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Biomedical subjects

G Remuzzi

Publications and source records attributed to G Remuzzi.

At least 379 records · Page 21Linked to original sources
PubMed1989

Supranormal von Willebrand factor multimers in scleroderma.

Platelet adhesion-aggregation reactions play an early and pivotal role in the pathogenesis of systemic sclerosis in scleroderma, but the mechanisms are incompletely understood. We determined whether or not plasma from 11 consecutive patients with scleroderma contained a subset of larger than normal ("supranormal") multimers of von Willebrand factor (vWF) that are potent inducers of platelet aggregation and adhesion. Supranormal multimers were found in all patients on at least one of two different occasions 9 to 12 months apart, whatever the duration and severity of the disease, but in none of the normal controls. Administration of low-dose aspirin (40 mg) to five of the 11 patients for ten days to inhibit the platelet release reaction slightly reduced the amounts of supranormal multimers suggesting that they might originate in part from platelets. Supranormal multimers may contribute to the pathogenesis of systemic sclerosis by inducing platelet aggregation and enhancing adhesion to subendothelium under the conditions of elevated shear stress occurring in the partially occluded vessels of the arterial microcirculation of scleroderma.

Adult↗
PubMed1989

Subcutaneous desmopressin (DDAVP) shortens the bleeding time in uremia.

The intravenous infusion of 1-deamino-8-D-arginine vasopressin (DDAVP) is used as a nontransfusional form of treatment in patients with congenital and acquired bleeding disorders, including patients with uremia associated with prolonged bleeding times. Since uremic patients experience minor bleeding episodes that might be self-managed at home (particularly epistaxis, gingival bleeding, and menorrhagia), we carried out a double-blind, placebo-controlled crossover study in nine uremics to evaluate whether the prolonged bleeding times could be shortened by subcutaneous injections of DDAVP. One hour after administration, the bleeding time was significantly shortened (P less than .01) and became normal in seven of nine patients. After 4 hr, the bleeding time was still shorter than baseline (P less than .01), but in only three patients was it still normal. There was no significant bleeding time change after placebo. When the same patients were treated with the same dose of DDAVP infused intravenously, the bleeding times were not significantly different from those measured after subcutaneous administration. Hence, subcutaneous DDAVP is an alternative method for short-term shortening of the bleeding time in uremia, at least as effective as intravenous DDAVP but with the possibility of self-administration by the patients at home.

Adult↗
PubMed1989

Abnormalities in arachidonic acid metabolites in nephrotoxic glomerular injury.

Arachidonic acid metabolites are suspected of contributing in various ways to major pathophysiological events that occur in toxic and immune glomerular injury. This paper focuses on the role of arachidonate metabolites in the experimental models of adriamycin nephrosis and cyclosporin A nephrotoxicity in rats as examples, respectively, of a toxic nephropathy characterized by increased glomerular permeability to proteins and a toxic nephropathy with macrophage accumulation and progressively deteriorating renal function. The important pathogenic contribution of thromboxane A2 to the impairment of renal function in these experimental models is discussed.

Animals↗
PubMed1989

Renal vascular and thrombotic effects of cyclosporine.

Cyclosporine A (CyA) given to prevent xenograft rejection induces renal function impairment. In the last few years many studies have been devoted to understanding the mechanism(s) of CyA-induced renal insufficiency. In humans, several specific findings--interstitial fibrosis, toxic tubulopathy, peritubular capillary congestion, arteriolopathy--have been associated with CyA administration. It is now recognized that CyA renal toxicity mainly manifests under three different syndromes: (1) acute reversible decrease in glomerular filtration rate (GFR), (2) acute microvascular disease with the pattern of thrombotic microangiopathy, and (3) chronic irreversible renal damage. This review analyzes the available evidence that the clinical syndromes of CyA nephrotoxicity are related to changes induced by CyA on renal vessels. Experimental studies have failed to document that the activation of renin-angiotensin axis or sympathetic nervous system plays a relevant role in the development of CyA-associated renal vasoconstriction, which is the main causal factor of acute reversible decrease in GFR, whereas it is possible that changes in arachidonic acid metabolites with vasoactive properties contribute to this CyA-induced phenomenon. In this context, findings of increased urinary TxB2 and protective effect of TxA2 receptor blocking are of particular interest. Since the introduction of CyA in clinical practice, a syndrome of thrombotic microangiopathy resembling hemolytic uremic syndrome/thrombotic thrombocytopenic purpura has been recognized in humans and reproduced in experimental animals. This is a rare form of vascular toxicity attributed to CyA which may have a poor prognosis and possibly results from a direct toxic effect of CyA on vascular endothelium. The syndrome of chronic progressive deterioration of renal function associated with CyA was first recognized in humans. Until recently the possibility of reproducing this syndrome in animals in order to better understand its nature was not addressed. As in humans, when animals are given CyA for greater than 2 months they may develop chronic renal insufficiency with tubular arteriopathy and interstitial fibrosis. A peculiar form of tubulointerstitial damage has been recognized in association with CyA, and called striped interstitial fibrosis, that is probably due to tubular collapse induced by afferent vasoconstriction. This lesion may be improved by withdrawal of CyA, but renal function usually does not normalize.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗
PubMed1989

