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Bradykinin (BK) enhances diuresis and natriuresis in saline volume-expanded dogs.

15 micrograms bradykinin was given with large amount of physiological saline solution intravenously to dogs. Significantly greater diuresis and natriuresis were obtained compared with those of simple saline volume expansion experiments. Bradykinin in small doses which were selected as giving no influence on blood pressure enhanced additively diuresis and natriuresis, similarly with subpressor doses of A II, AVP, and MX in saline volume expanded dogs. Since all four agents are having cellular Ca-mobilizing action in common, it is suggested that phosphoinositide system may be involved in this enhancement of renal sodium and water excretion.

Aldosterone↗

Importance of circulating and urinary tissue kallikrein in the control of acute natriuresis and diuresis evoked by water immersion in man.

In ten human subjects water immersion produced a two-fold diuresis and a three-fold increase in sodium secretion together with a marked fall in plasma renin activity and aldosterone. In contrast, circulating and urinary (active and total kallikrein) remained unchanged throughout the immersion period. Our results indicate that the acute diuresis and natriuresis evoked by water immersion in man is not regulated by circulating or urinary tissue kallikrein.

Adult↗

Alterations in renal inner medullary levels of amino nitrogen during acute water diuresis and hypovolaemic oliguria in rats.

Levels of total amino compounds (ninhydrinpositive substances, n.p.s.) have been measured in the inner medullas of rats during acute water diuresis and following the induction of hypovolaemic oliguria by the injection (i.p.) of 30% polyethylene glycol 20,000 (PEG) in 0.9% saline. Mean medullary fluid n.p.s. concentrations fell from 26.5 mmol to 15.2 mmol Gly equiv/l (-43%) within 2.5 h from the onset of diuresis, while the mean calculated tissue osmolality decreased from 738 mosmol/kg (control) to 369 mosmol/kg H2O. By 24 h n.p.s. and osmolality had returned to control levels. By 0.5 h after injection of PEG the mean concentration of n.p.s. had increased from 26.4 mmol to 32.7 mmol Gly equiv/l (+24%) and by 4 h had reached 60.4 mmol Gly equiv/l (+19%). During this time the calculated mean tissue fluid osmolality rose from 696 to 1037 mosmol/kg H2O. Levels of n.p.s. did not increase further for up to 12 h. It is proposed that losses of amino compounds may make a significant contribution to the overall decrease in medullary cellular osmotic potential accompanying reduced tissue fluid osmolality, and that increased levels of these solutes may provide short-term osmoprotection during antidiuresis of rapid onset, in contrast to the more slowly accumulating methylamines and polyhydric alcohols.

Animals↗

Dopamine-induced diuresis in the cat without changes in renal hemodynamics.

The effects of intravenous (i.v.) and intraarterial (i.a.) injection and infusion of dopamine (DA) on renal hemodynamics, regional sympathetic activity and kidney function were investigated in anaesthetized cats. In response to the i.v. bolus injection of DA (25 microgram/kg), mean arterial blood pressure (MABP) was increased by 19.7%, renal blood flow (RBF) by 16.6%, and regional sympathetic discharges were inhibited. The principal effect of i.a. bolus injection of DA into the renal artery was vasoconstriction. Vasodilation was observed neither after lower doses of DA nor after pretreatment with phenoxybenzamine. During continuous i.v. infusion of 10 microgram DA kg-1 min-1 MABP, RBF, renal sympathetic discharges and glomerular filtration rate (GFR) did not change, whereas urine volume was increased by 120.5%, sodium excretion by 99.7%, chloride excretion by 143.2%, and potassium excretion by 31.9%. Urine osmolality was decreased and osmolal clearance increased. Raising the DA dose to 25 microgram kg-1 min-1 resulted in a fall of GFR, but the diuretic response was not significantly different from that of the low dose. Bulbocapnine (6 mg/kg i.v.) antagonized the DA-induced diuresis. In conclusion, the diuretic effect of DA in the cat is not dependent on a change in RBF, GFR or renal sympathetic activity. This suggests that a tubular site of action is primarily responsible for DA diuresis.

Animals↗

Urea and sodium in sheep kidneys during ethacrynic acid diuresis.

