Kidney injury, fluid, electrolyte and acid-base abnormalities in alcoholics

Vascular injury associated with ethanol intake is driven by AT1 receptor and mitochondrial dysfunction

BACKGROUND

Renin-angiotensin (Ang II)-aldosterone system (RAAS) is crucial for the cardiovascular risk associated with excessive ethanol consumption. Disturbs in mitochondria have been implicated in multiple cardiovascular diseases. However, if mitochondria dysfunction contributes to ethanol-induced vascular dysfunction is still unknown. We investigated whether ethanol leads to vascular dysfunction via RAAS activation, mitochondria dysfunction, and mitochondrial reactive oxygen species (mtROS).

METHODS

Male C57/BL6J or mt-keima mice (6-8-weeks old) were treated with ethanol (20% vol./vol.) for 12 weeks with or without Losartan (10 mg/kg/day).

RESULTS

Ethanol induced aortic hypercontractility in an endothelium-dependent manner. PGC1α (a marker of biogenesis), Mfn2, (an essential protein for mitochondria fusion), as well as Pink-1 and Parkin (markers of mitophagy), were reduced in aortas from ethanol-treated mice. Disturb in mitophagy flux was further confirmed in arteries from mt-keima mice. Additionally, ethanol increased mtROS and reduced SOD2 expression. Strikingly, losartan prevented vascular hypercontractility, mitochondrial dysfunction, mtROS, and restored SOD2 expression. Both MnTMPyP (SOD2 mimetic) and CCCP (a mitochondrial uncoupler) reverted ethanol-induced vascular dysfunction. Moreover, L-NAME (NOS inhibitor) and EUK 134 (superoxide dismutase/catalase mimetic) did not affect vascular response in ethanol group, suggesting that ethanol reduces aortic nitric oxide (NO) and H2O2 bioavailability. These responses were prevented by losartan.

CONCLUSION

AT1 receptor modulates ethanol-induced vascular hypercontractility by promoting mitochondrial dysfunction, mtROS, and reduction of NO and H2O2 bioavailability. Our findings shed a new light in our understanding of ethanol-induced vascular toxicity and open perspectives of new therapeutic approaches for patients with disorder associated with abusive ethanol drinking.

Perioperative Concerns in the Patient with History of Alcohol Use

Alcohol use is common in patients presenting for surgery and can result in significant physiologic changes and postoperative complications. Anesthesia providers must be aware of the potential risks associated with alcohol consumption and take steps to minimize them. Perioperative management includes assessing patients for alcohol use, providing alcohol cessation interventions, adjusting the anesthetic plan according to the patient's alcohol use history, providing appropriate pain management strategies, and closely monitoring patients during and after surgery for signs of alcohol withdrawal.

Multiple Dyselectrolytemia in a Chronic Alcohol Abuser: A Case Report

Electrolyte disorders in alcohol-dependent patients can be due to a multitude of reasons. We discuss a patient with diabetes mellitus, seizure disorder, and alcoholism who presented with seizure episodes and vomiting following a binge alcohol intake. The evaluation showed life-threatening metabolic derangements that included hyponatremia, hypokalemia, hypomagnesemia, hypocalcemia, hypochloremia, hypophosphatemia with elevated blood glucose, and metabolic alkalosis with a normal anion gap. Subsequently, a detailed urinary analysis revealed a urinary loss of electrolytes. We emphasize that alcohol-induced tubular injury is a possibility when such a clinical presentation is seen in the emergency room. The complex interplay of various electrolytes in homeostasis posed a great challenge in the management of this patient. Our case reiterates this intricate electrolyte correction policy.

