Treating hyponatremia: damned if we do and damned if we don't.
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Adult↗
Biomedical subjects
T Berl
Publications and source records attributed to T Berl.
Effects of prostacyclin on the cAMP system in cultured rat inner medullary collecting duct cells.
Rat inner medullary collecting tubule (RIMCT) cells produce arachidonate derivatives including prostacyclin (PGI2). In RIMCT cells, PGI2 causes a dose-dependent increase in adenosine 3',5'-cyclic monophosphate (cAMP; fmol/micrograms protein) from a basal level of 15.6 +/- 1.7 to 32.4 +/- 5.7 at 0.3 microM, 63.3 +/- 8.3 at 3 microM, and 103.5 +/- 9.4 at 30 microM PGI2. At concentrations of arginine vasopressin (AVP) from 10(-7) to 10(-9) M, cAMP was greater in the presence than absence of 3 microM PGI2, suggesting independent sites of action. To assess whether the PGI2 effect is mediated by the prostaglandin E2 (PGE2) receptor, desensitization studies were performed. A 6-h preincubation with 10 microM PGE2 blunted the response to 3 microM PGE2 by 90 +/- 2% but the PGI2 response was decreased by only 31 +/- 5%, P less than 0.001. Carbaprostacyclin (carba-PGI2), a stable analogue of PGI2, blunted the cAMP response to PGI2 by 94 +/- 3% but to PGE2 by only 46 +/- 7%, P less than 0.005. The postreceptor effect of PGI2 on components of the adenylate cyclase was examined. The response to forskolin was markedly potentiated by PGI2. PGI2 (3 microM) caused an increase in cAMP of 67 fmol/micrograms over basal in the absence of forskolin, of 164 fmol/micrograms at 10(-7) M forskolin, of 386 fmol/micrograms at 10(-6) M forskolin, and of 563 fmol/micrograms at 10(-5) M forskolin. The response of PGI2 was likewise potentiated by forskolin. Water permeability alone or in response to AVP in isolated perfused inner medullary collecting tubules was not affected by carba-PGI2.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Epidermal growth factor-stimulated phosphoinositide hydrolysis in cultured rat inner medullary collecting tubule cells. Regulation by G protein, calcium, and protein kinase C.
Epidermal growth factor (EGF) exhibits specific saturable binding to cultured rat inner medullary collecting tubule cells and stimulates inositol trisphosphate (IP3) production by these cells in a dose-dependent fashion. EGF-stimulated IP3 production is enhanced by GTP gamma s or AIF4- and is inhibited by GDP beta s or pertussis toxin. Alterations in extracellular Ca2+ have no effect on either basal or EGF-stimulated IP3 production. Similarly, treatment with EGTA which decreases cytosolic Ca2+ is without effect. In contrast, treatment with ionomycin which increases cytosolic Ca2+ has no effect on basal IP3 production but enhances the response to EGF. Activation of protein kinase C inhibits IP3 production in response to either EGF or AIF4-. These studies demonstrate the occurrence of EGF-stimulated phospholipase C activity in the rat inner medullary collecting duct. Stimulation by EGF is transduced by a pertussis toxin-sensitive G protein, unaffected by alterations in extracellular Ca2+, insensitive to a decrement in cytosolic Ca2+, enhanced by an increase in cytosolic Ca2+, and inhibited by protein kinase C.
Animals↗
Adrenergic control of cAMP generation in rat inner medullary collecting tubule cells.
