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PubMed1992

Atrial natriuretic peptide may not play a role in diuresis and natriuresis after cardiac operations.

Human atria through release of atrial natriuretic peptide play an important role in extracellular fluid homeostasis. This study investigates the perioperative role of atrial natriuretic peptide, renin, angiotensin, aldosterone, and vasopressin in patient response to cardiopulmonary bypass after coronary artery bypass operations. Serum levels of these hormones were measured, along with hemodynamic profiles, urine output, and urine electrolytes, before induction of anesthesia, after discontinuation of cardiopulmonary bypass, 1 hour postoperatively, and 3 hours postoperatively. Serum levels of atrial natriuretic peptide were found to be significantly elevated immediately after discontinuation of cardiopulmonary bypass. These elevations did not correspond temporally to elevated central venous pressure or tachycardia. Significant natriuresis and diuresis were observed during the first postoperative hour. This diuresis failed to correspond temporally with alterations noted in serum levels of atrial natriuretic peptide, renin, angiotensin, aldosterone, and vasopressin. The mechanism responsible for the increases in serum atrial natriuretic peptide and the postoperative natriuresis and diuresis after cardiopulmonary bypass remain unknown.

Aged↗
PubMed2005

Diuresis renal scintigraphy "F-0" in diagnosing of upper urinary tract obstruction in children: the clinical significance.

BACKGROUND: The aim of this study was to assess the clinical relevance of diuresis renal scintigraphy after simultaneously administered radiopharmaceutical and diuretic (DRS "F-0") in diagnosing obstruction of upper urinary tract in children with previously documented hydronephrosis and ureterohydronephrosis, analyzing the value of qualitative and quantitative scintigraphy parameters. MATERIAL AND METHODS: This retrospective study enrolled 82 children (30 girls and 52 boys aged between 2 months and 16 years; mean 5.8 +/- 4.5 years) with previously documented hydronephrosis or ureterohydronephrosis (42 left-sided, 28 right-sided and 12 bilateral). DRS "F-0" was started after intravenous administration of diethylene-triamine- pentaacetic acid (DTPA) mixed with furosemide. Results of DRS "F-0" were analyzed qualitatively (visual analysis of scintigrams and renography curves) and quantitatively (time to reach maximum of the kidney curve-T max, washout of the tracer-WO, the furosemide clearance half-time (F/2) and individual kidney function - IKF) and compared with the final diagnoses obtained in 37 children (42 nephroureteric units - NU) after surgery, in 41 children (48 NU) during the medical follow-up lasting at least 6 months, and in 4 children (4 NU) using invasive diagnostic procedures. Diagnostic criteria for obstructed NU (kidney with corresponding ureter) considered presence of pathological at least two of five scintigraphy variables characterized as a sign of obstruction. RESULTS: Forty true positive and 37 true negative results were detected using diagnostic criteria for obstructed and normal NU by means of DRS "F-0". DRS "F-0" failed to detect obstruction in 5 children with a total of 6 obstructed NU, while the results were marked as false positive in 9 children (11 NU). Qualitative scintigraphy analysis was found to be the most sensitive (91%) and accurate predictor (85%) in differentiating obstruction from non-obstructive renal unit. High sensitivity in predicting obstruction was also found for both washout of the radiopharmaceutical (87%) and for furosemide clearance half time (85%). Overall sensitivity of DRS "F-0" using proposed diagnostic criteria in differentiating obstruction was 87%, specificity 77% and accuracy 82%. However, DRS "F-0" has been shown to be more sensitive (90%) in children with UPJ and UVJ obstruction concerning children in whom obstruction was caused by other urinary tract diseases. CONCLUSION: This study showed DRS "F-0" as a sensitive and reliable method in diagnosing children with obstructions of the upper urinary tract. The great advantage of the protocol DRS "F-0" over other diuresis renography protocol modalities is due to the shorter time of the acquisition by half, and the avoidance of additional diuretic application. However, conventional quantitation of diuresis renogram did not improve the sensitivity and specificity with respect to the qualitative analysis of scintigrams and renography curves.

