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PubMed2005

Clinical presentation of type 1 diabetes.

OBJECTIVE: To identify the presenting features of type 1 diabetes in a national incident cohort aged under 15 yr, the duration of symptoms, the occurrence of diabetic ketoacidosis (DKA) at presentation, and the frequency of a family history of diabetes. METHODS: A prospective study was undertaken of incident cases of type 1 diabetes using an active monthly reporting card system from January 1, 1997 to December 31, 1998 in the Republic of Ireland. Follow-up questionnaires were distributed to pediatricians nationally. RESULTS: Two hundred and eighty-three incident cases were identified. Polyuria, polydipsia and weight loss were the main presenting symptoms in all age categories. Nocturnal enuresis was reported in 19% under 5 yr and in 31% aged 5-9.99 yr. Constipation was noted in five patients and in 10.4% under 5 yr of age. The median duration of symptoms was highest in the youngest (under 2 yr) and oldest (10-14.99 yr) age categories. Presentation in moderate/severe DKA occurred in 25% overall and six of nine of those aged under 2 yr. A family history of type 1 diabetes in a first-degree relative was found in 10.2%. CONCLUSIONS: This study confirms the abrupt onset of type 1 diabetes, the absence of a family history, and the importance of the classical symptoms of polyuria, polydipsia, and weight loss in the majority of cases. It reveals secondary enuresis as an important symptom, especially in those under 10 yr, and constipation in the under 5 yr age group. The very young (under 2 yr) are more difficult to diagnose, have more variability of symptom duration, and are more likely to present in moderate/severe DKA. A high index of suspicion aids early diagnosis.

Adolescent↗
PubMed2006

Clinical efficacy of an alpha1A/D-adrenoceptor blocker (naftopidil) on overactive bladder symptoms in patients with benign prostatic hyperplasia.

AIM: We evaluated the efficacy of an alpha1a/d blocker, naftopidil, on storage symptoms in patients with benign prostatic hyperplasia (BPH), using frequency/volume charts (FVC). METHODS: A total of 81 patients with BPH (52-91 years, mean age 69.0 years) were studied. The inclusion criteria were: (i) one or more episode(s) of urinary urgency/day; (ii) a score of eight or more points on the International Prostate Symptom Score (I-PSS); and (iii) three or more points in any of the scores for three items (frequency, nocturia, and urgency) of the I-PSS. The patients received 50-75 mg/day of naftopidil for 6 weeks. All the patients were examined for 2-day FVC before and after the administration of naftopidil. I-PSS, quality of life index, and uroflowmetry were also evaluated. RESULTS: Total I-PSS decreased from 19.1 to 10.5 points (P < 0.0001), with significant improvement of both storage and voiding symptom scores (P < 0.0001, both). The score for urgency decreased from 3.1 to 1.4 (P < 0.0001). Daytime and night-time frequency decreased from 9.3 to 8.0 (P < 0.0001) and from 2.7 to 2.0 (P = 0.0009), respectively. Mean volume/void increased from 174.0 to 188.6 mL (P = 0.0453). Nocturia decreased from 3.2 to 2.3 (P < 0.0001) in 40 patients who suffered from nocturia two times or more. Notably, significant improvement of nocturia was observed in the patients both with and without nocturnal polyuria (P = 0.0006 and 0.0135, respectively). CONCLUSION: The alpha1a/d blocker naftopidil improves not only voiding symptoms but also storage symptoms, and is effective for nocturia in patients with BPH regardless of the existence of nocturnal polyuria.

Adrenergic alpha-Antagonists↗
PubMed1993

Frequency-volume charts: comparison of frequency between elderly and adult patients.

Urinary frequency is a common complaint in the elderly and can be due to many different causes. To clarify the aetiology of frequency, patient-maintained frequency-volume charts were evaluated as a diagnostic tool. We studied 215 patients who complained of frequency. They were divided into 2 groups based on age: 85 were over 65 years of age (elderly group) and 130 were less than 64 years old (adult group). Compared with the adults, elderly patients had a smaller urinary volume during waking hours and a larger volume during sleeping hours, with more frequent episodes of voiding and a smaller volume voided during the latter period. Analysis of the cause of frequency led to the patients being subdivided into 6 diagnostic categories. Among elderly patients, nocturnal polyuria (37%) and an unstable bladder (34%) were frequent causes. In adult patients an unstable bladder (28%) and polyuria due to excessive fluid intake (23%) were most common. As a result of our findings, 108 patients were advised not to be concerned about their micturition and/or restriction of fluid intake. Seventy-six patients (35%) required anticholinergic medication. Frequency-volume charts, together with a detailed medical history, provide useful information on the diagnosis and treatment of frequency.