The possibility of uphill transport of urea from the collecting ducts of sheep fed diets containing 14% protein (HP) and 4.9% protein (LP) was explored by measuring cortex to papilla and urine to papilla gradients of urea during ethacrynic acid diuresis. Clearance studies were done on adult, unanesthetized, hydropenic, vasopressin infused sheep. Saline was given to compensate for urine loss during ethacrynic acid diuresis. Following a period of antidiuresis, ethacrynic acid administration caused and increase in fractional water excretion to 0.33 (HP) and 0.44 (LP), an increase in fractional sodium excretion to 0.28 (HP) and 0.41 (LP), and an average increase in glomerular filtration rate of 14.7%. Fractional potassium excretion showed no consistent change. Renal concentrating ability and medullary sodium accumulation were inhibited. Antidiuretic LP and HP medullary urea accumulation patterns were lost. However, identical but small ascending cortex to papilla urea gradients remained in the LP and HP animals. There was no significant difference between the urea concentration in urine and papilla tissue water. The results fail to provide support for the presence of active urea transport from the collecting ducts of sheep fed high or low protein diets.

Animals↗

An attempt to quantitate the contribution of antidiuretic hormone to the diuresis of left atrial distension in conscious dogs.

In order to quantitate the contribution of the antidiuretic hormone (ADH) to the diuresis of left atrial distension 52 experiments have been performed in 12 conscious, chronically instrumented beagle dogs. Left atrial pressure was increased by a reversible mitral stenosis by about 10 cm H2O (1.0 kPa) for 60 min. Plasma ADH concentration (range between 1.3 and 6.0 pg . ml-1) (radioimmunoassay) decreased in every experiment, the average decrease being about 50%. An i.v. infusion of vasopressin (0.05 mU . min-1 . kg-1) abolished the diuretic effect of left atrial distension or decreased the urine volume below control values; natriuresis was not affected. The magnitude of the vasopressin effect was dependent on the concurrent sodium excretion: when sodium excretion was low during left atrial distension, vasopressin was more effective in reducing the urine volume than when sodium excretion was high. It is concluded that the diuresis of left atrial distension is mediated (a) by a suppression of ADH and (b) by factors controlling sodium excretion, the contribution of these two mechanisms being dependent on the concurrent sodium excretion.

Animals↗

Altitude diuresis: endocrine and renal responses to acute hypoxia of acclimatized and non-acclimatized subjects.

As a result of our recently published studies we have thought that altitude diuresis resulting from hypoxic stimulation of the arterial chemoreceptors reduces the cardiac volume overload. To test this hypothesis, cardiovascular, endocrine and renal responses to stepwise acute exposure to simulated altitude (6,000 m) were compared in ten acclimatized recumbent mountaineers a mean of 24 days, SD 11, after descending from Himalayan altitudes of at least 4,000 m, with those found in ten non-acclimatized recumbent volunteers. The results showed that natriuresis and diuresis typified the renal responses to altitude exposure of both the acclimatized as well as non-acclimatized subjects, as long as altitude was well tolerated. It was concluded that the renal effects were mediated by atrial natriuretic peptide release and slight suppression of arginine-vasopressin (AVP) secretion, that the increased urine flow at altitude offset the cardiac (volume) overload resulting from hypoxic stimulation of the arterial chemoreceptors, and that enhanced AVP secretion, as found in the non-acclimatized subjects at and above 4,000 m, coincided with subjective and objective distress, i.e. with inadequate altitude adjustment owing to insufficient chemoreflex effects and central hypoxia.

Acclimatization↗

Normotensive normoxic men undergoing water diuresis fail to respond to stimulation of their peripheral arterial chemoreceptors by almitrine with an increase in plasma concentrations of atrial natriuretic factor.

The purpose of this study was to investigate the possible participation of atrial natriuretic factor (ANF) in the natriuretic and diuretic response occurring after stimulation of the peripheral arterial chemoreceptors by almitrine bismesylate in normoxic humans. The experiments were performed in 14 healthy male volunteers undergoing water diuresis. Each subject participated in two experiments. In one of them they ingested 100-mg almitrine at 12 p.m. The other study served as a control. Surprisingly, our subjects responded to almitrine with an elevation of urine flow only, whereas sodium excretion remained almost unchanged over the whole period of the experiments. As regards ANF plasma concentrations, no statistically significant differences between the control and the almitrine group could be observed. Moreover, no direct connection between ANF plasma concentrations and renal volume excretion was detectable. We conclude that a specific stimulation of peripheral arterial chemoreceptors by almitrine in humans undergoing water diuresis did not seem to raise ANF plasma concentrations as is the case at high altitude. Therefore we would suggest that there exists no specific reflex influence of these receptors on ANF release.

