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PubMed1979

Treatment of severe 2,4-D and mecoprop intoxication with alkaline diuresis.

1 Self-poisoning with a selective weedkiller containing 2,4-D and mecoprop in a 39 year old man resulted in prolonged deep coma, pyrexia, hyperventilation, hypoxaemia, myotonia, skeletal muscle damage and electrocardiographic changes consistent with cardiomyopathy. 2 The admission plasma concentrations of 2,4-D and mecoprop were 400 and 751 microgram/ml respectively. The patient remained gravely ill with no signs of improvement for 2 days with supportive therapy and there was no fall in the 2,4-D level. 3 Alkaline diuresis greatly increased the renal clearance of 2,4-D, and there was a rapid fall in plasma concentration (T1/2 3.7 h) with corresponding clinical improvement. The effect on the elimination of mecoprop was similar, but less dramatic. 4 Forced alkaline diuresis may improve the otherwise very poor prognosis in severe intoxication with 2,4-D and related weedkillers.

2,4-Dichlorophenoxyacetic Acid↗

PubMed1988

Renal lithium handling during water loading and subsequent d-DAVP-induced anti-diuresis.

Assuming that lithium is exclusively reabsorbed in the proximal tubules pari passu with sodium (Na), the lithium clearance (CLi) has been advanced as an index of filtrate delivery from the proximal tubules. In order to determine whether water loads in a range commonly given during clearance studies affect CLi, we studied nine normal subjects (Na intake 150 mmol day-1) on three water loads resulting in stable urine flow rates of 2.2 +/- 0.9, 6.1 +/- 0.7 and 11.7 +/- 3.0 ml min-1, respectively. We also studied the effect of acute anti-diuresis (urine flow less than 1 ml min-1) induced by d-DAVP given i.v. at the end of all studies. Water loading up to induction of maximum water diuresis did not significantly affect absolute or fractional CLi. Sodium and chloride excretion were reduced at the highest water intake level. Administration of d-DAVP caused a 50% reduction in fractional Na excretion and a small but significant rise in fractional lithium reabsorption from 75.5 +/- 3.9 to 77.5 +/- 3.6%. We conclude that CLi is hardly affected over a wide range of water intakes and urine flow rates, despite concomitant changes in Na excretion. The finding that d-DAVP, which probably enhances Na reabsorption in the thick ascending limb of Henle's loop, also enhanced lithium reabsorption, suggests that lithium may be partly reabsorbed in this nephron segment. Thus, lithium may not be the exact, quantitative marker of Na reabsorption in the proximal tubules that it is purported to be.

Deamino Arginine Vasopressin↗

PubMed2004

Unreliable residual volume measurement after increased water load diuresis.

BACKGROUND: The aim of the present study was to examine whether increased water load intake prior to ultrasound examination of the lower urinary tract, affects the measurement of postvoid residual urine volume. PATIENTS AND METHODS: Ninety four male patients with postvoid residual volumes after increased water load diuresis of more than 100 mL (PVR1) were included in the present study. All patients underwent a second PVR measurement by an urologist with a portable transabdominal bladder ultrasound scan without having received an increased water load (PVR2). A comparison of the measurements was performed and the PVR values were also correlated with other parameters, such as age, International Prostate Symptom Score, prostate volume and serum prostate-specific antigen (PSA) values. RESULTS: Postvoid residual urine volume after increased water load diuresis (PVR1) differed from that recorded after normal bladder filling and voiding at first desire (PVR2), with the former being larger than the later in every patient (P < 0.001). The PVR values, PVR1 and PVR2, were independent to patient age, symptom score prostate volume and PSA value. CONCLUSIONS: Measurement of postvoid residual volume in a relaxed patient, who voids at first desire, represents everyday life and should be the correct method of testing.

Adult↗

PubMed1979

Diuresis renography and morphology in upper urinary tract obstruction.

The results of a combined study of 25 patients with idiopathic hydronephrosis are presented. Diuresis renography was performed pre-operatively and surgically removed specimens of the renal pelvis and ureter were examined by light and electron microscopy. There was good correlation between the results of these 2 methods of assessment which have defined 2 broad categories of patients with renal pelvic dilatation. These findings are discussed with particular reference to the clinical value of diuresis renography.

Adolescent↗

PubMed1983

Does perfusion equal diuresis in the upper urinary tract?

Pressures occurring in the upper urinary tract during perfusion and diuresis were compared in an unsedated dog preparation. Perfusion pressures were significantly higher, suggesting that a product of diuresis actively reduces upper tract tone.

Animals↗

PubMed1984

A comparison between diuresis renography and the Whitaker test in 64 kidneys.