Adolescent↗
PubMed2005

Classification of nocturia in the adult and elderly patient: a review of clinical criteria and selected literature.

Nocturia increases with age and significantly affects quality of life in both men and women. Attempts to determine the pathogenesis of nocturia have been based on frequency-volume charts, and three types of nocturia have been identified: low voided volume (previously termed low bladder capacity), nocturnal polyuria, and mixed origin. Validated clinical criteria based on frequency-volume data allow the type of nocturia to be specified using two threshold values, i.e. largest voided volume/body weight ratio <4 mL/kg for low voided volume; and nocturnal urinary output/body weight ratio >10 mL/kg for nocturnal polyuria. The utility of these thresholds was validated in a study of elderly patients with two or more nocturia episodes/night. Two other studies have improved the understanding of the epidemiology of nocturia. The first showed that in men and women, increased incidence with age was greater for nocturia than for the six other common lower urinary tract symptoms. The second study suggested that prostate changes in men (particularly bladder outlet obstruction caused by benign prostatic hyperplasia, which has been considered to be a major cause of nocturia) appear to play a relatively small role in the development of nocturia; the correlation was based on overall symptom score for seven common urological symptoms. Nocturia should thus be treated independently of other lower urinary tract symptoms, especially in men. The application of valid diagnostic criteria to differentiate the underlying cause of nocturia should help lead to more appropriate and effective management of this pervasive problem.

Adult↗
PubMed1992

Effects of experimental potassium depletion on renal function and urinary prostanoid excretion in normal women during moderate anti-diuresis.

The hypothesis that potassium depletion (KD) might play a role in stimulating the renal synthesis of prostanoids, and that these materials can contribute to hypokalaemic renal dysfunction, has been tested. Healthy women were studied either in normal potassium balance (N,n = 14), or in experimental KD. KD was induced by low dietary potassium intake (less than or equal to 10 mmol day-1) and natriuretic treatment, associated with replacement of net NaCl and water loss. By using different depletive patterns, two groups with estimated cumulative potassium deficits of 160 +/- 43 mmol (KD1, n = 8) and 198 +/- 22 mmol (KD2, n = 6), respectively, were obtained. Renal function by the clearance (cl.) method and urinary PGE2, 6-keto-PGF1 alpha, TxB2 concentrations by the RIA method were measured during hypotonic polyuria (oral water load) and subsequent moderate antidiuresis induced by the infusion of low-dose lysine-8-vasopressin (LVP). Compared to the N group, only in the KD2 group do glomerular and tubular dysfunctions typical of hypokalaemia and reduced prostanoid excretions (significant for 6-keto-PGF1 alpha and TxB2 but not for PGE2) appear during polyuria besides the significant reductions of plasma potassium concentration, urinary potassium excretion and the significant increase in plasma renin activity. During LVP infusion the urinary prostanoid excretions were all significantly lower in absence of significant differences in urinary flow rate. Concerning its renal effects, LVP lost its ability to reduce the creatinine cl., while expressing a trend towards reduction in fractional chloride excretion. Indomethacin pretreatment restored the LVP effect on creatinine cl. and increased the antichloruretic LVP effect (although not significantly). To the extent that urinary prostanoid excretions reflect their intrarenal synthesis, our data demonstrate that KD inhibits this biosynthesis. A depressed production of prostanoids endowed with vasodilating and chloruretic activity probably played a role in attenuating the renal vascular hyporeactivity and the urinary chloride dispersion induced by KD.

Adult↗
PubMed1996

Effective role of the renin-angiotensin system in the control of prostanoid synthesis and renal function in healthy women with moderate salt depletion.