Adolescent↗
PubMed1991

Reduction of nocturnal diuresis and natriuresis during treatment of obstructive sleep apnea (OSA) with nasal continuous positive air pressure (nCPAP) correlates to cGMP excretion.

In ten patients with severe obstructive sleep apnea (OSA) profound changes in renal function could be demonstrated at night during nCPAP therapy. Natriuresis and diuresis decreased by about 50% while creatinine excretion rate and urinary osmolality did not change. We found parallel changes in the excretion of ANP's second messenger cyclic guanosine monophosphate (cGMP) in a dose-response-related manner to natriuresis respectively diuresis. These data are in agreement with recently demonstrated decrease of nocturnal plasma levels of atrial natriuretic peptide (ANP) during nCPAP therapy in apneic patients. This may be an indicator for an increased cardiac volume load during obstructive apnea. The decrease of diuresis, natriuresis and cGMP excretion demonstrate the beneficial effects of nCPAP treatment on the cardiovascular system. Therefore measurements of cGMP excretion may be a useful parameter to assess the cardiovascular function of apneic patients before and during treatment.

Adult↗
PubMed1990

[Maltose-dextran--a new combination solution for the induction of diuresis in man].

40 healthy men received an infusion solution of low molecular dextran with either 0%, 5%, 10% or 20% Maltose over a 60 min period. The combination of LMWD with 10% maltose solution showed a significant increase of urine excretion from 132 ml/h to 315 ml/h at the end of the infusion. The overall excretion rate in 3 h was 683 ml, 185 ml more than infused. The increase in urine excretion from 53.0 ml/h to 173.5 ml/h after the application of 5% maltose/dextran 40 solution was only due to a water diuresis. The maltose concentration was not high enough to induce a visible osmotic diuresis. The application of 20% maltose/dextran 40 solution showed a clear osmotic effect. Nevertheless, there was no significant increase in the urinary excretion rate compared to the LMWD solution without any maltose. The high oncotic and osmotic pressure of this combination activated mechanisms, which were opposed to the induced osmotic diuresis.

Adolescent↗
PubMed1992

Influence of ureteral status on kidney washout during technetium-99m-DTPA diuresis renography in children.

To assess the influence of the ureter on renal washout during 99mTc-DTPA diuresis renography, ureteral images were reviewed in 42 children (median age: 5 mo) referred for hydronephrosis. Sixty-minute acquisitions were obtained in hydrated patients under bladder drainage. Furosemide was injected at 30 min. An abnormal ureter was defined as an intense and continuous image of greater than 10 min. A washout index was determined on renal (KT1/2) and ureteral (UT1/2) curves. Curve patterns corresponding to normal (type I), obstructive (II) and nonobstructive (III) cases were described. Compared with the x-ray data, diuresis renography was highly sensitive (91%) and specific (98%) for detecting any abnormality. Despite an obstructive KT1/2 (greater than 20 min), no patient with an abnormal ureter underwent therapy at the ureteropelvic junction. After surgery at the lower level, hydronephrosis regressed. Our data indicate that abnormal ureter findings at diuresis renography have to be recognized before planning therapy for children with hydronephrosis.

Adolescent↗
PubMed1991

[Role of brain cholinergic system on diuresis and natriuresis induced by volume expansion in rats].

The role of brain cholinergic system on diuresis and natriuresis induced by volume expansion was studied in conscious rats. In a series of experiments, the diuretic, natriuretic and kaliuretic responses induced by volume expansion were compared in three groups of conscious rats pretreated respectively with intracerebroventricular (icv) injection of artificial cerebrospinal fluid (ACSF), atropine and hexamethonium. The natriuretic, kaliuretic and diuretic responses induced by volume expansion were much less in the animals with icv injection of atropine than in the control group with injection of ACSF (P less than 0.01). While the group pretreated with icv injection of hexamethonium showed no significant decrease in these responses of volume expansion than that of the control (P greater than 0.05). Volume expansion produced no change in insulin and PAH clearance in both the atropine and the ACSF group. Thus the atropine suppressed diuresis, natriuresis and kaliuresis are independent of changes in GFR and RPF. It is inferred from the results of the present investigation that volume expansion induced diuresis and natriuresis appear to be due to inhibition of water and sodium reabsorption in the renal tubules and regulated by certain brain cholinergic system.

