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PubMed1976

The influence of water diuresis on the course of experimental E. coli bacteriuria after unilateral nephrectomy in rats.

In rats of both sexes with experimental E. coli infection of the urinary bladder, we evaluated by quantitative bacteriology urinary and kidney tissue infection during low diuresis, during hydropenia, and during water diuresis. Particular attention was given to the question of whether the hypertrophying kidney following contralateral nephrectomy has the same sensitivity to infection ascending from the bladder as a normal kidney. The results showed that water diuresis results in a long-term significant bacteriuria with penetration of microorganisms into the kidney. However, we did not find that infection of a solitary kidney following contralateral nephrectomy was of any greater degree than infection in the kidneys of rats with both kidneys intact.

Animals↗
PubMed1994

Effects of glucagon on diuresis, renal plasma flow and glomerular filtration in sheep.

The effects of intravenous infusion of glucagon (100 ng.kg-1.min-1) on diuresis, renal plasma flow and glomerular filtration rate were studied in conscious sheep. Diuresis began to decrease upon initiation of glucagon infusion, down to 50% of its baseline value at the end of glucagon infusion. Glomerular filtration rate was also decreased by 75%. With regard to renal plasma flow, the decrease started at the beginning of glucagon infusion, but remained restricted. It was not possible, from these results, to explain the reduced diuresis by a decrease in renal plasma flow; the observed anti-diuretic effect could be the consequence of a modification of either the filtration coefficient or water tubular reabsorption.

Animals↗
PubMed1996

Delayed onset of diuresis in a patient with acute renal failure due to hemorrhagic fever with renal syndrome who also developed anterior hypopituitarism.

A 23-year-old man developed acute renal failure (ARF) due to hemorrhagic fever with renal syndrome (HFRS). The patient also developed anterior hypopituitarism as a complication of HFRS. The patient's oliguric phase was very much prolonged for over 10 days before the diuresis began. The urine output during the oliguric phase was near anuric (< 50 ml/day). Interestingly, the patient began to diurese just after the institution of glucocorticoid and thyroid hormone replacement therapy. The plasma atrial natriuretic polypeptide went up to a smaller peak (150.0 pg/ml) at the onset of diuresis compared with 15 other patients (292.4 +/- 190.4 pg/ml) who did not develop anterior hypopituitarism. The delayed onset of diuresis and smaller increase of plasma ANP may have a causal relationship with the patient's hypopituitarism.

Acute Kidney Injury↗
PubMed1977

[Kidney kallikrein-kinin system in different mechanisms of diuresis].

Water and saline loading and Lasix administration lead to the intensification of the renal kallikrein-kinin system activity in rats. A positive correlation between the kallikrein excretion, urine volume and "osmotically free water" clearance was established in water and osmotic diuresis. There was the highest amount of kallikrein excreted by the kidneys during the "escape" phenomenon after saline loading. Kallikrein excretion correlated positively with sodium excretion in osmotic diuresis. The role played by the kallikrein-kinin system in control of diuresis, sodium excretion and concentrating capacity of the kidneys is discussed.

Animals↗
PubMed1998

Obstruction score of ureteropelvic junction investigated by modified F-15 diuresis renography.

AIM: Introduction and assessment of an obstruction score in patients with obstructive uropathy, based on a diuresis renography time-activity curve. METHODS: Twenty-eight adults with unilateral pelviureteric junction obstruction were assessed by ultrasound scan, furosemide-enhanced intravenous urography and modified (F-15) 99mTc-DTPA diuresis renography. Renal unit drainage pattern was assessed by the obstruction score (sum of the time to peak, the index of excretion, and the tracer washout 40 min after furosemide administration). Renal units were classified as normal (0-3), equivocal (4-7) or obstructed (8-10). Renal function was determined by a split renal function and individual kidney glomerular filtration rate. The whole kidney minimum transit time was assessed as an interval on time scale between tracer input and output curve. RESULTS: After a 28-month mean follow-up, ultrasound findings were improved in 23 and unchanged in 5 patients. Regarding the response to furosemide, intravenous urography showed improvement in 19, no change in 8, and deterioration in 1 patient. The upper urinary tract on the affected side was obstructed in 26 and equivocal in 2 patients. Postpyeloplasty outcome was normal in 12 and equivocal in 16 cases. Overall drainage function was improved in 27 and unchanged in 1 patient. Parenchymal function was improved in 20, unchanged in 2, and deteriorated in 6 patients. Whole kidney minimum transit time was significantly reduced (5.55 +/- 1.56 to 4.41 +/- 0.83 min; p<0.001). CONCLUSION: The F-15 diuresis renography supplemented with the obstruction score system may be used for assessing the upper urinary tract urodynamics as initial diagnosis and in long-term follow-ups.