The interaction between moderate salt depletion and urinary excretions of prostanoids (PGE2,6-keto-PGF1 alpha and TxB2), as well as the effective role of the activated renin-angiotensin system (RAS), in the control of renal function and urinary prostanoid excretions have been investigated in healthy women. Salt depletion (SD, n = 8) was induced by low sodium chloride dietary intake (< or = 60 mmol per day) and combined treatment with natriuretic and potassium sparing drugs. The cumulative sodium deficit was 381 +/- 55 mmol. The renal function and urinary excretion of prostanoids were evaluated during hypotonic polyuria (oral water load) and subsequent moderate antidiuresis (lysine-8-vasopressin (LVP) low-dose infusion). Basal plasma renin activity (PRA) and urinary aldosterone excretion were determined, before the water load, in both the SD group and control studies in normal balance of sodium and potassium (N, n = 20). Paired studies were performed in the absence and in the presence of enalapril in the same SD group, as well as in a subgroup, with normal sodium and potassium balance, previously studied (N3, n = 6). In the SD vs. N group, significantly higher values of PRA and urinary aldosterone excretion were found. The renal antinatriuretic mechanism was activated and the diuretic response to water load depressed. During polyuria, the urinary 6-keto-PGF1 alpha and TxB2 excretions were significantly higher, probably reflecting an increase in the renal synthesis of their precursors. During the late LVP infusion, the urinary PGE2 excretion was also significantly increased, in absence of significant differences in urinary flow rate. In both SD and N3 groups, enalapril decreased the mean arterial pressure (MAP). Despite the decrease in MAP, not significantly different in SD vs. N3 group, the drug did not significantly affect the creatinine clearance. Also, the urinary prostanoid excretions were not significantly affected by enalapril. However, in the SD group, but not in the N3 group, the drug was effective in significantly decreasing the absolute and fractional excretions of sodium and chloride. Moreover, the plasma potassium concentration significantly decreased, despite the concurrent decrease in urinary potassium excretion. The data suggest that: (1) in salt depletion, the prostanoid release from the renal cortical structures was stimulated; (2) the renal prostanoid synthesis, either activated (sodium depletion) or not (normal sodium and potassium balance), was not affected by the RAS pharmacological blockade in the short-term; (3) in salt depletion, the RAS blockade recruited a homeostatic mechanism responsible for the improved renal salt conservation, as well as for the redistribution of potassium between the extra- and intra-cellular compartments.

Adult↗
PubMed2004

Extracellular calcium antagonizes forskolin-induced aquaporin 2 trafficking in collecting duct cells.

BACKGROUND: Urinary concentrating defects and polyuria are the most important renal manifestations of hypercalcemia and the resulting hypercalciuria. In this study, we tested the hypothesis that hypercalciuria-associated polyuria in kidney collecting duct occurs through an impairment of the vasopressin-dependent aquaporin 2 (AQP2) water channel targeting to the apical membrane possibly involving calcium-sensing receptor (CaR) signaling. METHODS: AQP2-transfected collecting duct CD8 cells were used as experimental model. Quantitation of cell surface AQP2 immunoreactivity was performed using an antibody recognizing the extracellular AQP2 C loop. Intracellular cyclic adenosine monophosphate (cAMP) accumulation was measured in CD8 cells using a cAMP enzyme immunoassay kit. To study the translocation of protein kinase C (PKC), membranes or cytosol fractions from CD8 cells were subjected to Western blotting using anti-PKC isozymes antibodies. The amount of F-actin was determined by spectrofluorometric techniques. Intracellular calcium measurements were performed by spectrofluorometric analysis with Fura-2/AM. RESULTS: We demonstrated that extracellular calcium (Ca2+ o) (5 mmol/L) strongly inhibited forskolin-stimulated increase in AQP2 expression in the apical plasma membrane. At least three intracellular pathways activated by extracellular calcium were found to contribute to this effect. Firstly, the increase in cAMP levels in response to forskolin stimulation was drastically reduced in cells pretreated with Ca2+ o compared to untreated cells. Second, Ca2+ o activated PKC, known to counteract vasopressin response. Third, quantification of F-actin demonstrated that Ca2+ o caused a nearly twofold increase in F-actin content compared with basal conditions. All these effects were mimicked by a nonmembrane permeable agonist of the extracellular CaR, Gd3+. CONCLUSION: Together, these data demonstrate that extracellular calcium, possibly acting through the endogenous CaR, antagonizes forskolin-induced AQP2 translocation to the apical plasma membrane in CD8 cells. In hypercalciuria, this mechanism might blunt water reabsorption and prevent further calcium concentration, thus protecting against a potential risk of urinary calcium-containing stone formation.

