90 min period during parenteral infusion of saline. As compared to gastroenteric infusion we found an increase of the total osmolarity by 13% (P less than 0.02) in the cortex of the kidney. b) Studies with Indomethacin. As compared to saline infusion into the stomach indomethacin-treated rats decrease their urinary flow rates in 90 min by 26% (P = n.s.) in the presence of equivalent saline infusion into the aorta. Total osmolarity of the parenteral loaded rats increases by 17% (P less than 0.01) in the cortex of the kidney. 2. Indomethacin leads to an increased concentrating ability of the kidney in both gastroenteric and parenteral loaded rats. 3. In the presence of indomethacin plasma albumin of the kidney increases in the cortex and in the outer medulla of the kidney. In the inner medulla, and in the papillary tip, however, albumin concentration decreases significantly. As compared to gastroenteric saline infusion, the osmolarity of the kidney tissue increases and the urinary flow rate decreases during equivalent parenteral infusion of isotonic saline. The prostaglandins are not responsible for the pronounced diuresis during infusions of isotonic saline into the stomach.
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ROSE RJ. Some physiological and biochemical effects of the intravenous administration of five different electrolyte solutions in the dog. J Vet Pharmacol Ther 1979. [DOI: 10.1111/j.1365-2885.1979.tb00402.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Applegate CW, Gutman RA. Renal intracortical blood flow distribution, function and sodium excretion in response to saline loading of anesthetized and unanesthetized dogs. Pflugers Arch 1976; 366:125-30. [PMID: 1033514 DOI: 10.1007/bf00585866] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In order to study the effect of anesthesia on the canine response to saline loading, experiments were performed on 10 dogs, first while awake and then during pentobarbital anesthesia. Individual kidney function and intrarenal blood flow response to saline loading (7.5% body weight) were measured in each condition and all data are reported as the average of a single kidney. CIN is considerably reduced under anesthesia (24.7 +/- 3.2 vs. 43.2 +/- 3.9 ml/min, P less than 0.01). A directionally similar reduction of PAH clearance was noted (89 +/- 17 vs. 122 +/- 13 ml/min). The natriuretic response to saline loading of the dogs reached 290 +/- 61 muEq/min while awake, but only 70 +/- 27 muEq/min while anesthetized. No measurable increase of CIN or CPAH occurred in response to saline loading either in the anesthetized or unanesthetized state. The natriuresis was entirely due to a rise of CNA/GFR in both circumstances. The change of CNA/GFR in response to saline load was also appreciably larger while awake (1.2 leads to 4.7% vs. 0.7 leads to 1.8%). Although the fraction of blood flow to the outermost quarter of the kidney was initially the same (31 +/- 3 vs. 29 +/- 3%) awake or anesthetized, the changes with saline loading were in the opposite direction and the values reached were significantly different (37 +/- 3, awake, vs. 27 +/- 3%, P less than 0.05). We conclude that while increased outer cortical blood flow is not necessary for natriuresis, it may occur during sodium loading and may facilitate sodium excretion.
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Abstract
Three aspects of potential renal involvement in patients with valvular heart disease are discussed. These include (1) disturbances in renal salt and water handling and their implications with respect to diuretic management; (2) the hemodynamic effects of angiographic contrast agents with identification of potentially dangerous effects on the kidneys; and (3) the histologic patterns of bacterial endocarditis in the kidney and their similarity to those of immunologically mediated disease.
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Diamond H, Meisel A. Influence of volume expansion, serum sodium, and fractional excretion of sodium on urate excretion. Pflugers Arch 1975; 356:47-57. [PMID: 1238979 DOI: 10.1007/bf00583520] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The relative contributions of volume expansion and increased fractional excretion of sodium to the uricosuria of saline infusion were assessed in 19 subjects by volume expansion with rapid infusion of 21 of hypertonic saline (3%), isotonic saline (0.9%), or hypotonic saline (0.45%). Urate excretion increased 385 mug/min (P less than 0.01) with hypertonic, 145 mug/min (P less than 0.05) with isotonic saline, and 294 mug/min (P less than 0.001) with hyptonic saline. When 150 meq of sodium chloride was administered as appropriate volumes of hypertonic, isotonic of hypotonic saline, the magnitude or uricosuria was correlated with volume load (r = 0.66, P less than 0.002). fractional excretion of sodium correlated with infusion volumes for all studies taken together (r = 0.35, P greater than 0.1). The relationship between fractional excretion of sodium and fractional excretion of urate was entirely attributed to their correlation with infusion volume. Both post-pyrazinamide urate excretion and pyrazinamide suppressible urate excretion increased with volume expansion.