Alcohol Intake and Arterial Hypertension: Retelling of a Multifaceted Story

Alcoholic beverages are common components of diets worldwide and understanding their effects on humans' health is crucial. Because hypertension is the leading risk factor for cardiovascular diseases and all-cause mortality, the relationship of alcohol consumption with blood pressure (BP) has been the subject of extensive investigation. For the purpose of this review, we searched the terms "alcohol", "ethanol", and "arterial hypertension" on Pubmed MeSH and selected the most relevant studies. Short-term studies showed a biphasic BP response after ingestion of high doses of alcohol, and sustained alcohol consumption above 30 g/day, significantly, and dose-dependently, increased the risk for hypertension. These untoward effects of alcoholic beverages on BP can be mediated by a multiplicity of neurohormonal mechanisms. In addition to the effects on BP, excess alcohol intake might contribute to cardiac and renal hypertensive organ damage, although some studies suggest possible benefits of moderate alcohol consumption on additional cardiovascular risk factors, such as diabetes and lipoprotein(a). Some intervention studies and cumulative analyses support the evidence of a benefit of the reduction/withdrawal of alcohol consumption on BP and cardiovascular outcomes. This is why guidelines of scientific societies recommend avoidance or limitation of alcohol intake below one unit/day for women and two units/day for men. This narrative article overviews all these topics, providing an update of the current knowledge on the relationship between alcohol and BP.

Tripterygium Wilfordii Polyglycosides (TP) Ameliorate Alcoholic Kidney Injury in Rats by Regulating Protein Expression Associated with the Nuclear Factor Erythroid 2-Related Factor 2 Signaling Pathway

Objective: To explore the mechanisms of protection of tripterygium wilfordii polyglycosides (TP) against alcoholic kidney injury by regulating Nrf2 signaling pathway in rats. Materials and Methods: Dividing rats into Control, Model, LD, MD and HD groups. The kidney was weighed to calculate kidney index. The morphology of the kidney was observed by HE staining. Nrf2, p-Nrf2 and HO-1 in kidney were detected by immunohistochemistry. Measuring Scr by Jaffe’s method and BUN by diacetyl-oxime method. The renal SOD and MDA were detected by colorimetry. The renal ROS was detected by fluorescence spectrometry. Results: Compared with Control, histopathological changes were observed in Model group, The kidney index, Scr, BUN, renal MDA and ROS concentrations increased significantly (P <0.001). Renal SOD activity, expression of p-Nrf2 and HO-1, p-Nrf2/Nrf2 decreased significantly (P < 0.001). With TP supplement, compared with Model, histopathological was improved, The kidney index, Scr, BUN, renal MDA and ROS concentrations decreased significantly (P <0.05, respectively); Renal SOD activity, p-Nrf2 and HO-1, p-Nrf2/Nrf2 increased significantly (P <0.05, respectively) in TP treated groups (LD, MD and HD). Conclusion: TP can prevent or reduce oxidative stress and attenuate alcoholic kidney injury via regulating Nrf2 signaling pathway in vivo.

Preventive Potential of the Aqueous Extract of the Mixture of Bidens pilosa (Asteraceae) and Cymbopogon citratus (Poaceae) Aerial Parts on Hypertension Induced by a Chronic Salt and Alcohol Consumption on the Rats

High blood pressure (HBP) is currently one of the main risk factors for cardiovascular and kidney diseases. Nowadays, populations make extensive use of alternative medicine for their health problems. Bidens pilosa (B. pilosa) and Cymbopogon citratus (C. citratus) are used individually in the traditional treatment of cardiovascular disorders. This study assessed the effects of the mixture of these two plants aqueous extract on HBP in rats. Male rats (42) were divided into 7 groups of 6 rats each. Normotensive rats received only distilled water and formed group 1. The other animals received ethanol + salt preceded by distilled water (10 mL/kg; group 2) and spironolactone (10 mg/kg; group 3); the aqueous extracts of the mixture (100 and 200 mg/kg; groups 4 and 5) isolated plants B. pilosa (200 mg/kg; group 6) and C. citratus (200 mg/kg; group 7). Animals were treated for 7 weeks during which water consumption and urine volume were assessed; then, hemodynamic parameters were recorded, and rats were sacrificed. Serum and some organs (liver, kidney, heart, and aorta) were used to evaluate biochemical parameters. Ingestion of ethanol + salt leads to a significant increase in urinary volume and water intake that were significantly prevented by the extracts from the mixture and isolated plants. Ethanol + salt solution significantly increased the blood pressure, heart rate, triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-chol), very-low-density lipoprotein cholesterol (VLDL-chol), atherogenic indices, liver and kidney function parameters, and malondialdehyde (MDA) levels. However, the levels of high-density lipoprotein cholesterol (HDL-chol), albumin, reduced glutathione (GSH), catalase, and superoxide dismutase (SOD) activity were significantly reduced. The extracts of the mixture and isolated plants significantly prevented all these variations with a more pronounced action for the lowest dose of the mixture on the lipid profile, oxidative stress, and kidney function. These observations confirm the beneficial effects of B. pilosa and C. citratus to manage hypertension.