Actins↗
PubMed1999

Atrial natriuretic peptide levels in geriatric patients with nocturia and nursing home residents with nighttime incontinence.

OBJECTIVES: To determine if nocturnal polyuria in geriatric patients with nocturia and nocturnal incontinence is associated with elevated plasma atrial natriuretic peptide (ANP) levels. DESIGN: Case series. SETTING: Four nursing homes and two board and care facilities. PARTICIPANTS: Fifty-four nursing home residents and 26 board and care residents with a mean age of 86. MEASUREMENTS: Daytime (7:00 a.m. to 7:00 p.m.) and nighttime (7:00 p.m. to 7:00 a.m.) urine volumes of incontinent nursing home residents were measured over 3 days and 3 nights by reweighing preweighed adults diapers and toileting inserts emptied by research staff for the board and care group. Blood was drawn in the early morning (5:00 a.m. to 7:00 a.m.) before subjects arose and in the evening after an hour of lying in bed (8:00 p.m. to 11:00 p.m.), and plasma ANP levels were determined by radioimmunoassay. RESULTS: Forty-nine (61%) of the subjects had nocturnal polyuria as defined by night/total urine volume ratios > or = 50%. There was no significant difference between those with night/total ratios > or = 50% versus < 50% in plasma levels of ANP in the early morning (44.2+/-33.3, median 35.7 pg/mL vs 40.9+/-39.2, median 28.5; P = .36 by Mann Whitney U) or in the evening (43.4+/-28.8, median 36.4 pg/mL vs 49.6+/-53.1, median 34.4; P = .58). Nor was there any significant correlation between night/total urine volume ratio and morning or evening ANP levels (r = .01, P = .96 and r = .23, P = .31, respectively). CONCLUSIONS: In this sample of geriatric patients with nocturia and nursing home residents with nighttime urinary incontinence, ANP levels were elevated, but increased nighttime urine production was not associated with higher levels. Because of the variability in ANP levels, our power to detect such an association was low, and we cannot draw any definitive conclusions. Although high plasma ANP levels are unlikely to be a primary cause of nocturia and nighttime incontinence, they may, when combined with other factors such as low antidiuretic hormone levels, sleep disorders, and low functional bladder capacity, contribute to these symptoms in some geriatric patients.

Aged↗
PubMedDate not supplied

Bedwetting--not always what it seems: a sign of sleep-disordered breathing in children.

ISSUES AND PURPOSE: Nocturnal enuresis (bedwetting) can linger long into childhood. Sleep research has documented that nocturia and bedwetting are symptoms of obstructive sleep apnea (OSA) in adults and that bedwetting is predictive of OSA in children. CONCLUSIONS: Nocturnal polyuria is a cardiovascular response to negative pressure breathing (inspiration against a closed glottis), which is characteristic of OSA. PRACTICE IMPLICATIONS: Evidence of nocturnal polyuria and sleep-disordered breathing are important signs of OSA, a serious but treatable condition.

Adult↗
PubMed1987

Type I (insulin dependent) diabetes: a disease of slow clinical onset?

Type I (insulin dependent) diabetes is usually believed to present acutely and it is assumed that metabolic decompensation is sudden. In a prospective family study, however, 10 of 13 subjects developing the disease showed progressive or intermittent development of hyperglycaemia over many months and the others had non-specific symptoms over a long period. All were first degree relatives of a child with type I diabetes; 10 were siblings (aged 5-24) and three were parents (aged 45-58). All possessed HLA-DR4 or DR3, or both, and all but two had been positive for islet cell antibodies for six to 86 months before diagnosis. Ten had non-specific symptoms for two to 14 months before the onset of thirst and polyuria; one remained asymptomatic even when insulin became necessary. Six subjects had an oral glucose tolerance test before clinical onset, of whom five were diabetic by World Health Organisation criteria four, four, six, seven, and 21 months before insulin was needed. Nine showed random blood glucose concentrations above the 97.5th centile (6.3 mmol/l) six to 34 months (median 12) before diagnosis. Two others had a glucose tolerance test result compatible with diabetes but had not reached the stage of needing insulin. Hyperglycaemia is often of insidious onset in type I diabetes, even in children and young adults. Diagnosis will inevitably be late if considered only when acute symptoms of thirst and polyuria develop.