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Daniel SS, Bowe ET, Lallemand R, Yeh MN, James LS. Renal response to acid loading in the developing lamb fetus, intact in utero. J Perinat Med 1975; 3:34-43. [PMID: 479 DOI: 10.1515/jpme.1975.3.1.34] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Response of the fetal kidney to metabolic acidosis was studied in five fetal lambs, 115-125 days gestation, in order to evaluate the renal contribution to elimination of hydrogen ion during intra-uterine development. Experiments were conducted on healthy unanesthetized fetuses, intact in utero, with catheters implanted at hysterotomy into a fetal femoral artery and vein and into the bladder via the urachus, four or more days prior to the study. A metabolic acidosis was induced by infusion of isotonic lactic acid, 15 m mole/kg, intravenously over a period of 90 minutes. Serial arterial samples were taken and urine collected in fractions before, during and for three hours following the infusion, for measurements of pH, bicarbonate, lactate and electrolytes as well as urine output. During the infusion, urine pH fell from 6.65 to 6.25 and was 6.34 three hours later (Figs. 1 to 4, Tabs. III to IV). Lactic acid infusion caused a prompt increase in urine output from a mean rate of 0.12 to a maximum of 0.28 ml/kg/min at the end of the infusion, returning to control rates three hours later. Lactate excretion increased from 0.05 to a maximum of 4.6 mumole/kg/min at the end of infusion; titratable acid increased from 0.22 to a maximum of 4 muEq/kg/min; the rates of excretion of lactate and titratable acid were still higher than control at the end of three hours. Ammonia excretion increased from 0.21 to a maximum of 0.56 muEq/kg/min three hours after the end of infusion. The acid infusion caused a small but significant fall in excretion of bicarbonate. During the 90 minutes of infusion and over the following three hours, about 800 mumole lactate was excreted while net acid excretion over the same period was no more than half that amount. The diuresis was also accompanied by a net loss of sodium and chloride, the excretion of these ions increasing more than threefold following acid infusion; excretion of potassium decreased to one-third its rate prior to the infusion. During the 90 minutes of infusion, blood pH fell from 7.36 to 7.13, base deficit rose from 3.8 to 16.4 mEq/L and lactate rose from 2.2 to 14.8 mM/L; there was also a small but significant rise in both blood PCO2 and PO2 (Figs. 1 to 2, Tabs. I to II). During the following three hours of recovery, pH rose gradually to 7.29, base deficit and lactate fell to 7.4 mEq/L and 8.7 mM/L respectively. Since renal excretion of net acid and lactate was small, the decrease in blood base deficit and lactate levels during the recovery must therefore be mainly due to equilibration in various fetal compartments as well as placental transfer. These experiments indicate that, in the lamb fetus, intact in utero, the kidney although limited by immaturity of several mechanisms, is capable of responding to an acid load and thus can make a small contribution to fetal homeostasis. The increase in excretion of net acid is accompanied by loss of sodium and chloride in the urine.
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Riley AL, Alexander EA, Migdal S, Levinsky NG. The effect of ischemia on renal blood flow in the dog. Kidney Int 1975; 7:27-34. [PMID: 1127863 DOI: 10.1038/ki.1975.4] [Citation(s) in RCA: 38] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Renal blood flow (RBF) and the distribution of cortical blood flow (microspheres) were measured in the dog after 90 min of total unilateral renal ischemia. RBF was 21% greater than control 2 min after release of the renal artery occlusion, and returned toward control 60 min later. At 2 min after release there was a small but significant increment in deep cortical blood flow which reverted to control by 60 min. When renal artery occlusion was maintained for 180 min, return of blood flow was blunted at 2 min after release of the occlusion, but was not significantly different from control within 10 min after release. Clearance rates of inulin and para-aminohippurate (Cin and Cpah) were 81 and 82% below control after release of occlusion. These data demonstrate that in the dog there is prompt and complete return of blood flow to or above control levels after complete renal artery occlusion. There was no evidence for the "no-reflow" phenomenon.