Animals↗
PubMed1990

Coordinated response of renal medullary enzymes regulating net sorbitol production in diuresis and antidiuresis.

The renal response to changes in hydration includes variation in intracellular sorbitol, a major inner medullary osmolyte. To examine the mechanism for changes in net sorbitol production, we measured activities of enzymes regulating sorbitol production (aldose reductase) and degradation (sorbitol dehydrogenase) in untreated, water diuretic, and antidiuretic (water restriction and/or vasopressin administration) rats. Collecting duct segments dissected from collagenase-treated kidneys of Sprague-Dawley rats were divided into outer medullary and three distinct inner medullary regions. Aldose reductase activity increased during antidiuresis and decreased during diuresis. In contrast, sorbitol dehydrogenase activity was very low during antidiuresis and increased during diuresis. These changes in enzyme activity were found after 3 days, but not after 1 day, of water diuresis/antidiuresis. Enzyme activity changed only in the deepest 50% of the inner medullary collecting duct. Thus, there is coordinated regulation of aldose reductase and sorbitol dehydrogenase activities so that (a) during water diuresis, aldose reductase activity decreases while sorbitol dehydrogenase activity increases; and (b) during antidiuresis (water restriction and/or vasopressin administration), aldose reductase activity increases while sorbitol dehydrogenase activity remains low. We conclude that long-term osmoregulation in response to physiologic stimuli involves both aldose reductase and sorbitol dehydrogenase activities in rat terminal inner medullary collecting duct segments.

Aldehyde Reductase↗
PubMed1989

Plasma arginine vasopressin, diuresis, and neonatal respiratory distress syndrome.

The pathogenesis of the diuresis that precedes the recovery from respiratory distress syndrome (RDS) in preterm infants has not been clearly delineated. To define the role of Arginine Vasopressin (AVP) or Antidiuretic Hormone in the diuretic phase of RDS, we obtained plasma AVP levels (radioimmunoassay) and sequential time-urine-plasma collections during the first, the third and the fifth days of life in twelve premature ventilated newborns. AVP levels were persistently elevated (12.7 +/- 7.6; 9 +/- 4.7 and 10.4 +/- 6.6 pg/ml, respectively) despite normal plasma sodium and osmolality. Maximum diuresis (output/intake greater than 0.72) occurred at 72 hours and preceded the improvement in FiO2/PaO2, significant on 5th day (p less than 0.01), and associated with a 10.6% decrease in body weight. These results suggest a nonosmotic release of AVP in ventilated newborns, and show a hypervasopressinemia unrelated to the diuresis associated with the recovery phase of RDS.

Arginine Vasopressin↗
PubMed1988

Salicylic acid causes a diuresis and natriuresis in normal and common bile-duct-ligated cirrhotic miniature swine.