The adrenergic nervous system profoundly alters water excretion by both renal and extrarenal pathways. The effects of catecholamines on cultured rat inner medullary collecting tubule cells were studied. The beta-adrenergic agonist, isoproterenol, increases cAMP from 19.5 +/- 2.3 to 79.4 +/- 14.4 fm/micrograms protein, P less than 0.001. The response to arginine vasopressin (AVP) is also greater in the presence of isoproterenol, but the increment is unchanged when compared to that seen in the absence of AVP. The agonist effect of isoproterenol is blocked by propranolol but not by the specific beta 1 antagonist, atenolol. The effect of alpha-adrenergic stimulation was studied by the use of norepinephrine (NE) in the background of the beta blocker, propranolol. NE decreases AVP-stimulated cAMP generation from 190 +/- 11 to 117 +/- 10 fm/micrograms, P less than 0.001, N = 6. The specific alpha 2 antagonist, yohimbine, but not the alpha 1 antagonist, prazosin, prevents the NE-induced decrease as AVP-stimulated cAMP is restored to 187 +/- 19 fm/micrograms. Similarly the selective alpha 2 agonist, clonidine, significantly inhibits both AVP- and isoproterenol-mediated cAMP generation. To define the site of alpha 2 inhibition in the adenylate cyclase (AC) complex the effect of pertussis toxin (PT) was investigated. After pretreatment with PT (1-1000 ng/ml), AVP-stimulated cAMP was not inhibited by NE. The alpha 1 agonist, phenylephrine, fails to inhibit AC or to increase cytosolic Ca in these cells.(ABSTRACT TRUNCATED AT 250 WORDS)
Adrenergic alpha-Agonists↗
Nicardipine and propranolol in the treatment of essential hypertension.
Two hundred thirty-four patients with supine diastolic blood pressure of between 95 and 114 mm Hg were enrolled into a double-blind, randomized, parallel, multicenter trial. The patients were randomized to either nicardipine 30 mg tid, propranolol 40 mg tid, or nicardipine 30 mg tid and propranolol 40 mg tid for six weeks. Two hundred six patients yielded data for analyses. Of the 28 not included, seven had missing data, whereas the remaining 21 were excluded because they either failed to meet inclusion criteria or were noncompliant at endpoint. Both nicardipine and propranolol as monotherapies and in combination achieved statistically significant, (P less than .01), supine diastolic blood pressure reduction relative to baseline. The combination of nicardipine and propranolol showed a greater reduction in supine diastolic and systolic measurements than either of the monotherapies. Nicardipine produced greater blood pressure reductions one hour after dosing, whereas the propranolol treatment tended to produce slightly greater blood pressure decreases eight hours after dose. The combination always resulted in the greatest blood pressure reduction, independent of time after dose. Adverse experiences were reported by 26% of patients in the nicardipine-treated group, most often transient vasodilatory effects, by 17% of the propranolol-treated patients, and by 18% of the combination-treated group. This study demonstrated at the doses studied that nicardipine alone produced equivalent blood pressure reductions to those obtained by propranolol alone, but that the combination of these two drugs produced greater reductions in blood pressures than either of the monotherapies.
Adult↗
Psychosis and water balance.
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Body Water↗
The cAMP system in vasopressin-sensitive nephron segments of the vitamin D-treated rat.
The present study was undertaken to investigate the cAMP system in isolated vasopressin (AVP)-sensitive segments of the hypercalcemic rat. Hypercalcemia was produced by supplementation of diet with dihydrotachysterol, achieving a mean serum calcium of 12.6 mg%. Maximal urinary concentration was only 1982 +/- 119 mOsm/kg H2O in pair, watered hypercalcemic rats when compared to 2478 +/- 93 mOsm/kg H2O in controls (N = 7) (P less than 0.01). Vasopressin stimulated adenylate cyclase activity at concentrations of vasopressin between 10(-9) and 10(-7) M was indistinguishable in the outer medullary collecting duct (OMCD) and inner medullary collecting duct (IMCD) of tubules dissected from hypercalcemic rats or normocalcemic rats. Likewise, in situ cAMP accumulation in response to 10(-7) M AVP was not significantly different in either OMCD or IMCD of hypercalcemic or normocalcemic rats at either isotonic or hypertonic media conditions. In contrast, while 10(-7) M AVP significantly (P less than 0.05) increased cAMP accumulation in the medullary ascending limb (MAL) of normocalcemic rats it failed to do so in the MAL of hypercalcemic rats. This failure to accumulate cAMP appears to be due to impairment in AVP-stimulated adenylate cyclase rather than to enhanced phosphodiesterase activity. A similar decrement in glucagon stimulated adenylate cyclase occurred with 10(-6) M glucagon. The results demonstrate that in chronic hypercalcemia the cAMP system in the OMCT and IMCD of the rat is intact, but the MAL demonstrates abnormal AVP responsiveness due to impaired adenylate cyclase.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Vasopressin and the concentrating mechanism.