Adolescent↗
PubMed1998

[The dobutamine-dopamine combination versus amrinone in congestive heart failure with a marked edematogenic sign complicated by functional kidney failure. A comparison between 2 different models of inotropic stimulation and diuresis potentiation].

BACKGROUND: We evaluated the diuretic output in patients with decompensated chronic heart failure (CHF), previously treated by i.v. infusion with dobutamine and dopamine (dob-dop) or with amrinone (amr). Our target was to identify the possible discrepancies in urinary output perhaps linked to the different type of inotropic stimulation in the two subsets. METHODS: Adjunctive therapy with dob-dop or amr was chosen because the administration of diuretics only, without cardiac support, as tested in previous hospitalizations, had been demonstrated to produce unfavourable results, mainly expressed by finding of a low output syndrome in 50% of cases or more. The administration of i.v. infusion was maintained during 17 hours (1000 min approximatively), and included infusion in separate pumps of the two amines, dobutamine at dose of 5 micrograms/kg/min and dopamine at dose of 2.8 micrograms/kg/min or, alternatively, i.v. infusion of amr, administered at dose of 7 micrograms/kg/min. Infusion volumes were similar in the two subsets. The two subsets were homogeneous relatively to renal impairment, i.e. to the parameters (urinary Na, U/P creatinine, U/P urea, urinary osmolality) we fixed as markers idoneous to demonstrate the occurrence of organic renal damage (acute tubular necrosis). RESULTS: The diuresis was recovered in all 24 patients, and the urine volume resulted more pronounced in the subset attributed to the dob-dop at both the 8th and the 17th hour readings. We found no harmful alterations in HR and AP, whereas renal function parameters have been shown to enhance in both the dob-dop and amr arms. The diuretic effectiveness of the SIEV obtained by catecholamine implementation exercised a synergistic, favourable effect on diuresis, renal flow, glomerular filtration rate, and sodium post-proximal delivery. Amr resulted less effective then dob-dop simultaneous administration relatively to the diuretic effect. No remarkable differences were found in the two subsets as regards the heart rate, whereas a decrease in arterial pressure was found after amr. A persistent shift towards a condition of chronic renal failure, was identified in 4/24 patients, the two groups despite of the prolonged treatment at optimized doses: no remarkable side effects were reported. CONCLUSIONS: Thus, the selective effect upon renal hemodynamics, as exercised by dob-dop infusion low doses of dop, together with the enhanced renal output due to dob, has been shown to be more effective than amr influence: thus, the catecholamine therapeutical approach has been demonstrated to possess the best effectiveness in excitation of diuresis, among the CHF oliguric patients.

Aged↗
PubMed1976

A histochemical and morphologic study of postobstructive diuresis in the rat.