Adolescent↗
PubMed1998

Hyperosmolar nonketotic coma precipitated by lithium-induced nephrogenic diabetes insipidus.

A 45-year-old man, with a 10-year history of manic depression treated with lithium, was admitted with hyperosmolar, nonketotic coma. He gave a five-year history of polyuria and polydipsia, during which time urinalysis had been negative for glucose. After recovery from hyperglycaemia, he remained polyuric despite normal blood glucose concentrations; water deprivation testing indicated nephrogenic diabetes insipidus, likely to be lithium-induced. We hypothesize that when this man developed type 2 diabetes, chronic polyuria due to nephrogenic diabetes insipidus was sufficient to precipitate hyperosmolar dehydration.

Antimanic Agents↗
PubMed1992

Reversibility of renal tubular dysfunction in streptozotocin-induced diabetes in the rat.

Enzymuria and specific proteinuria were examined over a period of 19 days in 4 groups of 5 rats: a control group, a nondiabetic polyuric group, a group of streptozotocin-induced diabetic rats treated with insulin as of the 10th day after the injection of the drug, and a similar group of untreated diabetic rats. Increased urinary excretion of beta-N-acetyl-D-glucosaminidase, lactate dehydrogenase, and alanine aminopeptidase was observed shortly after the induction of diabetes. It was partly or totally reversible following insulin treatment. Nondiabetic polyuria had a slight effect on the excretion of alanine aminopeptidase only. The urinary excretion of beta 2-microglobulin also rapidly increased after the onset of diabetes to a level approximately 50 times the control values. This effect was largely reversible with insulin treatment and was absent in the nondiabetic polyuric group. A small but significant 3-fold increase in albumin excretion was also noted but was not affected by insulin treatment. We conclude that streptozotocin-induced diabetes causes an early tubular dysfunction that is unrelated to polyuria and is reversible upon insulin treatment. This tubular dysfunction is best revealed by the urinary excretion of the low molecular weight protein beta 2-microglobulin. Our results suggest that it would be of interest to further examine the usefulness of sensitive markers of tubular dysfunction, especially low molecular weight proteinuria, in the detection of early stages of diabetic nephropathy.

Animals↗
PubMed1993

Hormonal, fluid, and electrolyte responses of sheep during chronic intravenous infusion of epidermal growth factor.

Epidermal growth factor (EGF) has been shown to increase water intake and urine volume. To further characterize these responses the effects of EGF on fluid balance, electrolyte, and hormone profiles were examined. After an 8-day control period, ewes received intravenous EGF at doses of 0 (n = 6), 2 (low dose, n = 6), 10 (medium dose, n = 6), or 20 micrograms/h (high dose, n = 5) for 4 days. During EGF treatment, water intake and urine volume increased (both P < 0.001) in a dose-related fashion, although fluid balance was unaffected. Feed intake and fecal dry matter output were reduced (both P < 0.001) by the two higher doses of EGF. EGF had no effect on plasma potassium, sodium, or osmolality, but there was a dose-related natriuresis (P < 0.001). Treatment with EGF increased plasma renin activity and aldosterone in the medium and high dose groups (both P < 0.001). Thus chronic intravenous infusion of 10-20 micrograms EGF/h into sheep caused polydipsia, polyuria, and natriuresis with neutral fluid balance. Whether the resultant polydipsia or polyuria was the primary response to EGF remains unclear.

Animals↗
PubMed2006

Leptospirosis leads to dysregulation of sodium transporters in the kidney and lung.