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Migdal S, Alexander EA, Bruns FJ, Riley AL, Levinsky NG. Effect of hemodilution on the distribution of renal blood flow. Circ Res 1975; 36:71-5. [PMID: 1116231 DOI: 10.1161/01.res.36.1.71] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We evaluated the effects of hemodilution, expansion of intravascular volume, and expansion of interstitial volume on the distribution of cortical renal blood flow, utilizing the microsphere technique. Hemodilution without volume expansion (saline exchange) produced an increase in fractional blood flow in zone 1 (outermost zone) of the cortex from 34 plus or minus 1% to 43 plus or minus 2% and a decrease in fractional blood flow in zone 4 (innermost zone) from 16 plus or minus 2% to 13 plus or minus 2%. Hemodilution without volume expansion or a decrease in plasma protein concentration (isoncotic exchange) produced a similar redistribution in blood flow in zone 1 from 34 plus or minus 2% to 41 plus or minus 2% and in zone 4 from 14 plus or minus 2% to 10 plus or minus 1%. Hemodilution with intravascular volume expansion (hyperoncotic albumin infusion) also produced a superficial shift; blood flow in zone 1 increased from 27 plus or minus 1% to 30 plus or minus 1% and that in zone 4 decreased from 19 plus or minus 2% to 15 plus or minus 1%. Previous studies have demonstrated a redistribution to the juxtamedullary area after saline expansion. Our data demonstrate that hemodilution causes flow to redistribute to the superficial rather than the deep cortex. This superficial shift appears to be secondary to decrease hematocrit rather than to dilution of plasma proteins or expansions of intravascular volume. The deep shift in cortical blood flow which occurs during saline loading is presumably a consequence of expansion of interstitial volume.
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Fitzgibbons JP, Gennari FJ, Garfinkel HB, Cortell S. Dependence of saline-induced natriuresis upon exposure of the kidney to the physical effects of extracellular fluid volume expansion. J Clin Invest 1974; 54:1428-36. [PMID: 4436441 PMCID: PMC301698 DOI: 10.1172/jci107890] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
In many previous studies, the natriuresis induced by saline loading has been demonstrated to persist even though glomerular filtration rate (GFR) has been decreased to below pre-expansion levels by a reduction in renal artery pressure. In such studies, however, the kidney has been exposed to the effects of volume expansion for varying periods of time before renal artery pressure was controlled. The present experiments were designed to evaluate whether this period of exposure induces critical changes in intrarenal factors that are responsible for the natriuresis.Experiments were carried out in rats, in which renal artery pressure was decreased to 70 mm Hg either at the onset of saline loading (immediate clamping experiments) or after 45 min of saline loading had elapsed (delayed clamping experiments). In the delayed clamping experiments, consonant with previous studies, mean sodium excretion, 3.2 mueq/min, remained markedly increased above control, despite a reduction in GFR to 91% of the hydropenic control value. In contrast, when renal artery pressure was comparably reduced at the onset of saline loading mean sodium excretion was only trivially increased, 0.4 mueq/min, although GFR increased to 140% of the hydropenic control value. These results exclude an important role for either a circulating hormone or a reduction in plasma oncotic pressure in the natriuretic response to saline loading, and indicate that intrarenal factors are the critical determinants of the natriuresis. We have used the difference in response to saline loading in the immediate and delayed clamping experiments to evaluate the role of two intrarenal factors, interstitial hydrostatic pressure and renal plasma flow. Interstitial pressure changes were estimated from changes in tubular pressure and diameter by using the in situ compliance characteristics of the tubules. In a group of rats saline loaded without aortic clamping, interstitial pressure increased by 4-5 mm Hg and renal plasma flow increased by 2.5 ml/min. During the period of reduced renal artery pressure, however, neither interstitial pressure nor renal plasma flow was detectably increased above control in either the immediate or the delayed clamping experiments. The only noteworthy difference between the experiments in which a natriuresis occurred (unclamped and delayed clamping studies) and the experiments in which no natriuresis occurred is that in the former group the kidney was at least transiently exposed both to an increase in renal plasma flow and interstitial pressure. These findings indicate, first, that extracellular fluid volume expansion can induce a natriuresis only if the kidney has been exposed to at least a transient increase in either interstitial hydrostatic pressure or renal plasma flow (or both); and, second, that a sustained increase in interstitial pressure and renal plasma flow is not required for the natriuresis to persist.