Renal functional abnormalities constituting the syndrome of postobstructive diuresis imply both altered tubular and glomerular membrane properties. To determine the morphologic and ultrastructural correlates of this disorder a rat model was developed and 32 postobstructed kidneys were studied by light and electron microscopy at the midpoint of diuresis and compared to 22 controls. The abnormal morphology was: dilated distal tubules and collecting ducts, isolated proximal and distal tubule cells that allowed free access of luminal contents to the basement membrane, widened terminal bars and intercellular spaces, thickening of the glomerular basement membrane and, depending upon the portion of nephron, normal or reduced adenosine triphosphatase and acid phosphatase content. In order to confirm the functional nature of the nephrons studied as well as to assess glomerular and tubular permeability, horseradish peroxidase and cytochrome c were infused. These tracers, normally permeable to the glomerular basement membrane, were found in the intercellular spaces and to a lesser extent within cell organelles in the postobstructed diuretic animals whereas controls demonstrated a retarded filtration of horseradish peroxidase, no tracer in the intercellular spaces and large amounts of tracer contained within cell organelles. Absence of enzyme activity in the medulla and reduced dark to light cell ratios in the cortical collecting ducts correlated with prior observations made by others of diminished concentration and acidification processes, respectively. An increase in adenosine triphosphatase activity and renin granules within the juxtaglomerular cells indicated increased renin activity. These observations suggest that the renal functional abnormalities of postobstructive diuresis are attributable to altered glomerular and tubular permeabilities as well as with changes in metabolic activity.

Animals↗
PubMed1994

Regional changes in the extravasation of albumin in the canine kidney: comparison of bradykinin and water diuresis.

This report describes the adaptation of the albumin bound Evans blue dye (EB) extraction technique and its use in identifying regional changes in albumin extravasation rates. We present data to justify our technical approach and highlight the use of this method by describing differences resulting from two different models of induced diuresis and natriuresis. Results observed under control conditions (Group 1) are compared to those obtained following the infusion of bradykinin (BK) into the left kidney (Group 2) or hypotonic saline-induced water diuresis (Group 3). EB and water content of tissue samples of cortex (CTX), outer medulla (OM), inner medulla (IM), and papilla (PAP) regions are reported. Under control conditions a significant heterogeneous distribution of EB and water content (wet/dry tissue weight) between zones was observed. Left kidney EB values for the CTX, OM, IM, and PAP in Group 1 were 125 +/- 11, 398 +/- 56, 763 +/- 51, and 741 +/- 52 micrograms EB/g dry tissue and respective wet/dry tissue ratios were 4.48 +/- 0.05, 5.10 +/- 0.19, 7.13 +/- 0.37, and 6.35 +/- 0.32. In Group 2, BK caused a selective increase in cortex EB content to 201 +/- 7 (P < 0.01) micrograms EB/g dry tissue, without altering water content values. Results of EB extraction in Group 3 revealed no change in the CTX but significant increases in the OM, IM, and PAP regions: 576 +/- 40 (P < 0.01), 910 +/- 60 (P < 0.01), and 850 +/- 69 (P < 0.05) micrograms EB/g dry tissue, respectively. Likewise, tissue water content values were unchanged in the CTX but significantly greater in the OM, IM, and PAP: 6.02 +/- 0.22, 8.90 +/- 0.25, and 8.40 +/- 0.17, respectively (P < 0.01, all three values). This technique clearly shows the regional heterogeneity of the renal microvascular network and allows the localization of intrarenal changes in albumin extravasation. This method provides evidence that BK increases albumin extravasation in the cortex only and that changes in the renal medulla are obtained in hypotonic saline-induced water diuresis.

Albumins↗
PubMed1989

Dissociation between activation of the hypothalamo-hypophyseal antidiuretic system and the type of diuresis during acute intracranial hypertension. Experimental observation.

Acute cerebral compression by a supra- and infratentorial balloon produced a triphasic pattern of diuresis. The 1st phase was characterized by polyuria associated with five fold increase of plasma (p) antidiuretic hormone (ADH) concentration, decreased urine osmolality in spite of natriuresis and blood pressure elevation. The 2nd phase was characterized by oliguria, a decrease of pADH and reduced urine Na+ concentration, whereas urine osmolality transiently increased. At this stage there was respiratory arrest and fall of blood pressure. The final stage was diabetes insipidus (DI), when EEG activity had disappeared. An increase of serum osmolality mainly occurred during the last DI phase. Serum Na+ concentration fluctuated slightly during the whole period of diuresis. These results present evidence, that the diuresis pattern reflects the hypothalamo-hypophyseal antidiuretic system (HHAS) reaction to acute intracranial pressure (ICP) increase with the vegetative symptoms of cerebral shock.