Fifty-seven patients have provided 64 dilated pelvicaliceal units for study by diuresis renography and the Whitaker test. Of 45 kidneys showing a type I or type IIIa renographic response (unobstructed), 32 were, according to Whitaker's criteria, obstructed, 8 fell into an equivocal zone and only 5 were unobstructed. Thirty-five of these kidneys--33 of which were associated with moderate or severe loin pain--were operated on for presumed obstruction with generally excellent symptomatic and renographic result. Thus the detection of a type I or type IIIa response in a dilated, painful system cannot be taken to exclude obstruction. Better correlation was obtained between renography and the Whitaker test in patients exhibiting a type IIIb or type II renographic response. Diuresis renography is a sensitive indicator of urodynamic disturbance in the upper urinary tract and an ideal means of evaluating post-operative progress. The Whitaker test provides a reliable means of selecting patients who will benefit from pyeloplasty.

Adolescent↗

PubMed1985

Evaluation of obstructive uropathy in children. 99mTc-DTPA renography studies under conditions of maximal diuresis.

Renographic studies under standardised conditions of maximal diuresis provoked by hypotonic saline infusion and frusemide were used in 17 patients with dilatation of the upper urinary tract in order to distinguish between obstructed and non-obstructed urinary tracts. Of the six patients who were obstructed on clinical and X-ray evidence only three showed an obstructed pattern on the renographic curves after maximal diuresis. After operation these three patients showed improvement in both renographic curve and functional images of the renal parenchyma. A new method of identifying the parenchymal area is described.

Adolescent↗

PubMed1985

Diuresis and renal functional recovery in chronic retention.

Fifty-five patients with chronic urinary retention and incipient or actual renal failure were studied. In the majority of patients renal function improved after bladder decompression, irrespective of whether or not a diuresis occurred. Excessive loss of salt and water was rarely a matter of concern and most patients did not require intravenous fluid replacement. Several lost weight and experienced a fall in blood pressure during the period of diuresis without adverse effect upon renal functional recovery. A profound fall in blood pressure occurred in only three patients, all of whom required long-term sodium supplementation. It is concluded that the problem of salt and water loss after bladder decompression in patients with renal failure is exaggerated and difficult to predict. Over-enthusiastic replacement of fluid in strict accordance with output could readily lead to fluid overload and prolongation of the diuretic period. Therefore fluid replacement should be determined by the clinical condition of the patient and measurement of improving renal function with less emphasis on urine output and its electrolyte content.

Aged↗

PubMed1986

Metabolic consequences of forced diuresis following prostatectomy.

The efficacy and metabolic consequences of a standardised forced diuresis regime following prostatectomy were studied in three parts. A retrospective review of 372 patients. A detailed prospective study of blood and urine electrolyte changes in 25 patients. A prospective study of urinary oxalate levels in 15 patients. The regime was effective in safely preventing post-operative clot retention. In 54% of patients the plasma sodium fell below 135 mmol/l. Hypokalaemia was mild and transient except in patients on long-term diuretics. There was a significant per-operative fall in serum calcium levels. It was concluded that forced diuresis is a safe and effective method of reducing clot retention following prostatectomy. The high incidence of post-operative hyponatraemia suggests that absorption of glycine solution at transurethral prostatectomy is a common occurrence.

Creatinine↗

PubMed1988

Diuretic-induced urinary flow rates at varying clearances and their relevance to the performance and interpretation of diuresis renography.

Minute-by-minute urinary flow rates before and after the intravenous injection of 40 mg frusemide were investigated in 29 well hydrated adult patients with varying creatinine clearances. Total urinary flow rates 3 to 6 min after frusemide ranged from 1 to 42 ml/min (mean 19). At 15 to 18 min after the diuretic, flow rates ranged from 8 to 46 ml/min (mean 23). Flow rates were proportional to creatinine clearance (r = 0.73; r = 0.8) and decreased with falling clearance, although significant diuresis (4 ml/min/kidney) was achieved down to single kidney clearances of 10 ml/min. Where single kidney clearances were less than 31 ml/min, single kidney flow rates of 10 ml/min or more were not guaranteed. Below this clearance, diuresis renography remains completely reliable and unequivocal in the majority of cases. However, perfusion pressure flow studies will not necessarily be urodynamically comparable and it should not be expected that the results of the two tests will agree in individual cases of upper tract dilatation. Recommended timing for frusemide administration should be 20 min into the test, or 15 min before radiopharmaceutical injection.

Aged↗

PubMed1978

Transient water diuresis and syndrome of inappropriate antidiuretic hormone secretion (SIADH) induced by forebrain lesions of different location.