Angiotensin-converting enzyme inhibition ameliorates the defect in glomerular size selectivity in hyponatremic hypertensive syndrome.

The glomerular size-selective properties in a patient with "hyponatremic hypertensive syndrome" were investigated before and after administration of the angiotensin-converting enzyme inhibitor enalapril. Hyponatremic hypertensive syndrome is a rare condition of renovascular hypertension characterized by electrolyte abnormalities (hyponatremia, hypokalemia), polyuria, and high renin activity. In this patient a marked increase in urinary protein excretion was observed. Treatment with enalapril normalized BP, corrected electrolyte abnormalities, and reduced proteinuria. Glomerular filtration rate (GFR), renal plasma flow (RPF), and the clearance of neutral dextrans of graded sizes were measured before and after 6 months of enalapril (20 mg/d) administration. Theoretical analysis of dextran and inulin clearance data with a model of glomerular size selectivity were adopted to separate effects of hemodynamic changes on macromolecule filtration from changes of intrinsic membrane selective properties. After enalapril urinary protein excretion decreased, GFR was unchanged and RPF almost doubled. Fractional clearance values of dextran molecules were markedly elevated in comparison with the corresponding values measured in a group of normal controls and were normalized by enalapril. Theoretical calculation of membrane pore characteristics showed that enalapril treatment reduced the radius of all membrane pores by approximately 1 nm. Altogether these results indicate that enalapril normalized glomerular filtration of neutral macromolecules and circulating proteins in a human condition of angiotensin II-induced proteinuria. Enalapril effectively restored glomerular size-selective function, reducing dimensions of membrane pores, independently of its effect on renal hemodynamics.

Aged↗
PubMed1989

Blunted excretory response to atrial natriuretic peptide in experimental nephrosis.

Adriamycin (ADR) nephrosis and a model of unilateral ADR-induced proteinuria were produced in Sprague-Dawley (S.D.) rats to investigate the mechanism of sodium retention by the nephrotic kidney. Plasma volume, as measured by the dilution principle using radioiodinated serum albumin, was significantly higher in nephrotic animals than in control ones (NS: 69.61 +/- 15.02: control: 47.05 +/- 5.32 ml/kg: P less than 0.01). Similarly plasma levels of immunoreactive ANP (iANP) were significantly higher in nephrotic animals compared to controls (NS 104.22 +/- 36.41: control 59.94 +/- 20.88 pg/ml; P less than 0.05). Using the unilateral model we found a markedly reduced diuretic and natriuretic response to the infusion of synthetic rat atrial natriuretic peptide (ANP 1-28) in proteinuric kidney but not in contralateral kidney, despite a comparable increase in glomerular filtration rate. To explain the blunted diuresis and natriuresis in the presence of normal glomerular response to ANP, we investigated the possibility of an abnormality at post-glomerular level by studying ANP receptor density and affinity of the inner stripe of outer medulla and the inner medulla in ADR-and vehicle-treated rats. The inner stripe of outer medulla and the inner medulla receptor density and affinity were not significantly different in ADR rats as compared to animals given the vehicle alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

Effects of tertatolol on renal function in the isolated perfused rat kidney.