Animals↗
PubMed1991

Radionuclide diuresis pyelography.

Radionuclide diuresis renography continues to be relied upon as a major diagnostic tool to differentiate obstructive and nonobstructive hydronephrosis. Controversy continues to exist with respect to methodology and interpretation of intermediate obstructive patterns. In this study radionuclide diuresis pyelography was performed in 11 renal units with hydronephrosis and a pre-existing percutaneous nephrostomy tube in place. The procedure consisted of the introduction per kidney of 20 muc./kg. 99mtechnetium-diethylenetriaminepentaacetic acid and sterile saline as a bolus into the renal pelvis via a percutaneous nephrostomy tube to produce a volume equal to the capacity of the hydronephrotic system. The kidney was monitored with a gamma camera and computer system. Furosemide (0.3 mg./kg.) was injected intravenously halfway into a 40-minute study. The time/activity curves thus generated were relatively independent of the cortical transport phase. The 2 types of curves were accelerated and constant. Analysis of these pyelogram curves revealed a strong correlation between the presence of an accelerated clearance rate response to furosemide and hydronephrosis without obstruction in 5 of 6 renal units. A constant clearance rate response to furosemide correlated with the presence of obstruction in 4 of 5 units. These observations may indicate that diuretic pyelogram curve dynamics may reflect not only the presence or absence of obstruction but also the ability of the hydronephrotic kidney to respond to the diuretic. More experience must be accumulated to determine the conditions under which diuresis pyelography may become useful clinically.

Child↗
PubMed1981

Changes in renal and urinary kallikrein activity by mannitol-induced osmotic diuresis.

1. Osmotic diuresis was induced in male Sprague-Dawley rats by a 30% (w/v) mannitol solution injected three times at 15-min intervals. Kallikrein excretion increased for a short period after the first two injections, but, despite marked diuresis, the increment of kallikrein excretion after the second injection was less marked than after the first and no enhanced kallikrein excretion was observed after the third injection of mannitol. 2. Urinary kallikrein excretion correlated only with urinary potassium excretion. No correlation was found with either urine volume or urinary sodium excretion. 3. At the end of the osmotic diuresis kallikrein activity was significantly reduced both in the urine and in the renal cortex. At that time plasma aldosterone concentration was slightly greater in the mannitol-treated than that in the control group, but the difference did not reach statistical significance. 4. In this experiment no relationship was observed between the activity of the renal kallikrein-kinin system and the plasma aldosterone concentration. 5. The transient increase in urinary kallikrein excretion is interpreted as a wash-out effect of renal kallikrein, which is followed by a diminished kallikrein activity in urine and in renal cortex.

Aldosterone↗
PubMed1981

Diuresis in the ascitic patient: a randomized controlled trial of three regimens.

To compare the efficacy of three commonly used diuretic regimens in the treatment of ascites, we randomized 90 patients to three treatment groups: Sequential Spironolactone (spironolactone followed by furosemide if necessary), Combination (spironolactone and furosemide in combination), and Furosemide (furosemide given alone). Diuretics were begun at a low dose by mouth and the dosage increased until a 0.4-0.8 kg daily diuresis was achieved. The clinical and laboratory findings were comparable for the three experimental groups on admission to the study. All three regimens achieved a comparable rate of diuresis. To do so was far more difficult with furosemide alone, which required repetitious upward adjustments in dosage and massive KCl supplements. The incidence of encephalopathy, hepatorenal syndrome, and marked electrolyte abnormalities was similar for the three treatment groups except that severe hyperkalemia was more frequent on combination therapy. We conclude that diuresis should be initiated with one of the two spironolactone regimens and not with furosemide as the sole agent.

Ascites↗
PubMed1981

Urea secretion in medullary collecting duct of the rat kidney during water and mannitol diuresis.