Inhibition of ADH-secretion and transient water diuresis was observed as acute effects of radio-frequency lesions in the septal region of goats. The water diuresis was not compensated for by drinking and therefore rapidly induced pronounced hypernatremia and hypovolemia. The development of hypovolemia was accompanied by a rise in plasma renin activity. Lesions of the same kind, but extending into the preoptic region near the medial portion of the supraoptic nuclei induced the inability to excrete excessive water characteristic of SIADH. Determinations of plasma arginine vasopressin suggested that the lesions causing SIADH did not produce any noticeable increase in basic ADH-secretion. The results suggest that impulses from juxtaventricular receptors regulating ADH-release and water intake to a considerable extent are transmitted via the septal region, and that elimination of this impulse traffic is sufficient to turn water balance to the negative side. However, reflex volumetric inhibition of the ADH-secretion does not seem to be mediated by pathways passing through the septal region.

Animals↗

PubMed1968

The time course of changes in renal tissue composition during mannitol diuresis in the rat.

1. The time course and extent of changes in the composition of renal tissue slices in osmotic diuresis were determined by sacrificing groups of rats before and during the intravenous infusion of mannitol (15 g/100 ml.) for up to 7(1/2) hr.2. Very rapid changes in tissue water and solute contents occurred within 15 min, preceding the times of maximal diuresis, with little subsequent change even up to 7(1/2) hr.3. The main changes were:(a) an increase in water content in all slices, particularly the papilla; (b) a very profound decrease in papillary and medullary urea content in the first 15 min, with a small, but significant, further decrease, subsequently; (c) a small, but significant, rapid decrease in papillary sodium, and small non-significant increases in the outer medulla and cortex. Subsequent changes in any segment were small and non-significant; (d) apart from small changes in the first 15 min ammonium and potassium contents remained fairly constant.4. The rates of change in papillary and urinary urea concentrations were similar, so that after 30 min, any differences between tip and urinary concentrations were small and non-significant.5. The findings are discussed in terms of factors influencing counter-current mechanisms. It is concluded that altered medullary blood flow is mainly responsible for the rapid changes in medullary composition.6. The relation between papillary and urinary urea concentrations is explicable in terms of passive handling, with equilibration across a freely permeable collecting duct membrane.

Ammonia↗

PubMed1971

Effect of diuresis on Staphylococcus aureus kidney infections in mice.

In the Cornett strain of mice, water diuresis did not prevent hematogenous production of pyelonephritis by Staphylococcus aureus. Increased fluid intake did not affect the numbers of organisms deposited in the kidneys or the rate of growth during the first 4 hr after inoculation. Drinking the glucose solution did not enhance bacterial proliferation within the renal parenchyma. Subcutaneous injection of saline to supplement for interruption of drinking after inoculation reduced the numbers of organisms recovered in the kidneys but not sufficiently to prevent production of pyelonephritis. Incorporating penicillin as a marker indicated that fluids administered by subcutaneous injections were rapidly delivered to the kidneys. Combining diuresis with treatment did not influence the rapidity of delivery of antimicrobial to the kidneys or the length of time that it was present in the renal homogenate.

Animals↗

PubMed1976

Effects of catecholamines injected into the septal area of the rat brain on natriuresis, kaliuresis and diuresis.

Urinary output of Na+ and K+, and volume of urine have been studied in conscious, unrestrained, water-loaded male rats following the intraseptal injection of catecholamines. Natriuresis and kaliuresis increased after injecting noradrenaline (NA), the intensity being dose related. The dose-response curve suggests that a monomolecular interacting takes place between NA and pharmacological receptors present in the septal area. No change was observed in diuresis. Systematic mapping of the septal area yielded about the same results for all sites except a zone located in the lateral nucleus that was more sensitive. An alpha blocker (dibenamine), injected intraseptally before NA, showed an inhibitory effect while a beta blocker (propranolol) yielded a potentiation effect. These same effects of the blocking agents were observed when adrenaline was used instead of NA. Lidocaine, which inhibits the re-uptake of NA, showed an enhancement of the natriuretic and kaliuretic effect of NA, and the same effect was observed when the enzymatic destruction of NA was prevented by nialamide, an inhibitor of monoaminoxidase. Dopamine showed a natriuretic effect, but no effect was observed on K+ and urine output. Serotonin had no action on natriuresis, kaliuresis and diuresis.

Adrenergic alpha-Agonists↗

PubMed1975

Kaluresis and diuresis after administration of antidiuretic hormone to hyperkalemic dogs.