Leptospirosis is a public health problem worldwide. Severe leptospirosis manifests as pulmonary edema leading to acute respiratory distress syndrome and polyuric acute renal failure (ARF). The etiology of leptospirosis-induced pulmonary edema is unclear. Lung edema clearance is largely affected by active sodium transport out of the alveoli rather than by reversal of the Starling forces. The objective of this study was to profile leptospirosis-induced ARF and pulmonary edema. We inoculated hamsters with leptospires and collected 24-h urine samples on postinoculation day 4. On day 5, the animals were killed, whole blood was collected, and the kidneys and lungs were removed. Immunoblotting was used to determine expression and abundance of water and sodium transporters. Leptospirosis-induced ARF resulted in natriuresis, lower creatinine clearance, and impaired urinary concentrating ability. Renal expression of the sodium/hydrogen exchanger isoform 3 and of aquaporin 2 was lower in infected animals, whereas that of the Na-K-2Cl cotransporter NKCC2 was higher. Leptospirosis-induced lesions, predominantly in the proximal tubule, were responsible for the polyuria and natriuresis observed. The polyuria might also be attributed to reduced aquaporin 2 expression and the attendant urinary concentrating defect. In the lungs, expression of the epithelial sodium channel was lower, and NKCC1 expression was upregulated. We found that leptospirosis profoundly influences the sodium transport capacity of alveolar epithelial cells and that impaired pulmonary fluid handling can impair pulmonary function, increasing the chance of lung injury. Greater knowledge regarding sodium transporter dysregulation in the lungs and kidneys can provide new perspectives on leptospirosis treatment.

Acute Kidney Injury↗
PubMed2003

Altered expression of major renal Na transporters in rats with bilateral ureteral obstruction and release of obstruction.

Urinary tract obstruction impairs urinary concentrating capacity and reabsorption of sodium. To clarify the molecular mechanisms of these defects, expression levels of renal sodium transporters were examined in rats with 24-h bilateral ureteral obstruction (BUO) or at day 3 or 14 after release of BUO (BUO-R). BUO resulted in downregulation of type 3 Na+/H+ exchanger (NHE3) to 41 +/- 14%, type 2 Na-Pi cotransporter (NaPi-2) to 26 +/- 6%, Na-K-ATPase to 67 +/- 8%, type 1 bumetanide-sensitive Na-K-2Cl cotransporter (BSC-1) to 20 +/- 7%, and thiazide-sensitive cotransporter (TSC) to 37 +/- 9%. Immunocytochemistry confirmed downregulation of NHE3, NaPi-2, Na-K-ATPase, BSC-1, and TSC. Consistent with this downregulation, BUO-R was associated with polyuria, reduced urinary osmolality, and increased urinary sodium and phosphate excretion. BUO-R for 3 days caused a persistant downregulation of NHE3 to 53 +/- 10%, NaPi-2 to 57 +/- 9%, Na-K-ATPase to 62 +/- 8%, BSC-1 to 50 +/- 12%, and TSC to 56 +/- 16%, which was associated with a marked reduction in the net renal reabsorption of sodium (616 +/- 54 vs. 944 +/- 24 micromol x min-1 x kg-1; P < 0.05) and phosphate (6.3 +/- 0.9 vs. 13.1 +/- 0.4 micromol x min-1. kg-1; P < 0.05) demonstrating a defect in renal sodium and phosphate reabsorption capacity. Moreover, downregulation of Na-K-ATPase and TSC persisted in BUO-R for 14 days, whereas NHE3, NaPi-2, and BSC-1 were normalized to control levels. In conclusion, downregulation of renal Na transporters in rats with BUO and release of BUO are likely to contribute to the associated urinary concentrating defect, increased urinary sodium excretion, and postobstructive polyuria.

Animals↗
PubMed1981

Cisplatin nephrotoxicity in rats: defect in papillary hypertonicity.