The role of vasopressin in the kidney has classically been considered to result from its ability to increase water permeability in the collecting duct. Recent data, however, suggest that the hormone may also promote urinary concentration by increasing interstitial tonicity. The mechanisms whereby vasopressin could enhance interstitial tonicity include increasing urea permeability in the inner medullary collecting tubule, stimulation of solute reabsorption in the thick ascending limb of the loop of Henle, increasing the glomerular filtration rate of juxtamedullary nephrons, and decreasing vasa recta blood flow. We review experiments directed at assessing the role of vasopressin in these four processes. The multitude of effects of vasopressin appears to be well integrated and contributes to the tightly regulated urinary concentration mechanisms.
Animals↗
Reduced osmotic and nonosmotic release of vasopressin after meclofenamate in the conscious dog.
Both in vivo as well as in vitro experiments suggest that prostaglandins (PG) may influence arginine vasopressin (AVP) release. Recent studies on conscious dogs have shown that cyclooxygenase inhibition with meclofenamate reduces basal AVP release as well as AVP release in response to hypoxia. The current experiments were performed in order to test whether PG synthesis inhibition affects osmotic- and nonosmotic-stimulated AVP release in a similar manner. Osmotic AVP release was tested by slowly infusing hypertonic saline intravenously in water-diuresing dogs and serially sampling plasma for AVP concentration. Experiments were performed both with and without meclofenamate (2 mg/kg and 2 mg X kg-1 X h-1 iv) pretreatment. AVP release to a comparable osmotic stimulus was greatly reduced after meclofenamate administration. Nonosmotic AVP release was tested by inducing systemic hypotension with an intravenous infusion of nitroprusside. Hypotension was associated with an increase in AVP concentration, which was partially blunted after meclofenamate administration. Experiments performed with only a saline vehicle administered showed no decrease in AVP release in response to comparable hypotension. The findings of these studies suggest that endogenous PG may be involved in both osmotic and nonosmotic AVP release in the conscious dog.
Animals↗
Effect of cAMP on prostaglandin E2 production in cultured rat inner medullary collecting tubule cells.
Studies were performed to determine whether cAMP impairs prostaglandin (PG) E2 production in a homogeneous population of cultured rat inner medullary collecting duct cells. Three structurally different cAMP analogues were shown to decrease PGE2 synthesis by 48.4% in the basal state and by 49.3% in response to the divalent cation ionophore A23187 (5 microM). Thromboxane B2 production was similarly suppressed. An increase in endogenous cAMP by forskolin also decreased PGE2 synthesis. To determine the locus of the cAMP effect we examined the response to exogenously added arachidonic acid. At a concentration of arachidonic acid (5 micrograms/ml) sufficient to render the phospholipase-dependent fraction negligible (as evidenced by the lack of a mepacrine effect), cAMP had no effect on PGE2 production, suggesting phospholipase as the site of cAMP action. Further evidence for a phospholipase-mediated mechanism derives from studies employing [5,6,8,9,11,12,14,15-3H(N)]arachidonic acid in which cAMP analogues had no effect on the rate of cellular arachidonic acid incorporation, but did impair the release of tritiated arachidonic acid in response to ionophore. These results suggest the existence of a negative feedback system that, by impairing phospholipase activity and PGE2 synthesis, could enhance the action of cAMP in the antidiuretic state.
8-Bromo Cyclic Adenosine Monophosphate↗
Effects of calcium on vasopressin-mediated cyclic adenosine monophosphate formation in cultured rat inner medullary collecting tubule cells. Evidence for the role of intracellular calcium.