During steady-state water or mannitol diuresis, the microcatheterization technique was used to study the handling of urea, fluid, sodium, potassium, and total solute along the length of the medullary collecting duct in anesthetized rats. During water diuresis, the remaining fraction of filtered urea increased along the collecting duct as indicated both by regression analysis of all samples and by comparison of paired data from the beginning and end of the duct [(TF/P)urea/In = 43.3 and 50.7%, respectively]. During mannitol diuresis, similar urea entry into the medullary collecting duct was observed, (TF/P)urea/In increasing from 60.7 to 66.5%. Comparison of collecting duct urea handling in proximal and distal segments (beginning to midzone and midzone to papillary tip) suggested that urea entry occurred to a greater extent in the distal portion of the medullary collecting duct. The results demonstrate urea secretion into the medullary collecting duct in diuretic states when urine flow is high and intratubular urea concentration low. Whether urea entry into the collecting duct is an active or passive process cannot be determined from this study, but comparison between urea concentrations in the papillary interstitial fluid and in the urine or tubular fluid raises the possibility of an active urea secretory mechanism in the collecting duct.

Absorption↗
PubMed1999

F+0 diuresis renography in infants and children.

UNLABELLED: The purpose of this study was to evaluate the feasibility of modifying diuresis renography by the simultaneous administration of 99mTc-mercaptoacetyltriglycine (MAG3) and furosemide in the investigation of hydronephrosis and hydroureteronephrosis in infants and children. Two parameters were assessed: the diuretic response in normal kidneys and the ability of the F+0 study to differentiate between renal obstruction and nonobstruction and to identify the level of obstruction in cases of renal obstruction. METHODS: Seventy-two patients (48 males, 24 females; age 2 d to 7 y; median age 6 wk) with sonographic diagnoses of hydronephrosis or hydroureteronephrosis were reviewed prospectively over a 3-y period. All patients had prior sonographic studies and micturating cystourethrography. Bladder catheterization was not routinely performed and was undertaken only if the child had suspected vesicoureteric junction (VUJ) obstruction or grade II or more vesicoureteric reflux. A weight-adjusted dose of 99mTc-MAG3 (maximum 200 MBq, minimum 20 MBq) and 1 mg/kg of furosemide (maximum 40 mg) were administered intravenously at the same time. Posterior imaging of the kidneys and bladder was performed for 20 min and followed by gravity-assisted drainage or imaging after voiding. All patients were followed-up for 6-12 mo, and the final diagnoses were based on either surgery or conservative management with repeated sonography or follow-up 99mTc-MAG3 studies (or both). The results of the F+0 diuresis renography were then compared with the final diagnoses. RESULTS: A renal unit was defined as a kidney and its ureter. There were 151 renal units with 1 patient having bilateral duplex kidneys, 6 patients having unilateral duplex kidneys and 1 patient having a solitary kidney. Fifty-five normal renal units and 96 abnormal renal units on the basis of sonographic findings were assessed. The furosemide clearance half-time for the 55 normal renal units was 1.3-6.3 min (mean 3.8 min). Of the 96 abnormal renal units, 53 were classified as nonobstructed and 43 were classified as obstructed. Of the 53 renal units classified as nonobstructed, there were 48 true-negative studies and 5 false-negative studies; of the 43 renal units classified as obstructed, there were 40 true-positive studies and 3 false-positive studies. The sensitivity was 88.9%, specificity was 94.1% and accuracy was 91.7%. The level of obstruction, either pelviureteric junction or VUJ, was also correctly identified. CONCLUSION: F+0 diuresis renography shows excellent diuretic responses in normal kidneys and is a valid method for the investigation of hydronephrosis and hydroureteronephrosis in infants and children.

Child↗
PubMed1979

Renal excretion kinetics of high-dose cis-dichlorodiammineplatinum(II) administered with hydration and mannitol diuresis.

The effect of hydration and mannitol diuresis on the nephrotoxicity and renal excretion kinetics of high-dose cis-dichlorodiammineplatinum(II) was examined in seven men undergoing treatment for testicular or bladder carcinoma. The elimination half-life averaged 26.8 hours, shorter than values previously reported from studies not employing hydration and diuresis. In addition, no signs of nephrotoxicity were observed. The results suggest that hydration and mannitol diuresis decrease the nephrotoxicity of cis-dichlorodiammineplatinum(II) by increasing its rate of elimination.