Risk factors for overcorrection of severe hyponatremia: a post hoc analysis of the SALSA trial

Background

Hyponatremia overcorrection can result in irreversible neurologic impairment such as osmotic demyelination syndrome. Few prospective studies have identified patients undergoing hypertonic saline treatment with a high risk of hyponatremia overcorrection.

Methods

We conducted a post hoc analysis of a multicenter, prospective randomized controlled study, the SALSA trial, in 178 patients aged above 18 years with symptomatic hyponatremia (mean age, 73.1 years; mean serum sodium level, 118.2 mEq/L). Overcorrection was defined as an increase in serum sodium levels by >12 or 18 mEq/L within 24 or 48 hours, respectively.

Results

Among the 178 patients, 37 experienced hyponatremia overcorrection (20.8%), which was independently associated with initial serum sodium level (≤110, 110–115, 115–120, and 120–125 mEq/L with 7, 4, 2, and 0 points, respectively), chronic alcoholism (7 points), severe symptoms of hyponatremia (3 points), and initial potassium level (<3.0 mEq/L, 3 points). The NASK (hypoNatremia, Alcoholism, Severe symptoms, and hypoKalemia) score was derived from four risk factors for hyponatremia overcorrection and was significantly associated with overcorrection (odds ratio, 1.41; 95% confidence interval, 1.24–1.61; p < 0.01) with good discrimination (area under the receiver-operating characteristic [AUROC] curve, 0.76; 95% CI, 0.66–0.85; p < 0.01). The AUROC curve of the NASK score was statistically better compared with those of each risk factor.

Conclusion

In treating patients with symptomatic hyponatremia, individuals with high hyponatremia overcorrection risks were predictable using a novel risk score summarizing baseline information.

10-Dehydrogingerdione ameliorates renal endoplasmic reticulum/oxidative stress and apoptosis in alcoholic nephropathy induced in experimental rats

BACKGROUND

Chronic alcoholism induces kidney injury (KI), leading to increased mortality in alcoholic hepatitis patients. Endoplasmic reticulum stress (ER) represents the main initiator of kidney diseases and alcoholic nephropathy.

AIMS

We used alcoholic nephropathy rat model followed by 10-dehydrogingerdione (10-DHGD) intake as potential modulator. This is to focus on ER/oxidative stress/inflammatory and apoptotic pathways involvement.

MAIN METHOD

Alcoholic nephropathy was induced by alcohol administration (3.7 g/kg/body weight) orally and daily for 45 days. 10-DHGD (10 mg/kg/day) was administered either alone or along with alcohol.

KEY FINDINGS

Our results demonstrated significant increase in kidney function parameters like f creatinine, urea, uric acid, and blood urea nitrogen (BUN) levels. Renal ER/oxidative stress markers such as cytochrome P450 family two subfamily E member 1 (CYP2E1), C/EBP homologous protein (CHOP), and endoplasmic glucose-regulated protein 78 (GRP-78) demonstrated also significant increase. Inflammatory mediators like nuclear factor-kappa B (NF-kB), tumor necrosis factor-α (TNF-α), and transforming growth factor-β (TGF-β along with apoptotic marker caspase-3 behaved similarly. Antioxidant molecules like reduced glutathione (GSH), superoxide dismutase (SOD), and catalase demonstrated marked decrease.

SIGNIFICANCE

10-DHGD administration resulted in significant modulation represented by an enhancement in the kidney functions and the histopathological patterns in a conclusion of its potential to ameliorate the pathological changes (kidney injury) induced by alcohol intake.