We explored the effects of alterations in extracellular and intracellular calcium concentration on arginine vasopressin (AVP)-stimulated cAMP formation in cultured rat inner medullary collecting tubule cells. cAMP formation remains constant at extracellular calcium concentrations between 0.5 and 4.0 mM, which did not change intracellular calcium. Maneuvers that alter intracellular calcium concentration are associated with marked changes in cAMP generation. EGTA decreases intracellular calcium and enhances AVP-stimulated cAMP formation, while increasing cellular calcium with 2 microM A23187 decreases AVP-stimulated cAMP formation in the presence, but not in the absence, of extracellular calcium. The changes in cAMP formation observed when intracellular calcium is altered are associated with reciprocal changes in prostaglandin E2 (PGE2) synthesis. Despite greater than 95% inhibition of PGE2 synthesis with 5 microM meclofenamic acid, the changes in cAMP formation accompanying alterations in intracellular calcium concentration are still evident. These studies suggest that intracellular calcium critically influences AVP-stimulated cAMP formation. It does so by a mechanism independent of PG that is probably mediated by a direct effect of the cation on the adenylate cyclase complex.
Adenosine Triphosphate↗
Syndrome of inappropriate antidiuresis in the absence of arginine vasopressin.
The syndrome of inappropriate antidiuresis (SIAD) is usually associated with inappropriately elevated plasma arginine vasopressin (AVP) concentrations. We describe herein a patient with a macroprolactinoma who had symptomatic hyponatremia due to SIAD. Although the patient had excessive thirst, severe plasma hypoosmolality, and hyperosmolar urine, no immunoassayable AVP could be detected. During long term treatment with bromocriptine, there was gradual shrinkage of the prolactinoma coincident with improvement in the ability to excrete a water load and normalization of the thirst threshold. At this point, plasma immunoactive AVP was measurable during a hypertonic saline infusion for the first time. By high pressure liquid chromatographic analysis, this immunoactive substance coeluted with AVP. These studies suggest that the SIAD in this patient was due to the production of an antidiuretic substance distinct from AVP in association with his prolactinoma.
Adult↗
Control of prostaglandin E2 synthesis in cultured rat inner medullary collecting tubule cells: the role of calcium.
We investigated the role of calcium in basal, ionophore- and hormone-stimulated prostaglandin E2 (PGE2) production by rat inner medullary collecting tubule cells. Basal PGE2 production is significantly decreased in the absence of calcium (4.49 +/- 0.79 vs. 19.99 +/- 3.47 pg/micrograms protein/h, p less than 0.001). No further increment is seen at 4 mM calcium. The ability of the calcium ionophore A23187 to stimulate PG production is proportional to the amount of calcium present in the extracellular space. Bradykinin is a potent stimulus to PG production even in the virtual absence of calcium while arginine vasopressin has only a modest effect. Neither bradykinin nor arginine vasopressin exhibit any further PG stimulation at 1 mM calcium; both bradykinin and arginine vasopressin increase PGE2 production significantly when calcium is increased to a supraphysiologic level. The data suggests an important role for intracellular rather than extracellular calcium in the control of PG production. Bradykinin but not vasopressin display significant calcium-independent stimulatory effects on PG synthesis.
Animals↗
Renal toxicity in uranium mill workers.
Although the kidney is the critical organ limiting occupational exposure to soluble uranium compounds, there have been no adequate studies evaluating renal tubular dysfunction in chronically exposed workers. The present investigation evaluated kidney function among 39 uranium mill workers and 36 local cement plant workers of equivalent age, sex, and race. The uranium workers showed a significantly higher excretion of beta-2-microglobulin and five amino acids than the reference group. Although the levels of tubular proteinuria were mild, a dose-effect relation existed between the clearance of beta-2-microglobulin, relative to that of creatinine, and the length of time that the uranium workers had spent in the yellowcake drying and packaging area, the work area with the highest exposures to soluble uranium. Age did not account for this relationship. Glomerular function was significantly better among the uranium workers than among the referents, though this may have been the result of differences in the physical activity of the groups during the collection period. The data presented suggest reduced renal proximal tubular reabsorbtion of amino acids and of low molecular weight proteins, consistent with uranium nephrotoxicity.
Adult↗
Potassium-aldosterone response in dogs with chronic renal insufficiency.