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Bruns FJ, Alexander EA, Riley AL, Levinsky NG. Superficial and juxtamedullary nephron function during saline loading in the dog. J Clin Invest 1974; 53:971-9. [PMID: 4815088 PMCID: PMC333081 DOI: 10.1172/jci107663] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
A modification of the microdissection technique of Hanssen was utilized in dogs to measure superficial (SNGFR) and juxtamedullary nephron filtration rate (JMGFR) in control and saline-expanded dogs. During control studies SNGFR was 60+/-4 and JMGFR was 72+/-5 nl/min. During saline loading SNGFR was 74+/-8 and JMGFR was 65+/-6 nl/min. The ratio SNGFR: JMGFR significantly increased from 0.84+/-0.03 to 1.15+/-0.08. Glomerular perfusion rate (GPR) was measured with the microsphere method during control and saline loading. Superficial GPR did not change significantly but juxtamedullary GPR increased from 225+/-42 to 323+/-39 nl/min. Calculated superficial nephron filtration fraction was unchanged after saline expansion but juxtamedullary filtration fraction decreased from 0.34+/-0.07 to 0.24+/-0.07. The data demonstrate a tendency for filtration to shift toward the superficial part and plasma flow toward the deep part of the kidney cortex. GFR in juxtamedullary nephrons appears to be less plasma flow-dependent than in superficial nephrons. The fall in filtration fraction in the deep cortex may affect sodium excretion by juxtamedullary nephrons.
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Binswanger U. Calcium metabolism and kidney disease. ERGEBNISSE DER INNEREN MEDIZIN UND KINDERHEILKUNDE 1974; 34:105-53. [PMID: 4608434 DOI: 10.1007/978-3-642-65746-7_4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Abstract
Animals subjected to certain cardiovascular manipulations, such as arteriovenous fistulas, diminish their urinary sodium excretion. It has been shown that closure of such fistulas results in a prompt increase in the rate of sodium excretion. However, the nature of the renal mechanisms increasing the excretion of sodium when the initial cardiovascular abnormality is corrected has remained unclear. Since the elucidation of such mechanisms might provide information pertinent to other sodium-retaining states, the effect of closure of chronic Teflon-Silastic arteriovenous shunts was studied in desoxycorticosterone acetate (DOCA)-treated dogs by utilizing micropuncture techniques.Nephron filtration rates were measured first during a control period with open arteriovenous shunts and then again after closure of the shunts in 12 dogs. Nephron filtration rate rose 32% while total glomerular filtration rate (GFR) decreased 8%. After closure of the arteriovenous shunt, fractional reabsorption increased 6%, while total kidney filtration fraction increased from 0.31 to 0.35. Renal plasma flow decreased from a mean of 111 ml/min to 90 ml/min. Closure of the arteriovenous shunts increased sodium excretion from a mean of 21 mueq/min to 45 mueq/min. Concomitantly, a redistribution of filtrate to superficial nephrons occurred. Since pharmacological doses of DOCA were being administered while total GFR was not increased and fractional reabsorption of sodium in the proximal tubule was not inhibited, it was concluded that filtrate distribution to superficial nephrons may have contributed to the observed natriuresis, although alternate explanations were also deemed possible.
