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Renal nerves are involved in the natriuresis and diuresis produced by central administration of clonidine in the rat.

To determine whether renal nerves are involved in natriuresis or diuresis produced by the intracerebroventricular administration of clonidine (0.2, 2.0, and 8 micrograms/kg/min, and 2.0 microliters/min), urine flow, and sodium excretion were measured before and during clonidine administration from innervated and contralateral denervated kidneys in anesthetized (Inactin, 0.1 g/kg, ip) Sprague-Dawley rats. Baseline urine flow and sodium excretion were elevated after renal denervation prior to infusion of clonidine. Examining urine flow and sodium excretion before and during clonidine infusion indicated significant increases in urine flow and sodium excretion from the innervated kidneys but not from the denervated kidneys, possibly due to the renal sympatho-inhibition in the innervated kidney. However, the higher doses of clonidine (2 and 8 micrograms/kg/min) may have diffused out of the intracerebroventricular space into the peripheral circulation and produced their effect by a direct action on the kidney. Subsequently, two experiments were performed to distinguish between a central action and peripheral action. First, clonidine was administered centrally with concurrent administration of an alpha 2-blocker, yohimbine (8 micrograms/kg/min, i.v.), peripherally. In a second experiment the dose of clonidine was reduced 10-fold such that this reduced dose did not produce a peripheral action but still produced the renal responses to central administration. The results of the latter two studies further confirmed that natriuresis and diuresis produced by intracerebroventricular administration of clonidine is in part mediated by renal nerves.

Animals↗

[A case of significant natriuresis and improvement of proteinuria by Temocapril, an ACE inhibitor with biliary excretion, in loop diuretics resistant edema in membranous nephropathy].

A 50-year-old man with WPW syndrome and chronic atrial fibrillation controlled by digoxin exhibited nephrotic syndrome due to membranous nephropathy in 1994. For massive edema resistant to loop diuretics, administration of 2 mg/day of Temocapril, an ACE inhibitor with biliary excretion, was started. It provided marked natriuresis and rapid improvement of massive anasarca. Moreover, 6 months later at the time of writing this report, nephrotic proteinuria has decreased and abnormally depressed Ccr level has elevated. For massive edema resistant to loop diuretics in nephrotic syndrome, Temocapril might bring about a beneficial effect possibly through the induction of natriuresis, which has been suppressed by the over-expression of angiotensin II in tubulointerstitium.

Angiotensin-Converting Enzyme Inhibitors↗

Antidiuretic activity of terlipressin (triglycyl-lysine vasopressin)--role of pressure natriuresis.

Terlipressin (triglycyl-lysine vasopressin TP), a "hormonogen" analogue, was introduced in gastroenterology for its low and protracted vasopressor action, reducing bleeding from gastrointestinal tract. Its antidiuretic activity, estimated originally in ethanol-anaesthetized rats (Sawyer's method) was claimed to be equally low and protracted. We performed several series of antidiuretic tests on conscious rats (Burn's method) with the following results. TP in low doses of 0.05-1.0 micrograms/kg exhibited typical dose-dependent antidiuretic effect. In the dose of 0.2 micrograms/kg, the dynamics of urine and sodium excretion did not differ from that after equivalent dose of lysine vasopressin and equipotent dose of DDAVP. The antidiuretic potency of TP (estimated by parallel line assay) was 175.0 U/mg. TP in doses of 5.0 and 20.0 micrograms/kg exhibited limited diuresis and marked natriuresis. High osmolality and sodium content were present in all portions of excreted urine. The discrepancy between previous and our results concerning antidiuretic activity of TP and the role of pressure natriuresis for overall renal action of TP are discussed.

Animals↗

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↗

An epoxygenase metabolite of arachidonic acid 5,6 epoxy-eicosatrienoic acid mediates angiotensin-induced natriuresis in proximal tubular epithelium.

Several laboratories have documented that angiotensin II (AII) induces natriuresis in proximal tubular epithelium by a mechanism that has as yet not been disclosed. The present studies were designed to test the hypothesis that cytochrome P450-dependent metabolites of arachidonic acid mediate this effect. In cultured rabbit proximal tubule a ketoconazole-sensitive product comigrating with 5,6-epoxy-eicosatrienoic acid (5,6-EET) on reverse phase and normal phase HPLC was stimulated two-fold by AII. We employed cultures of early S1 segments on a modified Ussing chamber as a bioassay to evaluate the effects of AII and 5,6-EET on unidirectional 22Na (apical to basolateral) flux (JNa). AII inhibited JNa, an effect that was abolished by ketoconazole. Furthermore, 5,6-EET decreased JNa in a manner analogous to AII, and the effect was potentiated by inhibition of endogenous 5,6-EET production. Employing the Ca2(+)-sensitive fluorescent probe, Fura 2, we observed a dose-dependent increase in [Ca2+]i with nM to microM 5,6-EET, effects that were abolished by depletion of extracellular Ca2+ and voltage-sensitive Ca-channel blockers. These observations support the hypothesis that 5,6-EET represents the second messenger that mediates AII-induced natriuresis via stimulation of Ca2+ influx through voltage-sensitive channels.