In patients with liver disease, or in normal subjects who are sodium-depleted, the administration of either a nonsteroidal anti-inflammatory drug or acetylsalicylate (aspirin) has a detrimental effect on the kidney; profound renal vasoconstriction and the retention of sodium and water may occur. We observed recently that salicylate (SA), in contrast to meclofenamate (MECLO) or aspirin, caused a diuresis and natriuresis in the sodium-depleted dog. To determine if SA would similarly affect the kidneys in a cirrhotic subject, the effects of SA (40 mg/kg) and subsequent MECLO treatment (2 mg/kg) were evaluated in five normal and six common bile-duct-ligated (CBDL) miniature swine. All six CBDL animals showed signs of biliary cirrhosis and four of the six were ascitic at the time of study. SA did not significantly alter renal blood flow or glomerular filtration rate in either the normal or CBDL animals. In both groups, SA caused a significant diuresis and natriuresis. MECLO, given after SA, caused a reduction in renal blood flow in the normal but not in the CBDL animals, but did not alter glomerular filtration rate in either group. In the CBDL animals, when MECLO was given alone a significant decrease in renal blood flow occurred. MECLO abolished the SA-induced diuresis and natriuresis in the normal swine but only affected the SA-mediated natriuresis in the CBDL animals. SA significantly reduced renal prostaglandin E2 excretion in both groups. With MECLO, prostaglandin E2 excretion was reduced further in the normals but not in the CBDL animals. These data demonstrate that SA does not produce detectable renal vasoconstriction in the cirrhotic pig.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

[Restoration of diuresis in the initial period of the oligoanuric stage of acute renal failure by dopamine-furosemide infusion].

Dopamine-furosemide infusion was used in 31 patients with acute renal insufficiency (ARI) of various etiology in the initial period of the oligoanuric stage. The circulating blood volume was recovered in all the patients by infusion therapy and diuresis stimulation with mannitol and furanthril. The failure of these therapeutic measures was indicative of the presence of the oligoanuric stage of ARI. Dopamine was administered by intravenous drop infusion at a dose of 1-4 microgram/kg/min for 3-4 h followed by intravenous injection of 200 mg of furanthril. Dopamine infusion lasted for 4 more hours (even longer, if necessary), and furanthil during the 1st day was administered at a dose of 200 g every 6 h. The recovery of diuresis and renal function was observed in 13 patients (41.93%), diuresis was recovered but renal insufficiency remained (ARI oligoanuric type was transformed into polyuric type) in 14 patients (45.16%), no effect was noted in 4 patients (12.9%).

Acute Kidney Injury↗
PubMed1988

Evaluation of a short-term saline diuresis protocol for the administration of cisplatin.

A study was undertaken to determine the toxic effects of cisplatin, an antineoplastic agent, on canine kidneys and bone marrow when administered during a 6-hour saline diuresis. Cisplatin (70 mg/m2 of body surface) was administered IV to 6 healthy dogs over a 20-minute period after 0.9% NaCl solution (saline) was administered IV for 4 hours at a rate of 18.3 ml/kg/hr. After cisplatin injection, saline diuresis was continued at the same rate for 2 hours. Each dog vomited within 8 hours after the drug was administered. Clinical status, weight gain, and food consumption were normal throughout the 27-day study. All measures of renal function remained unchanged and were within normal limits for 27 days after the drug was administered. Nadirs in the daily neutrophil count were observed on days 6 (3,240 +/- 404/microliters) and 15 (1,196 +/- 275/microliters). There were no important gross or histologic abnormalities referable to cisplatin administration when the dogs were necropsied at the conclusion of the study (day 27). We concluded that cisplatin can be administered safely at a dosage of 70 mg/m2 of body surface, using a short-term diuresis protocol, and that the drug induces a nadir in the neutrophil count on days 6 and 15.

Animals↗
PubMed1986

Regulation of arterial pressure: role of pressure natriuresis and diuresis.

The importance of the renal pressure natriuresis and diuresis mechanisms in long-term control of body fluid volumes and arterial pressure has been controversial and difficult to quantitate experimentally. Recent studies, however, have demonstrated that in several forms of chronic hypertension caused by aldosterone, angiotensin II (AngII), vasopressin, or norepinephrine and adrenocorticotropin, increased renal arterial pressure is essential for maintaining normal excretion of sodium and water in the face of reduced renal excretory capability. When renal arterial pressure was servo-controlled in these models of hypertension, sodium and water retention continued unabated, causing ascites, pulmonary edema, or even complete circulatory collapse within a few days. Apparently, other mechanisms for volume homeostasis, such as the various natriuretic and diuretic factors that have been postulated, are not sufficiently powerful to maintain fluid balance in the absence of increased renal arterial pressure when renal excretory function is reduced in these forms of hypertension. The intrarenal mechanisms responsible for pressure natriuresis and diuresis are not entirely clear, but they seem to involve small increases in glomerular filtration rate and filtered load as well as reductions in fractional reabsorption in proximal and distal tubules. During chronic disturbances of arterial pressure additional factors, especially changes in AngII and aldosterone formation, act to amplify the effectiveness of the basic renal pressure natriuresis and diuresis mechanisms in regulating arterial pressure and body fluid volumes.