Administration, Oral↗

Plasma atrial natriuretic factor during cold-induced diuresis.

The purpose of this study was to evaluate the possible contribution of atrial natriuretic factor (ANF) to cold-induced diuresis. Seven healthy men, dressed in shorts, were exposed to a cold environment (+12 degrees C) for 90 min, and also to a thermoneutral environment. Exposure to cold increased urine output and sodium excretion significantly but plasma ANF concentration remained unchanged. The increase in urinary potassium excretion during cold exposure was not significant (P = 0.0636) and plasma renin activity did not change either. Exposure to cold increased mean arterial pressure significantly but it did not affect heart rate. We concluded that acute exposure to the cold environment induced a diuretic response, which was a solute diuresis in its nature. Our results did not give support to the hypothesis that ANF might be involved in the renal response to cold exposure.

Adolescent↗

[The effect of acute diuresis augmentation on urea and creatinine clearance in healthy people and in patients with chronic renal insufficiency (author's transl)].

According to earlier observations no further augmentation of urea clearance should be possible above a urine flow of 2 ml/min (so-called augmentation limit). In normal people and in patients with renal insufficiency no augmentation limit of urea and creatinine clearance could be ascertained: increasing urine flow was correlated with augmentation of urea and creatinine clearance. Calculating the protein equivalent the augmentation of urea excretion by increased diuresis seems to be of clinical importance only in the treatment of renal insufficiency with small basic diuresis.

Creatinine↗

Inhibition of diuresis in the tsetse fly (Glossina morsitans) by ouabain and acetazolamide.

Acetazolamide and ouabain, metabolic inhibitors which interfere with certain membrane transport systems, reduce the rate of water elimination by male Glossina morsitans morsitans. The results suggest that water is transported across membranes during diuresis and that a ouabain sensitive Na+K+ATPase and an acetazolamide-sensitive carbonic anhydrase are involved in diuresis.

Acetazolamide↗

Diuresis urography in equivocal pelvi-ureteric obstruction.

In 43 patients with equivocal pelvi-ureteric obstruction, conventional urography was supplemented with diuresis urography. After peroral hydration with 0.5 liters fluid, a large volume of urographic contrast medium was administered and increased diuresis provoked by intravenous injection of furosemide. A relative obstruction of flow was then accentuated by increased dilatation of the renal pelvis. The technique deserves a wider use in the radiologic investigation of patients with equivocal obstruction at the pelvi-ureteric junction.

Adolescent↗

Fused pelvic kidneys: "hourglass sign" on Tc-99m DTPA diuresis renography.

A 13-year-old girl with fused pelvic kidneys detected on ultrasonographic examination was referred to our department for a diuresis renography to assess urine drainage dynamics and exclude the possibility of urinary tract obstruction. Renal scan demonstrated fused pelvic kidneys functioning normally without obstruction. The authors present this case to demonstrate the diuresis renography findings of the combined position, fusion and rotation anomalies of the kidneys that is a rare congenital anomaly of the urinary tract.

Adolescent↗

Eukaliuric natriuresis and diuresis in response to disprocynium24: studies on the tubular site of action.