Dogs infused with 2 meq KCl/kg per h exhibit electrocardiographic evidence of prelethal cardiotoxicity in about 3 h when serum potassium reaches a level between 10.2-10.5 meq/liter. During this time, their urine output of 30 ml/h is equal to the volume of KCl infused. Studies of the potassium distribution in these animals indicate that 20 percent of the infused ion is added to the extracellular fluid and red blood cell mass, 20 percent is excreted in the urine, while the remaining 60 percent is unaccounted for and presumably transferred to intracellular fluid. Dogs treated with moderately large doses of antidiuretic hormone intramuscularly before and during KCl infusion delay development of prelethal cardiotoxicity for about 5 h, with serum potassium levels comparable to those of untreated dogs. In addition, treated animals display a considerable diuresis and kaluresis with urine volumes nearly 4 times that of the volume infused. The potassium ion distribution in animals given antidiuretic hormone is much different from that of untreated dogs, with 55 percent of the infused ion found in the urine, about 15 percent in extracellular fluid and red blood cell mass, and only 30 percent presumably transferred to intracellular fluid. Transfer of potassium to intracellular fluid was calculated to be 3.1 plus or minus 0.7 meq/kg in antidiuretic-hormone-treated animals and 3.8 plus or minus 0.7 meq/kg in untreated (control) animals. Since these values are, within experimental error, quite comparable, it is possible that antidiuretic-hormone-induced kaluresis and diuresis are involved in protecting some animals from the effects of hyperkalemia by delaying the attainment of cardiotoxic blood levels.

Animals↗

PubMed1975

Electrolyte excretion and free-water production during onset of acute diuresis.

The concentration of major urinary solutes was studied in ureteral urine collected at 15- to 30-s intervals at the onset of acute diuresis induced in anesthetized dogs either by high-ceiling diuretics (mainly ethacrynic acid) or by osmotic diuretics. Phosphate/inulin clearance ratios remained unchanged; potassium/inulin clearance ratios rose rapidly. Principal attention is given to the mechanisms underlying a transient rise in urinary sodium and chloride concentrations during the onset of diuresis. When the data are corrected for washout artifacts from the pelvis and ureter, it can be shown that the initial collection periods are associated with a transient increase in free-water production and by the simultaneous secretion of urea from the interstitium into the tubular fluid. The former coincides in time with the rise in urinary chloride concentration and represents an augmentation of water reabsorbed in the collecting duct, which is relatively impermeable to chloride. Both responses are quantitatively consistent with the transition from a hyperosmotic to isosmotic medullary interstitium.

Animals↗

PubMed1993

Endothelin-induced natriuresis and diuresis are pressure-dependent events in the rat.

The goal of the current study was to determine the mechanism by which doses of endothelin (ET) that do not markedly affect the glomerular filtration rate (GFR) cause a natriuresis and diuresis. ET was infused into pentobarbital-anesthetized female rats at 50 ng.kg-1.min-1 iv for 30 min. In controls (n = 6 rats; n = 5 in all other groups), ET increased mean arterial blood pressure (MAP) from 95 +/- 2 to 131 +/- 2 (SE) mmHg, Na excretion (UNa V) from 0.34 +/- 0.07 to 1.83 +/- 0.2 meq/min, and urine flow rate (V) from 13 +/- 1 to 24 +/- 3 ml/min (all P < 0.01 vs. baseline). At 15 min during infusion of ET, the GFR was not affected (2.1 +/- 0.1 to 2.2 +/- 0.1 ml/min) but modestly decreased to 1.8 +/- 0.1 ml/min at 30 min (P < 0.05 vs. baseline). Either removing the capsule from both kidneys during surgery or maintaining renal arterial pressure at baseline values with an adjustable clamp on the aorta above the right renal artery abolished the ET-induced increase in UNa V and V. Meclofenamate also did not alter the ET-induced increase in MAP, V, or UNa V. To determine the intrarenal site of action of ET, experiments were conducted with ET plus amiloride or with a combination of amiloride plus furosemide; there was a larger ET-induced diuresis and natriuresis in amiloride-treated rats and an even larger response with amiloride plus furosemide compared with controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Amiloride↗

PubMed1997

Age-related changes in the pressure diuresis and natriuresis response.

The renal-excretory responses to changes in renal perfusion pressure (RPP) were studied in anesthetized young (3 mo old), adult (12 mo old), and senescent (24 mo old) rats to evaluate whether the pressure diuresis and natriuresis mechanism is altered as a function of age. Experiments were performed in anesthetized animals in which nervous and systemic hormonal influences to the kidney were fixed. Mean arterial pressure was similar in all three groups: 97.6 +/- 2.6, 102.1 +/- 3.7, and 95.2 +/- 5.2 mmHg in young, adult, and senescent rats, respectively. The relationships between RPP and diuresis/natriuresis or fractional excretions of water and sodium were similar in young and adult rats. However, in senescent rats the pressure-diuretic and pressure-natriuretic responses were slightly shifted to the right, so that diuresis and natriuresis were significantly lower at higher levels of RPP. Glomerular filtration rate was well autoregulated, and there were no differences between young and adult rats at each level of RPP. However, a significantly lower glomerular filtration rate was observed in senescent rats. These results indicate an age-related decline in the pressure-dependent sodium and water excretion that appears to be due to a decrease in glomerular filtration and an increase in tubular sodium reabsorption.

Aging↗