Tertatolol, a new beta-adrenergic blocker, increases glomerular filtration rate (GFR) and renal plasma flow (RPF), and enhances diuresis and natriuresis in experimental animals and humans. The mechanism underlying the renal effects of tertatolol has not been established. In the present study we addressed the possibility that tertatolol influences renal function by a direct intrarenal mechanism. For this purpose we used a preparation of isolated rat kidney perfused with an artificial cell-free medium. Tertatolol when given as a bolus injection into the renal artery at the dose of 25 and 50 micrograms/kg, but not of 12.5 micrograms/kg, significantly enhanced the glomerular filtration rate (GFR) and perfusate flow rate (PFR). In contrast, the intrarenal bolus injection of different doses of propranolol (100, 250, or 500 micrograms/kg) was unable to change GFR and PFR to a significant extent. While no change in urine flow rate was found when the lowest dose of tertatolol was used, the compound at the dose of 25 and 50 micrograms/kg progressively increased urine flow during the time of perfusion. A similar effect of tertatolol was observed for urinary sodium and potassium excretion. In contrast, different doses of propranolol did not significantly change the urine flow rate or sodium and potassium excretion rates. We conclude that tertatolol, but not propranolol, increases GFR and PFR, and enhances urine output and sodium excretion in the isolated perfused rat kidney. These findings indicate that tertatolol preserves renal function by a mechanism independent of systemic changes.

Adrenergic beta-Antagonists↗
PubMed1989

Hyperparathyroidism does not influence the abnormal primary haemostasis in patients with chronic renal failure.

Patients with chronic renal failure suffer from secondary hyperparathyroidism and have greatly increased blood concentrations of intact parathyroid hormone (PTH) and PTH fragments. Thus PTH has been regarded in the last few years as a uraemic toxin possibly responsible for many clinical manifestations of the uraemic syndrome including a tendency to prolonged bleeding. Since PTH inhibits platelet aggregation 'in vitro', the possibility that hyperparathyroidism of uraemia plays a role in the pathogenesis of uraemic bleeding has been considered. Clinical data to support this possibility is not available so far. In this study we have correlated the skin bleeding time, the best clinical marker of uraemic bleeding tendency, with serum concentrations of intact PTH or PTH fragments in 40 patients with chronic renal failure undergoing chronic haemodialysis. Since the skin bleeding time is known to be influenced by packed cell volume (PCV), we also considered two distinct groups of uraemic patients on the basis of their PCV values. The results indicated that bleeding time does not correlate with serum concentrations of intact PTH or PTH fragments. Also, no correlation has been found between PTH values and blood concentrations of calcium, phosphorus, magnesium and hydroxyproline. It is concluded that elevated PTH values in renal-failure patients do not contribute to uraemic platelet defect, as reflected by the skin bleeding time.

Adult↗
PubMed1989

Glomerular hyperfiltration and urinary prostaglandins in type 1 diabetes mellitus.

In order to determine whether glomerular hyperfiltration in diabetes is related to renal prostaglandin production we have studied the urinary excretion of PGE2, 6-keto-PGF1 alpha, and TXB2 in two sex, age and duration of diabetes matched groups of 9 and 10 Type 1 diabetic patients with either normal (mean 121, range 105-129 ml min-1 1.73 m-2) or supranormal glomerular filtration rate (154, 135-206 ml min-1 1.73 m-2). A group of 15 matched healthy volunteers served as control subjects. Urine was collected overnight for an uninterrupted period of at least 6 h. All studies in the patients were performed during insulin-induced sustained euglycaemia to prevent the confounding effect of variable degrees of blood glucose control on urinary prostaglandin excretion. Blood pressure was normal in all subjects. Urinary excretion of 6-keto-PGF1 alpha was significantly higher in the patients with glomerular hyperfiltration (median 17.1, range 4.5-33.6 ng h-1) than in those without (8.8, 1.5-13.8 ng h-1; p less than 0.05) or in normal control subjects (9.6, 5.2-15.5 ng h-1; p less than 0.05). No significant differences were found in the excretion rates of PGE2 and TXB2 between the three groups. Under conditions of controlled plasma glucose and insulin concentrations the urinary excretion of 6-keto-PGF1 alpha, the stable breakdown product of PGI2, a compound of endothelial, possibly glomerular, origin was elevated only in the diabetic patients with glomerular hyperfiltration.

6-Ketoprostaglandin F1 alpha↗
PubMed1989

Renal metabolism and urinary excretion of thromboxane B2 in the rat.