8,11,14-Eicosatrienoic Acid↗

Atrial natriuretic peptide-induced increase of glomerular filtration rate, but not of natriuresis, is mediated by prostaglandins in the rat.

This study addressed the question of whether some renal effects of atrial natriuretic peptide (ANP) are mediated by prostaglandins (PGs). Inhibition of PG synthesis (aspirin, 10 mg/kg) abolished the increase in inulin clearance (CIN) induced by ANP in rats. In contrast, diuresis and natriuresis remained significantly elevated after aspirin administration. ANP, either infused in vivo immediately before sacrifice or added to the incubation tubes, stimulated the synthesis of PGE2 and 6-keto-PGE1 alpha by isolated rat glomeruli but not by medullary or papillary slices. We conclude that the effect of ANP on the glomerular filtration rate is PG dependent, whereas that on diuresis and natriuresis is direct.

Animals↗

Relationship between natriuresis and changes in plasma atrial natriuretic factor, renin activity and aldosterone levels in fasting obese subjects.

This study was conducted to assess whether changes in atrial natriuretic factor (ANF) secretion could account for the natriuresis of the early phase of fasting. To this end, 8 AM (supine) and 10 AM (standing) plasma ANF concentrations were determined daily and compared with plasma renin activity and aldosterone levels in 8 obese subjects submitted to a 7-day total fast. Depiste constant daily sodium intake (51 mmol), urinary sodium excretion increased from 35 +/- 7 to 109 +/- 8 mmol/day after 4 days of fast (p less than 0.001) and declined thereafter. Urinary ketone excretion progressively increased over the whole period of fasting (p less than 0.001). Interestingly, fasting induced a decrease in plasma ANF concentrations (p less than 0.05). A contrast analysis revealed no significant change in ANF during the initial natriuretic phase of fasting but a decrease at the end of fasting averaging 36% (p less than 0.05) and 18% (p less than 0.05) at 8 and 10 AM respectively. In contrast, plasma aldosterone rose during fasting (p less than 0.05), the difference being significant at the end of fasting (p less than 0.01). Plasma renin activity and cortisol did not change significantly over the fasting period. Postural and/or diurnal changes of ANF, aldosterone, renin and cortisol were preserved during fasting (p less than 0.01). Postural changes of ANF were, however, attenuated at the end of fasting (p less than 0.05). These data indicate that the fasting natriuresis cannot be explained by changes in ANF levels but that the loss of sodium may contribute to a decline of basal ANF levels, with an attenuation of their physiological postural changes, and to a stimulation of the aldosterone secretion.

Aldosterone↗

Natriuresis-pressure relationship in polycystic kidney disease.

We studied, under outpatient conditions, nine patients with autosomal dominant polycystic kidney disease who were hypertensive on their usual diet, and nine normotensive healthy probands. The subjects were examined in random order on the 7th day after equilibration on a low-sodium diet (20 mmol/day) and again on the 7th day after equilibration on the same diet but with added sodium to yield a final intake of 200 mmol/day (or vice versa). Blood pressure was monitored non-invasively for 2 h at 4-min intervals using an automatic system. In healthy probands, mean arterial pressure (MAP) was similar on the low- and the high-sodium diets (92.7 versus 91.9 mmHg). In hypertensive patients, a significant (P less than 0.02) increase in mean MAP (107.2 versus 111.2 mmHg) and in systolic blood pressure (140.6 versus 148.7 mmHg) was observed irrespective of whether the glomerular filtration rate (GFR) was normal or reduced. The natriuresis pressure curve showed an upward shift (resetting) and a positive slope (sodium sensitivity). Patients with a reduced GFR as shown by inulin clearance differed from probands and patients with a normal GFR, by showing greater proportional changes in GFR and body weight. In hypertensive patients, atrial natriuretic factor (ANF) levels were higher at baseline and showed an exaggerated response to sodium loading. Changes in angiotensin II (Ang II) or in Ang II binding sites on platelets were similar in patients and controls and changed appropriately with the sodium intake. These data show a resetting of the natriuresis-blood pressure relationship and an increased blood pressure sensitivity to sodium in hypertensive patients with adult, dominant, polycystic kidney disease.

Adult↗

Diuresis and natriuresis after dihydropyridines: role of prostaglandin E.