Hepatic and renal damage by alcohol and cigarette smoking in rats

Chronic use of alcohol and tobacco cigarettes is associated to millions of deaths per year, either by direct or indirect causes. However, few studies have explored the additional risks of the combined use of these drugs. Here we assessed the effect of the combined use of alcohol and cigarette smoke on liver or kidney morphology, and on biochemical parameters in chronically treated rats. Male Wistar rats were allocated to receive 2 g/kg alcohol orally, which was followed by the inhalation of smoke from six cigarettes during 2 h (ALTB group) for 28 days. Other groups received alcohol alone (AL) or were exposed to cigarette smoke (TB) alone and were compared to control (CT) rats, which received water followed by ambient air. On day 29, rats were euthanized and blood samples were collected for aminotransferase enzymes (AST and ALT), creatinine, and urea analysis. Liver and kidney were weighted, dissected, fixed, and stained with hematoxylin and eosin for morphological analysis. Our results showed that necrosis was elevated in the AL, TB, and mainly the ALTB group in both liver and kidney of rats. Serum levels of AST and ALT were reduced by cigarette smoke exposure, independently of alcohol use. Serum creatinine levels increased after tobacco smoke exposure. On the other hand, TB and AL groups decreased serum urea levels, and their association restored that decrease. Absolute liver and kidney weights were lower in the cigarette smoke exposure rats. Lastly, body weight gain was lower in TB group and combined use restored it. Thus, we may infer that the use of alcohol, exposure to tobacco cigarette smoke or, mainly, their association promotes liver and kidney injuries, and this damage is related with biochemical changes in rats.

Restorative Effects of Aloe Vera Gel on Alcohol Induced Hepato-Nephrocellular Dysfunction

Excessive alcohol intake is associated with pathological conditions that are detrimental. Aloe vera is a plant that possesses antimicrobial and anti-oxidant properties. This study investigated the effects of Aloe vera gel on alcohol induced hepato-nephrocellular dysfunction in rats using the specific activities of glutathione-S-transferase (GST), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma glutamyl transferase (GGT) and lactate dehydrogenase (LDH) as well as concentration of some electrolytes as indices. Six groups of male albino rats containing 5 rats each were used in the experiments. Groups A and B were administered distilled water and 50 % (v/v) alcohol for 21 days respectively. Groups C and D were administered 50 % (v/v) alcohol, while groups E and F were administered distilled water for the first 14 days, followed by co-administration (without stopping alcohol or distilled water administrations) of 125 mg and 250 mg.kg–1 body weight Aloe vera gel respectively for 7 days. The administration of Aloe vera gel extract significantly modulated serum electrolytes imbalances with concomitant lowering of ALT, AST, ALP, GGT, LDH and GST rates when compared to group B. These results suggested the restoration of alcohol induced dys-function by Aloe vera gel.

Nephro-protective activity of wheatgrass juice against alcohol-induced oxidative damage in rats

The present study is an attempt to check the protective effect of fresh wheatgrass juice (WJ) as a potential therapeutic agent against alcohol-induced oxidative/nitrosative stress leading to nephrotoxicity in rats. Administration of 20% ethanol (5 g/kg b.wt/day) for 60 days resulted in a significant rise in the plasma concentrations of urea and creatinine with decreased levels of uric acid. Besides, a significant decrease in plasma electrolyte/mineral levels along with decreased activity of Na+/K+-ATPase activity was recorded in alcohol administered rats. In alcohol administered rats augmented lipid peroxidation (thio-barbituric acid reactive substance - TBARS) and nitric oxide (NOx) reflects the increased oxidative stress and nitrosative stress, moreover, we noticed a concomitant decrease in the levels of reduced glutathione (GSH) with decreased activities of antioxidant enzyme machinery viz., superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione reductase (GR) and glutathione s-transferase (GST). Administration of WJ to the alcoholic rats significantly restored the plasma biochemical markers and the kidney antioxidant status near to control group animal levels. These findings were further confirmed by the kidney histopathological studies, wherein the protective effect of WJ treatment in retaining the morphological features of the renal tissue in spite of the alcohol administration was evident. The rich repertoire of phenolic compounds present in the WJ from the freshly sprouted seeds synergistically protected the kidney from alcohol-induced damage.