We wanted to evaluate whether the kidney tissue can metabolize thromboxane (Tx) B2 and, specifically, whether the 2,3-dinor metabolite might be formed in the kidney and excreted in the urine. For this purpose, we used an isolated perfused kidney preparation exposed to vehicle or TxB2 at different infusion rates. Approximately 96% of the total TxB2 infused was recovered in the venous effluent, whereas approximately 1% was found in urine. Isolated perfused kidneys exposed to [3H]TxB2 eliminated in the urine 1.2% of the [3H]TxB2 infused, measured by thin-layer chromatographic analysis, and actively metabolized [3H]TxB2 to 2,3-dinor-TxB2, 11-dehydro-TxB2, and possibly 2,3,4,5-tetranor-TxB1. No metabolites of TxB2 were recovered in the venous effluent. As a marker of renal TxB2 metabolic activity, urinary 2,3-dinor-TxB2 was quantified by high-resolution gas chromatography-negative-ion chemical ionization mass spectrometry. The 2,3-dinor-TxB2 was detected both before and during TxB2 infusion in urinary samples but not in the venous effluent. The ratio of 2,3-dinor-TxB2-TxB2 increased during the infusion reaching a peak value immediately after stopping the TxB2 infusion. These results indicate that, in the rat, the kidney tissue metabolizes TxB2 to 2,3-dinor-TxB2, and both TxB2 and 2,3-dinor-TxB2 are excreted in the urine.

Animals↗
PubMed1989

Sequence of glomerular changes in experimental endotoxemia: a possible model of hemolytic uremic syndrome.

Glomerular morphological changes produced by 5-hour intravenous infusion of endotoxin (40 micrograms/kg/h) were studied in 57 rabbits. During endotoxin infusion all animals developed signs of endotoxemia, anemia, and transient leukopenia and thrombocytopenia. Acute renal failure also developed in all animals. By light microscopy a marked polymorphonuclear cell infiltration was the prominent finding within 1 h from the beginning of the infusion. At hour 5 fibrin deposits and thrombi were detected in most animals. The abnormalities were reversible. By electron microscopy endothelial damage was detected few minutes after the beginning of endotoxin infusion followed by leukocyte and platelet infiltration in glomerular capillaries. Fibrin appeared at hour 5 as free strands into the lumens or in large clumps along the luminal surface of endothelial layer. Occasionally, occlusive fibrin thrombi were seen. At hour 48 only mild endothelial damage was seen, associated with few polymorphonuclear cells in the glomerular capillary lumens. These results document the sequence of renal changes in the best available animal model of hemolytic uremic syndrome. Beside endothelial damage, leukocyte infiltration in glomerular capillaries is a prominent finding suggesting a role of inflammatory cells in the development of microvascular thrombosis.

Animals↗
PubMed1989

Differential inhibition by aspirin of platelet thromboxane and renal prostaglandins in the rat.

Aspirin (ASA) beside inhibiting platelet thromboxane A2 (TxA2) can suppress the formation of renal prostacyclin (PGI2) and prostaglandin E2 (PGE2) which play a crucial role in the control of renal hemodynamics. Previous studies based on urinary PG measurements have suggested that p.o. ASA can spare renal cyclooxygenase. We wanted to establish by direct measurement whether p.o. ASA has a renal sparing effect and to establish to which extent changes in renal cyclooxygenase activity can be predicted measuring urinary excretion of 6-keto-PGF1 alpha and PGE2. Our results showed that in normal rats 10 mg/kg of ASA given p.o. partially inhibits platelet TxA2 formation (measured as serum TxB2) and does not inhibit glomerular and medullary PGI2 and PGE2 synthesis. Higher doses of ASA (30-200 mg/kg) effectively and completely inhibit platelet TxA2 independently if given p.o. or i.v., and also inhibit glomerular and medullary PG synthesis. The kinetics of the effect of ASA on platelet vs. renal cyclooxygenase is different: the inhibition being irreversible in platelets, but rapidly reversible in glomeruli and medulla. Six hours after the administration of 10 and 30 mg/kg i.v. and 30 mg/kg p.o., kidney cyclooxygenase activity recovers completely. This transient inhibition of renal cyclooxygenase is not reflected by urinary excretion of 6-keto-PGF1 alpha and PGE2 (6- and 24-hr collection periods). In conclusion our present results indicate that doses of ASA enough to inhibit platelet TxA2, transiently inhibit glomerular and medullary PGI2 and PGE2. Although the inhibitory effect on platelets is long lasting, the effect on renal cyclooxygenase is transient and rapidly reversible.(ABSTRACT TRUNCATED AT 250 WORDS)

6-Ketoprostaglandin F1 alpha↗
PubMed1989

Bleeding disorders in uremia: pathophysiology and treatment.