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Gradowska L, Caglar S, Rutherford E, Harter H, Slatopolsky E. On the mechanism of the phosphaturia of extracellular fluid volume expansion in the dog. Kidney Int 1973; 3:230-7. [PMID: 4792039 DOI: 10.1038/ki.1973.36] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Keck W, Joppich R, von Restorff WD, Finsterer U, Prucksunand P, Brechtelsbauer H, Kramer K. Sodium excretion in conscious and anesthetized dogs after large saline infusions. Pflugers Arch 1973; 341:51-62. [PMID: 4737715 DOI: 10.1007/bf00587329] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Bennett WM, Bagby GC, Antonovic JN, Porter GA. Influence of volume expansion on proximal tubular sodium reabsorption in congestive heart failure. Am Heart J 1973; 85:55-64. [PMID: 4682006 DOI: 10.1016/0002-8703(73)90525-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Alexander EA, Doner DW, Auld RB, Levinsky NG. Tubular reabsorption of sodium during acute and chronic volume expansion in man. J Clin Invest 1972; 51:2370-9. [PMID: 4639021 PMCID: PMC292404 DOI: 10.1172/jci107049] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Renal hemodynamics and tubular fractional sodium reabsorption (FSR) were evaluated by clearance techniques during acute and chronic extracellular volume expansion in man. (1 - V/GFR) x 100 was used as an index of proximal and (C(H2O)/V) x 100 as an estimate of distal fractional reabsorption. After acute loading with isotonic saline 37 ml/kg body wt, proximal FSR decreased by 4.8% and distal FSR decreased by 4.4%. After comparable chronic expansion by mineralocorticoids ("escape"), proximal FSR also decreased by 3.9%, but distal reabsorption was not altered.In separate studies, subjects were progressively infused with saline to 57 (E(1)) and to 80 (E(2)) ml/kg body wt, and appeared to divide into "excreters" (maximum U(Na)V > 1000 muEq/min) and "nonexcreters" (maximum U(Na)V < 550 muEq/min). In the excreters, GFR rose, proximal FSR decreased by 7.1% after E(1) and only 0.9% further after E(2). Distal FSR fell by 14.8% after E(1) and by an additional 4.9% after E(2). In the nonexcreters, GFR was stable and proximal FSR did not fall significantly after E(1) or E(2). Distal FSR decreased 4.5% after E(1) and 1.3% further after E(2). It is concluded that both acute and chronic extracellular expansion decrease proximal FSR in man, but only acute loading depresses distal FSR. Ability of some men to excrete sodium rapidly after acute infusion is related to larger increases in GFR and greater decreases in both proximal and distal FSR than occur in men in whom natriuresis is more limited.
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Porter GA, Kloster FE, Bristow JD, Griswold HE. Interrelationship of hemodynamic alterations of valvular heart disease and renal function: influences on renal sodium reabsorption. Am Heart J 1972; 84:189-202. [PMID: 5075072 DOI: 10.1016/0002-8703(72)90333-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Wortsman J, Pak CY, Bartter FC, Deftos L, Delea CS. Pathogenesis of osteomalacia in secondary hyperparathyroidism after gastrectomy. Am J Med 1972; 52:556-64. [PMID: 5017248 DOI: 10.1016/0002-9343(72)90047-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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49
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Levy M. Effects of acute volume expansion and altered hemodynamics on renal tubular function in chronic caval dogs. J Clin Invest 1972; 51:922-38. [PMID: 5014619 PMCID: PMC302206 DOI: 10.1172/jci106887] [Citation(s) in RCA: 47] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
It is well established that dogs with chronic partial constriction of the thoracic inferior vena cava develop sodium retention, ascites, and respond poorly to acute saline loading. A group of such chronic caval dogs, and a group of normal controls were studied during hydropenia, and again after acute saline loading by clearance and recollection micropuncture techniques. After volume expansion, the caval dogs excreted 52 muEq/min per kidney of sodium compared with 370 muEq/min per kidney for the normal controls. During hydropenia and after the saline infusions, single nephron filtration rates, fractional reabsorption of sodium within the proximal tubule, and proximal delivery of filtrate to the distal nephron were comparable in both groups of dogs. Micropuncture of distal tubular segments confirmed that the loop of Henle was the major site for salt and water retention in the expanded caval dogs. Alteration of intrarenal hemodynamics by vasodilating one kidney and elevating systemic arterial blood pressure induced a normal natriuretic response in the saline-loaded caval dogs. Proximal tubular function remained unchanged and the loop of Henle appeared to be the major site responsive to these hemodynamic maneuvers. These same experiments in saline-loaded control dogs had no effect on function of the proximal or distal nephron and did not increase urinary excretion of sodium or water. These experiments provide evidence that the loop of Henle is the major site for sodium retention in volume-expanded chronic caval dogs excreting minimal amounts of sodium.
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Schrier RW, Regal EM. Influence of aldosterone on sodium, water and potassium metabolism in chronic renal disease. Kidney Int 1972; 1:156-68. [PMID: 4671219 DOI: 10.1038/ki.1972.23] [Citation(s) in RCA: 48] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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