We previously described that 1,1'-diisopropyl-2,4'-cyanine (disprocynium24, DP24) exerts an eukaliuric diuresis and natriuresis in the anesthetized rat. The purpose of the present study was to localize the tubular site of action of DP24. Employing micropuncture experiments in anesthetized rats, we first tested the effect of systemic application of DP24 (300 microg/kg + 300 microg/kg h, i.v.) on whole kidney excretion rates as well as on fluid, sodium and potassium ion delivery to the early distal tubule (V(ED), Na+(ED), K+(ED)). It was found that the eukaliuric diuresis and natriuresis in response to DP24 was accompanied by a substantial increase in V(ED) and Na+(ED), suggesting a predominant tubular site of action upstream to the early distal tubule, most likely in the proximal tubule. DP24 caused a comparable fractional, although minor absolute increase in K+(ED) as compared to Na+(ED). Second, application of DP24 into the first surface loop of the proximal tubule significantly increased V(ED) and Na+(ED) at a concentration of about 10(-7) M, indicating that DP24 may act from the intratubular site. Third, microperfusion of tubular segments revealed that effects of DP24 on the proximal convoluted tubule and the loop of Henle accounted for about 70 and 30%, respectively, of its diuretic and natriuretic action upstream to the early distal tubule. With regard to the loop of Henle, the quantitative effect of DP24 on fluid and Na+ reabsorption proposed a predominant effect on the straight part of the proximal tubule rather than the thick ascending limb. Intratubular DP24 did not affect reabsorption in the distal tubule. In summary, the present findings indicate that: (1) the diuretic and natriuretic effect of DP24 resides predominantly in the proximal tubule, and (2) DP24 may act from the intratubular site. Since DP24 increased V(ED) and Na+(ED) without apparently affecting sodium or potassium ion transport in the distal tubule, the mechanism of the eukaliuric response remains unclear.

Animals↗

The value of renal scintigraphy during controlled diuresis in children with hydronephrosis.

Dynamic renal scintigraphy (DRS) during controlled diuresis is the method of choice to diagnose the functional relevance of urinary tract obstruction in children with sonographically demonstrated hydronephrosis. However, there are no commonly accepted scintigraphic criteria for surgical intervention. On the basis of our findings, we propose four stages of washout (WO) of tracer following diuresis: in stage I, WO>50%, neither further diagnosis nor intervention is necessary; in stage II, 50%>/=WO>/=12%, repetition of DRS is advised within 3-4 months; and in stage III, 12%>WO>/=5%, DRS should be repeated within 1-2 months. Only in stage IV, WO<5%, should surgery be done immediately. This procedure reduces surgical interventions by 50% without increasing the risk of residual renal damage.

Diuresis↗

Inhibition of menstrual uterine motility during water diuresis.

Induced water diuresis blocks the central release of antidiuretic hormone (ADH) which is, in turn, supposed to play a role in the high uterine activity recorded during human menstruation. In order to further explore this possibility, uterine and antidiuretic activities were studied during water diuresis in 27 normal menstruating women, prior to the insertion of an intrauterine device. Shortly after the initiation of the water overload, simultaneous inhibition of both uterine and antidiuretic activities was obtained. Furthermore, the administration of ADH by intravenous infusion re-established the uterine motility to normal values while the administration of oxytocin did not. It is suggested that ADH has a direct role in the control of uterine activity during human menstruation.

Diuresis↗

Urinary enzyme excretion after a single dose of phenacetin and paracetamol (acetaminophen) during antidiuresis and during water diuresis.

2 g phenacetin or paracetamol in a single oral dose were administered to five healthy persons under the conditions of antidiuresis and subsequent water diuresis. Excretion of the brush border enzyme GGT, the cytoplasm enzyme LDH, and the lysosomal enzymes, NAG and GAL, was analysed before, during and after ingestion of the analgesics. Increased excretion of LDH and GGT indicated a similar moderate damage of the tubular epithelia after phenacetin and paracetamol. The state of diuresis appeared to have no influence.

Acetaminophen↗

Diuresis-dependent excretion of multiple forms of renal brush-border enzymes in urine.

The urinary brush-border enzymes alanine aminopeptidase (EC 3.4.11.2), alkaline phosphatase (EC 3.1.3.1) and gamma-glutamyltransferase (EC 2.3.2.2) and their activity pattern of soluble and particulate forms separated by ultracentrifugation were investigated over 8 h after a high intake of fluid (22 ml/kg body wt.). The activity pattern of the two multiple forms was markedly influenced by the urine flow rate. The time-related excretion of soluble forms of these three enzymes increased with the extent of urine output whereas the excretion of particulate form was independent on diuresis. Diuresis-dependent excretion of total activities of brush-border enzymes can be exclusively considered to be a consequence of changed excretion of soluble forms.

Alkaline Phosphatase↗