Aldosterone↗
PubMed1983

Interrelation between renal kallikrein and diuresis in rats.

In rats diuresis was produced by 1. furosemide (5 mg/kg/s.c.), 2. triamterene (50 mg/kg/p.o.), 3. mannitol (250 microliters, 30%) and 4. change (+ 35 mm Hg) in perfusion pressure in the isolated perfused rat kidney. In all experiments a prolonged increase in diuresis and natriuresis was effected. Urinary potassium excretion was markedly enhanced by furosemide and change in perfusion pressure, moderately increased by mannitol, and significantly depressed by triamterene. Urinary kallikrein excretion, however, showed in all of the experiments a biphasic course with an initial increase and secondary decrease. The increase of kallikrein excretion was observed only in the periods when urine flow started to increase. Thus, no correlation was found between kallikrein excretion and either urine volume or urinary sodium excretion. Kallikrein excretion correlated with potassium excretion in urine after furosemide, triamterene, and mannitol, however, it did not after increase in perfusion pressure. In renal cortical tissue kallikrein activity was reduced after all experiments, independently of the mechanisms, diuresis was induced.

Animals↗
PubMed1982

Hgcl2-induced acute renal failure in the rat. Effect of water diuresis, saline loading, and diuretic drugs.

A variety of pretreatment-treatment protocols were applied to rats with ARF induced by the subcutaneous injection of 6 mg of HgCl2 per kilogram body weight. Renin depletion induced by DOCA-saline pretreatment was associated with protection against HgCl2-induced ARF only when the saline diuresis was maintained by drinking 1% NaCl after injury. Twenty-four dehydration followed by free access to tap water annihilated the protective effect of DOCA-saline pretreatment despite maintained depletion of renal renin. Continuous intravenous loading with saline and furosemide, although increasing renal renin levels, afforded as much protection as saline loading alone. Ethacrynic acid, which did not increase salt excretion in our rats, as well as water diuresis, failed to be protective. A loose correlation was found between he amount of histological damage to the convoluted parts of the proximal tubules and the degree of renal functional impairment. Thus protection against HgCl2-induced ARF was independent of the renal renin level but closely related to urinary NaCl excretion after the injury. Saline diuresis could act by relieving or preventing tubular obstruction.

Acute Kidney Injury↗
PubMed1984

Hyperbaric diuresis at a thermoneutral 31 ATA He-O2 environment.

The basic pattern of body water exchange was studied in four Japanese male divers during exposure to a thermoneutral 31 ATA (He-O2) environment for 3 d (Seadragon V). The hyperbaric chamber temperature was raised from 25 degrees C +/- 0.5 degrees C at 1 ATA (air) predive to 31.5 degrees C +/- 0.3 degrees C at 31 ATA. Both rectal and mean skin temperatures were measured every hour (including during sleep) and were maintained at the same level at both pressures. The exposure to 31 ATA induced an increase in the daily urine flow and a corresponding reduction in the insensible (and evaporative) water loss without changing the total daily water output. However, the daily fluid intake decreased by 600 ml at 31 ATA, and hence the divers developed a state of negative fluid balance, as reflected by a reduction in body weight and an increase in hematocrit. All changes in the pattern of body water exchange observed at 31 ATA were gradually reversed during subsequent decompression. As observed in a previous dive to 31 ATA (Seadragon IV) in which there was a subtle cold stress (as indicated by the 1 degree C reduction in mean skin temperature at 31 ATA), the increase in daily urine flow at pressure was almost entirely due to the increase in overnight urine flow. However, the hyperbaric nocturia observed in the present dive was a water diuresis in nature whereas that in the previous dive was an osmotic diuresis. These results indicate that the hyperbaric diuresis at 31 ATA is due to an increase in overnight urine flow and that the hyperbaric nocturia is not in any way related to the subtle cold stress attendant in many hyperbaric environments.