To evaluate the potassium-aldosterone axis in chronic renal insufficiency, the plasma concentration of aldosterone was measured before and after a 50-mEq potassium challenge in dogs with intact kidneys (glomerular filtration rate 52 +/- 3.1 ml/min) and in dogs with one remnant kidney (glomerular filtration rate 16.1 +/- 2.1 ml/min). Fasting concentrations of circulating potassium and aldosterone and urinary potassium excretion rates were similar in both groups. In the 5 h following potassium chloride administration, less of the potassium load was excreted by dogs with one remnant kidney (30.2 +/- 3.3%) than by normal dogs (55.6 +/- 7.3%; p less than 0.01); serum potassium rose significantly more in dogs with chronic renal insufficiency than in normal animals. After potassium chloride, plasma aldosterone increased in both groups, but the increments in dogs with one remnant kidney were twice the increases in normal dogs (p less than 0.01). The increases in plasma aldosterone per unit increment in serum potassium, however, were similar in both groups (14.5 vs. 13.8 ng X dl-1/mEq X l-1). Thus, the hyperkalemia that follows a potassium load in dogs with chronic renal insufficiency is not due to a failure to secrete aldosterone but to a decrease in potassium excretion in the setting of decreased renal mass.
Aldosterone↗
The cyclic AMP system in the inner medullary collecting duct of the potassium-depleted rat.
The present study was undertaken to investigate the cyclic AMP system in the isolated inner medullary collecting tubule (IMCT) of hypokalemic (HK) rats. In situ incubation of IMCT with 10(-7) M arginine vasopressin (AVP) at 300 mOsm/kg H2O in control normokalemic rats increased cyclic AMP content (fmoles/mm) from 5.68 +/- 1.41 to 30.3 +/- 5.31 (P less than 0.001). In HK rats the increase in cyclic AMP was blunted from 7.18 +/- 2.0 to 14.78 +/- 3.14 fmoles/mm (P less than 0.05 compared to controls). No such blunting was observed in the outer medullary collecting duct of hypokalemic rats, but was seen in the IMCT when studied at 800 (P less than 0.05), 1200 (P less than 0.01), and 2000 mOsm/kg H2O (P less than 0.05). The increase in cyclic AMP was also blunted in IMCT of HK rats not allowed to become polyuric or polydipsic by pair-watering studied at 300, 800, and 1200 mOsm/kg H2O. To define the process responsible for the failure to normally increase cyclic AMP in HK, adenylate cyclase activity (AC) was determined at 800 mOsm/kg H2O. While basal AC was not different, the response to all concentrations of AVP between 10(-10) and 10(-6) M was markedly depressed in tubules from HK rats. In contrast AC response to 10(-2) M NaF was not different in IMCT of normokalemic and HK rats. While the abnormal cyclic AMP content with AVP could be explained by abnormal generation, a contribution of increased metabolism was also sought.(ABSTRACT TRUNCATED AT 250 WORDS)
3',5'-Cyclic-AMP Phosphodiesterases↗
Mechanism of concentrating defect in hypercalcemia. Role of polydipsia and prostaglandins.
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Animals↗
Mechanism of cold diuresis in the rat.
The effect of cold exposure (CE) on renal water excretion has not been clearly delineated. Conscious rats were exposed to decreased ambient temperature (15 degrees C). Forty-five minutes of CE resulted in reversible increases in urine flow and decreases in urine osmolality. The diuresis was not due to a diminished response to vasopressin (VP), as the antidiuresis associated with 500 microU of Pitressin given to water-diuresing rats was comparable at 15 and 30 degrees C. To determine whether the diuresis was due to intrarenal factors, glomerular filtration rate, renal blood flow, sodium excretion, and osmolar clearances were measured and found to be equivalent during control and cold conditions. To determine whether the observed diuresis was due to suppression of endogenous VP, VP-free Brattleboro rats undergoing a constant VP infusion were cold exposed. In these rats, CE was not associated with a change in either urine flow or urinary osmolality. This antidiuretic hormone-mediated mechanism was corroborated by a decrease in immunoassayable VP levels. To determine the mechanism whereby CE suppresses endogenous VP, plasma osmolality and hemodynamic parameters were measured. Although CE was not associated with a change in plasma osmolality, it did result in a significant increase in both mean arterial pressure and cardiac index. Pretreatment of rats with 6-hydroxydopamine prevented both the increase in mean arterial pressure and cold diuresis. We conclude that the diuresis observed upon exposure to 15 degrees C results from nonosmotic suppression of endogenous VP, as a consequence of the increase in mean arterial pressure.
Animals↗