It is known that calcium antagonists may produce a natriuresis and diuresis but the mechanisms are unknown and there have been few studies of the relative potencies of different drugs. This paper reports a study designed to measure the effect of nifedipine and nitrendipine on urine volume, sodium and potassium and the renal excretion of prostaglandin E2 (PGE2) in healthy, saline-loaded volunteers. Nifedipine and nitrendipine caused a significant natriuresis. Nifedipine also caused a significant diuresis but that produced by nitrendipine failed to reach statistical significance. Neither calcium antagonist altered PGE2 excretion. There was a small and insignificant fall in urinary potassium in all treatment groups. Blood pressure was not affected by the active treatments though heart rates tended to increase. We conclude that dihydropyridines have a potentially useful acute natriuretic effect which does not seem to be mediated by PGE2.

Adult↗

[Possible involvement of cyclic GMP (cGMP) in atrial natriuretic factor (ANF) induced natriuresis].

In order to clarify the mechanism of action of ANF on nephron, nephrogenous cGMP (NcGMP) was calculated. And the interrelationship between the changes in NcGMP, urinary sodium excretions or renal hemodynamics were investigated with direct intrarenal infusion of various doses of ANF. A small dose of ANF (0.03 micrograms/kg/min) increased sodium clearance (CNa) significantly without any appreciable changes in NcGMP, creatinine clearance (Ccr) or renal blood flow (RBF). A larger dose of ANF (0.1 or 0.3 micrograms/kg/min) significantly increased CNa, NcGMP, RBF and Ccr. A net increase in CNa (delta CNa) had a positive correlation with that in NcGMP (delta NcGMP), but the regression line did not pass through the zero point. These findings imply that a larger dose of ANF might effect on glomeruli and gene-rate cGMP to induce natriuresis by raising GFR. However natriuresis induces by a small dose of ANF considered to be caused by the other mechanisms, possibly by the direct or indirect effect of ANF on renal tubules.

Animals↗

[Increased natriuresis in narcotized and waking rats with spontaneous hypertension].

The influence of acute volume-salt loading on renal excretory function and hemodynamics was studied in urethane-anesthetized and conscious immobilized, spontaneously hypertensive rats (SHR) and normotensive Wistar-Kyoto (WKY) rats on osmotic diuresis. The SHR have been shown to response to the intravenous sodium chloride load with exaggerated natriuresis as compared with the WKY group. The increase in natriuresis in the SHR did not depend on diuresis changes but was due to the increased urinary sodium concentration. Blood pressure changes after sodium chloride load were greater in the WKY than in the SHR group, which may be associated with restricted responsiveness of the cardiovascular system in the SHR.

Animals↗

Selective dopamine-1 receptor stimulation produces natriuresis by a direct tubular action.

Fenoldopam mesylate, a selective dopamine-1 (DA-1) receptor agonist, was infused intravenously in 10 normal male subjects in metabolic balance. The study was designed to determine the mechanism of dopamine-induced natriuresis. During fenoldopam infusion renal plasma flow (RPF) and urine flow rate manifested a biphasic response. The RPF rose from 344 +/- 39 to 481 +/- 44 ml/min (P less than 0.05), decreased to control levels, and then rose to 497 +/- 38 ml/min (P less than 0.05). Urinary sodium excretion (UNaV) and fractional excretion of sodium (FENa) demonstrated a sustained increase during DA-1 receptor activation. The FENa rose from 1.6 +/- 0.1 to 2.7 +/- 0.6% (P less than 0.05). Glomerular filtration rate (GFR), blood pressure and heart rate were unchanged. Our results, specifically the dissociation of RPF from UNaV and FENa, demonstrate in man that stimulation of renal tubular DA-1 receptors causes natriuresis.

Adult↗

The effect of atrial natriuretic factor on natriuresis in acutely hypophysectomized saline-loaded rats.

Acute hypophysectomy (a.h.) (i.e. pituitary ablation 120 min prior to the experiment) abolished the ability of anaesthetized rats to excrete sodium following isotonic saline load (4% body weight). The diuretic response remained even slightly increased as compared to control sham-operated animals (s.o.) (maximal UNaV a.h. rats +/- SE: 0.65 +/- 0.10 mumol/min vs maximal UNaV in s.o. rats: 4.54 +/- 0.50 mumol/min). Alpha h-atrial natriuretic factor 1-28 (ANF) in a doses of 3.3 micrograms/animal.40 min restored natriuresis in a.h. rats following isotonic saline load to the level observed in s.o. rats (4.25 +/- 0.64 mumol/min), the change being transient. A decrease of blood pressure to 78.6 +/- 3.21 mm Hg during ANF infusion was followed by a reduction in the natriuretic effect of ANF, while the diuretic effect remained unchanged. Based on own results and literary data it could be suggested that impairment of ANF release or its renal effect are involved in the abolishment of homeostatically effective natriuresis in a.h. animals.

Animals↗

Mechanisms of sodium balance in hypertension: role of pressure natriuresis.