Adult↗
PubMed1981

The mechanism of ascitic fluid protein concentration increase during diuresis in patients with chronic liver disease.

The mechanism of increase in the protein concentration of ascitic fluid during diuresis was investigated in 27 patients with chronic liver disease. The albumin concentration increased in ascites from .58 +/- .49 gm.% in the initial paracentesis to 1.48 +/- .69 gm.% in the final paracentesis (P less than .001) as the serum albumin concentration increased from 2.40 +/- .44 gm.% 2.94 +/- .56 gm.% (P less than .001). The serum to ascites albumin concentration gradient decreased significantly from 1.82 +/- .39 gm.%-1.46 +/- .45 gm.% (P less than .001). Despite this decrease, the serum to ascites albumin concentration gradient was relatively constant (decrease of .36 gm.% or 20% of initial value) compared to either the absolute or percentage change in ascites total protein concentration (increase of 1.48 gm.% or 107% of initial value). In four patients studied prospectively, the plasma volume did not change (3.53 +/- .80 1.-3.73 +/- .59 1.) during diuresis, despite increase in total intravascular albumin (85.7 +/- 25.6 gm.-99.9 +/- 22.3 gm.; P less than .05) and decrease in total albumin in combined intravascular and peritoneal compartments (156.0 +/- 30.1 gm.-143.4 +/- 35.3 gm.; P less than .05). Since neither concentration without decrease in plasma volume or synthesis of protein without increase in total compartmental protein appear to be the major mechanism of serum protein concentration increase, the increase in serum protein concentration was attributed to redistribution of protein from ascites to the intravascular compartment. The increase in ascitic fluid protein concentration during diuresis can be attributed to an increase in serum protein concentration in the presence of the relatively stable serum to ascites albumin concentration gradient.

Ascitic Fluid↗
PubMedDate not supplied

Adrenaline and noradrenaline effects on diuresis.

The experiments were carried out on male Wistar rats administering the tested catecholamines intraperitoneally. Water for diuresis induction and indomethacin solutions were introduced into the stomach through a tube. The hypophysis was destroyed totally with a needle inserted into an ear under stereotaxic controls. Lower adrenaline doses increased water diuresis, higher doses decreased it. Noradrenaline exerted only in antidiuretic effect. There was an analogy between the effects of these amines in diuresis and on adrenergic receptors. Hypophysectomy increased the antidiuretic action of adrenaline which could be due to absence of ACTH. Lower doses of indomethacin inhibited and higher doses enhanced the antidiuretic effect of amines. Intermediate doses were ineffective.

Animals↗
PubMed1978

The renal kallikrein-kinin system in various types of diuresis and under the effects of inhibitors of prostaglandin synthesis in rats.

In rats with water load, rats with high-salt diet, rats treated with furosemide, and rats treated with indomethacin in low doses (2 mg/kg orally per day for five consecutive days) an enhanced urinary excretion of kallikrein was observed. Higher dosage of indomethacin (5 mg/kg), on the contrary, markedly reduced the urinary kallikrein excretion. The degree of activation of the renal kallikrein-kinin system was lowest in water diuresis, and highest at the high-salt diet. In salt- and furosemide-induced diuresis, positive correlations were found between the urinary kallikrein excretion, sodium excretion, urine flow rate, and renal concentration capacity. In water diuresis, a positive correlation was found solely between the kallikrein excretion and the urine flow rate. Indomethacin at low dosages elevated, and at high dosages reduced the activity of the renal kallikrein-kinin system; analogous effects were exerted on the urine flow rate and on sodium excretion.

Animals↗