Alcohol Consumption Can be a "Double-Edged Sword" for Chronic Kidney Disease Patients

Excessive drinking of alcohol is becoming a worldwide problem, and people have recognized that there exists a close relationship between chronic kidney disease (CKD) and alcohol consumption. However, there are many inconsistencies between experimental and clinical studies on alcohol consumption and kidney damage. The possible reason for this contradictory conclusion is the complex drinking pattern of humans and some bioactivators in wine. In addition, the design itself of the clinical studies can also produce conflicting interpretations of the results. Considering the benefits of light-to-moderate alcohol consumption, we recommend that CKD patients continue light-to-moderate drinking, which is beneficial to them. Because alcohol consumption can lead to adverse events, we do not advise non-drinkers to start to drink. Although light-to-moderate alcohol consumption may not pose a risk to patients with CKD, the patients’ condition needs to be considered. Consumption of even small amounts of alcohol can be associated with increased death risk. Additional clinical and experimental studies are needed to clarify the effect of alcohol on the kidneys and alcohol consumption on CKD patients.

Renal carnitine excretion following abstinence after chronic drinking

PURPOSE

Carnitine participates in the metabolism of lipids and cognitive activity. Excessive consumption of alcohol disturbes renal tubular canalicules, that increases urinary excretion of carnitine and its esters. The study evaluates restoration of the urinary free- and total carnitine as well as acylcarnitine excretion after chronic drinking and during the 49-days of controlled abstinence.

MATERIALS/METHODS

In 32 patients (6♀; 26♂), 26-60 years old, 2-30 years of alcohol dependence: 75-700g of pure alcohol (166±94g) of alcohol daily consumption, 2-360 (35±67) days of intoxication and 1.25±0.8 days of abstinence at admission, we determined urinary free (FC) and total carnitine (TC) as well as acylcarnitine (AC) and acylcarnitine/free carnitine ratio (AC/FC) at admission (T0), after 30 (T30) and 49 (T49) days of the controlled abstinence.

RESULTS

At T0 excretion of FC, TC and AC as well as AC/FC ratio were significantly higher as compared to the control group. After 30- and 49-days of abstinence, excretion of FC and TC decreased to the level of control group with an exception of the AC and AC/FC ratio at T30 that remained significantly increased.

CONCLUSION

30 days for the FC and TC and 49 days of abstinence for the AC and AC/FC ratio was sufficient to normalize urinary excretion of the carnitines.

Chronic ethanol feeding increases the severity of Staphylococcus aureus skin infections by altering local host defenses

Alcoholics are at increased risk of Staphylococcus aureus skin infection and serious sequelae, such as bacteremia and death. Despite the association between alcoholism and severe S. aureus skin infection, the impact of EtOH on anti-S. aureus cutaneous immunity has not been investigated in a model of chronic EtOH exposure. To test the hypothesis that EtOH enhances the severity of S. aureus skin infection, mice were fed EtOH for ≥12 weeks via the Meadows-Cook model of alcoholism and inoculated with S. aureus following epidermal abrasion. Evidence of exacerbated staphylococcal disease in EtOH-fed mice included: skin lesions that were larger and contained more organisms, greater weight loss, and increased bacterial dissemination. Infected EtOH-fed mice demonstrated poor maintenance and induction of PMN responses in skin and draining LNs, respectively. Additionally, altered PMN dynamics in the skin of these mice corresponded with reduced production of IL-23 and IL-1β by CD11b(+) myeloid cells and IL-17 production by γδ T cells, with the latter defect occurring in the draining LNs as well. In addition, IL-17 restoration attenuated S. aureus-induced dermatopathology and improved bacterial clearance defects in EtOH-fed mice. Taken together, the findings show, in a novel model system, that the EtOH-induced increase in S. aureus-related injury/illness corresponds with defects in the IL-23/IL-17 inflammatory axis and poor PMN accumulation at the site of infection and draining LNs. These findings offer new information about the impact of EtOH on cutaneous host-defense pathways and provide a potential mechanism explaining why alcoholics are predisposed to S. aureus skin infection.