This paper summarizes the role of the renal pressure natriuresis and diuresis mechanisms in maintaining sodium and water balance in hypertension. In all forms of chronic hypertension studied to date, the renal pressure natriuresis and diuresis mechanisms are abnormal, since increased arterial pressure is required to maintain normal excretion of sodium and water, and therefore fluid balance. When renal perfusion pressure is prevented from increasing in various forms of experimental hypertension, caused by infusion of mineralocorticoids, angiotensin II, vasopressin, or norepinephrine and adrenocorticotrophic hormone (ACTH), sodium and water retention continues until ascites, pulmonary oedema and circulatory collapse occur within a few days. Thus, chronic hypertension appears to be an essential homeostatic response that permits sodium and water balance to be maintained despite various abnormalities which tend to decrease renal excretory capability. The intrarenal mechanisms by which increased renal perfusion pressure maintains sodium and water balance in hypertension have not been fully elucidated, but appear to involve small changes in glomerular filtration rate (GFR) and reductions in fractional sodium reabsorption, due either to the direct hydraulic effects of pressure or to various indirect effects, such as changes in angiotensin II formation.

Adrenocorticotropic Hormone↗

[The effects of inhibition of converting enzyme by perindopril on renal hemodynamics and natriuresis in essential arterial hypertension].

Renal hemodynamics and natriuresis have been studied before and 6 hours after oral intake of perindopril (8 mg) in 8 hypertensive patients without renal failure. Then, the patients were treated with perindopril (8 mg per day) and renal hemodynamics was repeated on the fifth day, 6 hours after the morning intake of the substance. Sodium diet was controlled during the study (100 mmol sodium per day). Renal blood flow (RBF) and glomerular filtration rate (GFR) were measured by the clearance method using 131I-hippuran and 125I-iothalamate respectively. The results are as follows: (table; see text) Perindopril produced a potent renal vasodilatation after the first intake and the following days without any change in GFR. A significant decrease in FF was observed indicating that efferent as well as afferent arteriolar vasodilatation was induced. Perindopril produced an increase in natriuresis after the first intake and at D5; this natriuretic effect may be related to the changes in renal hemodynamics inducing a decreased sodium reabsorption in the proximal tubule.

Angiotensin-Converting Enzyme Inhibitors↗

Do diuretics have antihypertensive properties independent of natriuresis?

To ascertain whether diuretics have an antihypertensive effect independent of natriuresis, 12 stable patients on maintenance hemodialysis underwent a crossover evaluation with hydrochlorothiazide, 50 mg daily, metolazone, 5 mg daily, or placebo in 4-wk treatment periods for 6 mo. Compliance was assured by pill counts and serum drug concentrations. All patients had daily urine less than 100 ml. Pre- and postdialysis blood pressure, body weight, plasma volume, and plasma renin activity were monitored. Over the 6-mo study period there were no statistically significant changes in any parameter related to diuretic therapy. It is concluded that a functioning kidney with the ability to respond to diuretics with a natriuresis is necessary for the antihypertensive action of diuretics. Direct vascular effects of diuretics to lower peripheral resistance could not be demonstrated in this unique patient population.

Adult↗

Natriuresis and the renin axis in sodium-sensitive man.

We analysed the blood pressure, natriuretic and hormonal responses of 378 normal volunteers and 198 essential hypertensives after an intravenous infusion of 2 litres of isotonic saline and after a low-sodium diet and furosemide. Those in whom mean arterial blood pressure decreased by greater than 10 mmHg after sodium and volume depletion were considered sodium-sensitive, and those in whom a decrease of less than 5 mmHg was observed were considered sodium-resistant. Sodium-sensitive individuals had lower renin values than those who were resistant to sodium. Both normal and hypertensive sodium-sensitive individuals exhibited an 'exaggerated' natriuresis compared with resistant subjects. Sodium-sensitive subjects exhibited greater aldosterone responses to renin stimulation after volume depletion than resistant subjects. Sodium sensitivity is associated with exaggerated natriuresis as well as tighter coupling between renin and aldosterone. Relative volume expansion could account for the differences observed between sensitive and resistant individuals.

Aldosterone↗

[Role of the natriuretic factor in the phenomenon of "exaggerated natriuresis" in experimental hypertension].

Water and electrolyte excretion after a salt load, plasma natriuretic activity, and sensitivity of the kidneys to the natriuretic factor were studied in experiments on Wistar rats with renal hypertension and on SHR rats with spontaneous hypertension. The "exaggerated natriuresis" phenomenon is observed in animals with hypertension after a salt load. The plasma natriuretic activity in rats with experimental hypertension does not rise in response to an increse in the volume of extracellular fluid. The sensitivity of the kidneys to the natriuretic factor in animals with experimental hypertension is the same as that in the control animals. Consequently, the natriuretic factor has no decisive role in the "exaggerated natriuresis" phenomenon in these types of experimental hypertension.

Animals↗