Renal insufficiency is associated with a bleeding tendency. Hemorrhagic manifestations are usually mild (i.e., ecchymoses or purpura) but can be severe in occasional patients who may have gastrointestinal tract or intracranial bleeding. Modern techniques for the management of uremia have definitely reduced the incidence of severe bleeding episodes in patients with renal failure, but hemorrhages still represent a major clinical problem, particularly for patients undergoing surgery or invasive procedures. Although the pathogenesis of uremic bleeding has not been completely elucidated, in the past 10 years a number of studies have contributed substantially to our knowledge of the cause of uremic bleeding tendency and have indicated new therapeutic strategies. The present review will focus mainly on modern concepts of the cause of uremic bleeding and will critically analyze the various therapeutic approaches.

Aspirin↗
PubMed1989

Selective inhibition of platelet thromboxane generation with low-dose aspirin does not protect rats with reduced renal mass from the development of progressive disease.

Rats with extensive renal mass reduction develop hypertension, proteinuria and progressive glomerulosclerosis. Previous studies have demonstrated that these changes are associated with an increased urinary excretion of thromboxane compared with normal rats and that the administration of a thromboxane synthetase inhibitor prevents glomerulosclerosis and progressive renal function deterioration. On this basis it has been speculated that the thromboxane synthetase inhibitor, by inhibiting platelet thromboxane, reduces platelet aggregation and prevents the generation of substances that can influence glomerular functional properties. Because the thromboxane synthetase inhibitor also inhibits thromboxane synthesis by resident glomerular cells and lowers blood pressure in these animals, the question of whether platelet thromboxane is indeed the factor implicated in the development of renal disease after renal ablation remains unanswered. To address this issue the authors administered at different time intervals from the surgical procedure a low-dose of oral aspirin (ASA) to rats with remnant kidney. This approach resulted in selective inhibition of platelet cyclooxygenase leading to an almost complete prevention of platelet thromboxane generation. Low-dose ASA spared renal cyclooxygenase as documented by a lack of significant inhibition of glomerular and urinary 6-keto-PGF1 alpha and did not lower blood pressure. Renal function studies showed that low-dose ASA, despite inhibiting platelet aggregation, had no effect on proteinuria and progressive renal insufficiency irrespectively if administered late (ie, 80 days after surgery) and given daily for all the observation period (ie, 20 days) or earlier in the course of the disease (ie, 40 and 10 days after surgery). Histologic data showed that the degree of glomerulosclerosis and tubulo-interstitial damage was not significantly different in rats with reduction of renal mass alone compared with rats with remnant kidney given low-dose ASA. In conclusion, the present findings indicate that inhibition of platelet aggregation and thromboxane formation does not prevent the progressive glomerulosclerosis that develops in rats with surgical reduction of renal mass. It is suggested that the beneficial results obtained previously in the same model by the use of a thromboxane synthesis inhibitor must be attributed either to an effect on resident glomerular cell thromboxane synthesis or to lowering systemic blood pressure.

Animals↗
PubMed1989

Renal handling of aspirin in the rat.

Aspirin (ASA), in addition to blocking platelet cyclooxygenase, thus preventing thromboxane A2 formation, can also block renal cyclooxygenase thus inhibiting the renal synthesis of vasodilatory prostaglandins (PGs) which can induce renal function deterioration. The purpose of the present study was to clarify the pharmacological basis of the inhibitory effect of ASA on renal cell cyclooxygenase in the rat. ASA was given to rats either i.v. or p.o. at doses ranging from 10 to 200 mg/kg. After both i.v. and p.o. administration ASA was rapidly detected in plasma as intact molecule. The kinetics were of a dose-dependent type with a disproportionate increase in plasma level increasing the dose. Plasma salicylic acid (SA) concentrations peaked after ASA with a precursor product relationship. ASA levels in kidney homogenates were also determined after i.v. and p.o. ASA. Whereas after i.v. administration ASA was detected in the kidney as intact molecule, no ASA was detected in the kidney after p.o. administration. SA was measurable in the kidney after both i.v. and p.o. ASA with a time course which paralleled the plasma concentrations. Results of isolated kidneys perfused with a medium containing ASA and of kidney homogenates exposed to ASA "in vitro" indicate that ASA is rapidly converted to SA by kidney tissue enzymes. After ASA hydrolysis SA accumulates in the kidney and may protect renal cyclooxygenase from the inhibitor effect of ASA.

Animals↗