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There are clinical situations that may preclude the use of retrograde pyelography and renal arteriography in the differential diagnosis of the absent, dysgenetic and non-functioning kidney. At times these procedures are non-diagnostic. We present 8 cases to demonstrate the efficacy of selective renal phlebography as an aid in the diagnosis of these entities.
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The purpose of the present study was to examine the effect of the alpha 2-adrenoceptor antagonists yohimbine and idazoxan on kidney function in intact Sprague-Dawley rats and in Brattleboro rats with familial hypothalamic diabetes insipidus. Both drugs, injected intravenously at 0.5 mg/kg, led to a marked decrease of urine flow, sodium, potassium and chloride excretion in both strains of rats. Glomerular filtration rate and effective renal plasma flow did not change significantly in either strain. The study demonstrates that the alpha 2-adrenoceptor antagonists induce an antidiuretic effect without changes in renal hemodynamics. Antidiuretic hormone does not play a role in yohimbine- or idazoxan-induced antidiuresis. The data suggest a role for alpha 2-adrenoceptors in the renal tubular handling of water and salt.
In a group of 20 patients the influence of continuous positive-pressure Ventilation (PEEP) on cardiac output, kidney function and renal and intrarenal hemodynamics was investigated. During ventilation with PEEP 10 ccm H2O a reduction of cardiac output, glomerular filtrationrate, sodium excretion and urinary output was observed. Renal blood flow, especially the cortical fraction, also decreased. Dopamine infusion, in a dose of 4 ng.kg-1.min-1, during continuous PEEP-ventilation, induced an increase of cardiac output, glomerular filtrationrate, renal sodium excretion and diuresis. The decreased renal cortical perfusion particularly was improved by Dopamine application.
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The presence in the mammalian kidney of NPY and at least one of its receptor subtypes has been proven by several independent methodologies. Also, numerous studies using physiological and pharmacological approaches indicated that this peptide has the capacity to alter renal function. In particular, these studies suggest that NPY may exert renal vasoconstrictor and tubular actions that are species dependent, and may also influence renin secretion by the kidney. The question whether NPY plays an important role in the physiological regulation of renal hemodynamics and electrolyte excretion, remains largely unanswered at present. No major impairments in renal function have been reported in genetically models deficient in NPY or its Y1 receptor. Thus, additional studies are required to elucidate the role of NPY in the physiological and pathophysiological regulation of renal function.
The influence of normal (100%), reduced (50%), or increased doses (200%) of mineral content in food on selected kidney functions and on serum values of calcium, magnesium, phosphate and osmolality was tested in cattle (n = 6; age: 3-5 1/2 years; metabolic body mass: 106-132 kg0.75; non-pregnant, non-lactating) over 7 weeks. During the 19-day period of reduced mineral supply glomerular filtration rate, urine osmolality, 24-hour urine creatinine amount and serum electrolyte concentrations (exception: total magnesium) remained without significant deviations from the initial physiological values. In contrast to these results, the values of 24-hour urine volume, 24-hour urine osmolyte, serum/urine-ratio of creatinine, FECa and FEMg were significantly reduced. During the 15-day feeding period with over-supply of minerals the parameters 24-hour urine volume, serum/urine-ratio of creatinine, FECa, FEMg and FEPhosphate rose significantly. The proven influence of the supply with minerals on the renal electrolyte elimination can be used for the diagnosis of disturbances of mineral-feeding in "kidney-healthy" cattle.
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At the onset of diabetes mellitus, the glomerular filtration rate becomes supranormal. Discovery science has identified many abnormalities in the early diabetic kidney that apparently contribute to this phenotype. A serviceable understanding of the early diabetic kidney requires this information to fit together. It is the purpose of this article to present an archetype that explains multiple nuances of kidney function in early diabetes. We refer to this archetype as the "tubular hypothesis of glomerular filtration." Its basic tenet is that strange effects of diabetes on glomerular filtration stem from primary effects on the proximal tubule or loop of Henle that impact glomerular filtration by feedback through the macula densa. This theory can explain diabetic hyperfiltration, a paradoxical effect of dietary salt on glomerular filtration rate in diabetes, and the renal response to dietary protein and amino acid infusion in diabetes. The discussion centers on the kidney as an integrated system of parts rather than on the specific cellular mechanisms that comprise those parts.
OBJECTIVE: Renal scarring and renal failure remain life-threatening for children born with spinal dysraphism. We reviewed our data of spina bifida patients to evaluate whether optimal treatment of the neurogenic bladder from birth onwards can preserve kidney function. METHODS: We reviewed data on all newborns with spinal dysraphism who were referred to our hospital between January 1988 and June 2001. We looked at their situations at referral and at follow-up: the type of treatment, antimuscarinic agents, clean intermittent catheterisation (CIC), antibiotic prophylaxis, and operations (sling procedures, bladder augmentations, antireflux procedures). Renal function (ultrasound, DMSA scan, serum creatinin, creatinin clearance) and bladder function (urodynamic studies) were evaluated over time. RESULTS: Data of 144 children of 176 could be evaluated by the end of the study: 5 patients had pre-existing renal abnormalities, 69 had an overactive sphincter, 27 had reflux, and six had renal scarring. None are currently developing end-stage renal disease. All patients with spina bifida aperta started CIC and antimuscarinic therapy shortly after birth. Five of the six patients with renal scarring were started on therapy with intermittent catheterisation and antimuscarinic therapy several months after birth. Sixty-three of 82 children with spina bifida were dry at school age (age six), although 37 of these had not had an operation. CONCLUSION: We show that an early start to therapy helps to safeguard renal function for children born with spina bifida. Our data support other recent reports that children born with spina bifida can probably use their own kidneys for a lifetime, if they are given adequate urological treatment. To protect the upper urinary tract, we need to ensure low intravesical pressure by starting children early on CIC (the preferred treatment); antimuscarinic agents to counteract detrusor instability are indispensable in most cases. Proactive treatment of risks for upper tract deterioration results in a negligible loss of renal function, even when early urinary continence is included in the treatment protocol.