Blood Cell Count↗
PubMed1977

High dose cis-platinum diammine dichloride: amelioration of renal toxicity by mannitol diuresis.

A clinical trial was undertaken to improve the therapeutic index of cis-platinum diammine dichloride with a concomitantly administered mannitol induced diuresis. Sixty patients, heavily pretreated, were entered; fifty-one are evaluable. The technique of concomitant osmotic diuresis and CPDD administration is described in detail. Doses ranged from 3 mg/kg to 5 mg/kg. At 5 mg/kg, dose-limiting renal, marrow and ototoxicity were seen, and resulted in one drug death. Marrow toxicity was moderate. Renal toxicity was limited to transient elevations in serum creatinine levels, except in some patients who had renal impairment prior to CPDD treatment. These patients had moderate renal toxicity. Serial treatments as frequently as once every 3 weeks were used to maintain responses. Serial high dose CPDD produced only mild renal dysfunction. Ototoxicity, usually subclinical, was quantitated audiometrically, and found to be dose related, but not clinically prohibitive at 4 mg/kg or less. The overall response rate (PR/MR) was 42%. Clinically significant responses in epidermoid carcinoma of the head and neck, adenocarcinoma of the ovary, and germ cell tumors of the testis were seen. All six responding patients with germ cell tumor of the testis, had been resistant to low dose (1mg/kg) CPDD. Two responding patients with ovarian adenocarcinoma had been resistant to alkylating agents.

Adenocarcinoma↗
PubMedDate not supplied

Diuresis of cirrhotic ascites increases its opsonic activity and may help prevent spontaneous bacterial peritonitis.

Serial ascitic fluid samples were obtained during diuresis in seven patients with portal hypertension-related ascites. The samples were tested for concentrations of total protein, CH100, C3 and C4 as well as for in vitro opsonic activity. These parameters were all found to increase to a statistically significant degree when the initial specimen was compared to the final specimen: total protein = 1.5 vs. 2.7 gm per dl; CH100 = 9.3 vs. 20.2 units per ml; C3 = 13.4 vs. 23.8 mg per dl; C4 = 1.9 vs. 3.6 mg per dl, and opsonic activity = 0.8 vs. 1.9 log kill. This increased opsonic activity resulted in a greater than 10-fold increase in bacterial killing. This study demonstrates that diuresis of patients with cirrhotic ascites increases the concentrations of ascitic fluid complement components and increases the opsonic activity of ascitic fluid and may help protect patients from bacterial infection of their ascites.

Ascitic Fluid↗
PubMed1980

Blunting of furosemide diuresis by aspirin in man.

Experiments were performed on humans to study the blunting on the diuretic action of furosemide by prostaglandin synthetase inhibitors. Maximal water diuresis was instituted. At the peak of urine flow, clearance periods were performed during baseline conditions and repeated after the injection of aspirin and, subsequently, of furosemide. Control subjects did not receive aspirin. Urine flow rate (V), Cosm, and Na excretion (UNa) . V were significantly lower when the administration of the diuretic had been preceded by that of aspirin. In the absence of furosemide, however, aspirin did not influence renal hemodynamics nor Na and water reabsorption. Therefore, the same experimental protocol was repeated in paired experiments where each normal subject served as his own control, being studied twice, in the presence and absence of aspirin, respectively. The average changes in water and Na excretion induced by furosemide were not different when the patients were pretreated with aspirin as compared with those measured in the absence of prostaglandin inhibition. Changes occurring in individual experiments were significantly correlated (r = 0.95, P less than 0.01) with those in calculated furosemide clearance. Since aspirin, indomethacin, and meclophenamate are secreted by the organic acid transport system of the proximal tubule, competition for a common secretory mechanism, rather than prostaglandin inhibition, could mediate the blunting of furosemide diuresis.

Aspirin↗