We examined the effects of cisplatin (5 mg/kg BW) on renal function in rats. Three days after administration of cisplatin whole kidney clearance of inulin fell and 24-h urine volume increased. Maximal urine osmolality and papillary solute content were reduced. Superficial nephron glomerular filtration rate measured along the proximal tubule, where no leak of inulin could be demonstrated, was reduced in cisplatin-treated animals. Differences between superficial nephron glomerular filtration rate determined in proximal and distal tubules were greater in cisplatin-treated rats than in control rats. Neither a change in fluid or sodium movement along superficial nephrons nor a reduced early distal tubule transepithelial sodium gradient explain the polyuria. Urea was reabsorbed from, not added to, the loop fluid in cisplatin-treated animals. Morphologic changes were evident in the S3 segment of the proximal tubule in cisplatin-treated animals but the glomeruli were normal. Polyuria occurred despite diminished glomerular filtration rate in cisplatin nephrotoxicity. The diminished concentration of salt and urea in the papilla as a result of abnormal function of the collecting duct or pars recta portion of the proximal tubule contributed to the defect in concentrating ability.

Acute Kidney Injury↗
PubMed1999

Reduced abundance of aquaporins in rats with bilateral ischemia-induced acute renal failure: prevention by alpha-MSH.

We examined the effect of temporary renal ischemia (30 min or 60 min) and reperfusion (1 day or 5 days) on the expression of renal aquaporins (AQPs) and urinary concentration in rats with bilateral ischemia-induced acute renal failure (ARF). Next, we tested whether reducing ischemia/reperfusion (I/R) injury by treatment with alpha-melanocyte stimulating hormone (alpha-MSH) affects the expression of AQPs and urine output. Rats with ARF showed significant renal insufficiency, and urinary concentration was markedly impaired. In rats with mild ischemic injury (30 min), urine output increased significantly to a maximum at 48 h, and then nearly normalized within 5 days. Consistent with this, semiquantitative immunoblotting revealed that kidney AQP1 and AQP2 abundance was significantly decreased after 24 h to 30 +/- 5% and 40 +/- 11% (n = 8) of controls (n = 9), respectively (P < 0.05). Five days after ischemia, AQP2 abundance was not significantly decreased and urine output was normalized. In contrast, severe ischemic injury (60 min) resulted in a marked reduction in urine output at 24 h, despite a significant decrease in urine osmolality and solute-free water reabsorption, T(c)H(2)O. AQP1 and AQP2 abundance was markedly decreased to 51 +/- 5% and 31 +/- 9% (n = 10) of controls (n = 8) at 24 h (P < 0.05). After 5 days, the rats developed gradually severe polyuria and had very low AQP2 and AQP1 levels [11 +/- 4% and 6 +/- 2% (n = 5) of controls (n = 8), respectively; P < 0.05]. A similar reduction was observed for AQP3. The reduction in AQP expression in the proximal tubule and inner medullary collecting duct was confirmed by immunocytochemistry. Next, we found that intravenous alpha-MSH treatment of rats with ARF significantly reduced the ischemia-induced downregulation of renal AQPs and reduced the polyuria. In conclusion, the I/R injury is associated with markedly reduced expression of the collecting duct and proximal tubule AQPs, in association with an impairment of urinary concentration. Moreover, alpha-MSH treatment significantly prevented the reduction in expression of AQPs and renal functional defects. Thus decreased AQP expression is likely to contribute to the impairment in urinary concentration in the postischemic period.

Animals↗
PubMed1995

Xanthopterin-induced renal dysfunction: a reversible model of crystal nephropathy.

Xanthopterin (XPT), an unconjugated pteridine compound, affects cell growth and differentiation. When injected into rats, XPT has caused changes that have been interpreted as renal growth and hypertrophy. In the present study, we investigated the effect of intraperitoneal administration of XPT on the renal function in the rat. XPT administration was associated with polyuria and a reversible form of nonoliguric acute renal failure (ARF), with renal function declining maximally after 2 days and returning to normal after 7 days. The polyuria was due, at least in part, to a concentrating defect that was vasopressin resistant. The ability of XPT to induce ARF was modulated by dietary salt intake, being enhanced by a low-sodium diet and prevented by a high sodium intake. Histological examination of the kidneys showed intratubular crystal deposition and acute tubule necrosis, suggesting that XPT induces crystal nephropathy. There was an increase in wet and dry weights of the kidney and an increased DNA/protein ratio, compatible with a hyperplastic response. Because the severity of other crystal nephropathies may be modulated by urine flow rate and pH, we studied the ability of water diuresis or alkaline diuresis to protect against XPT-induced ARF. Both water diuresis and HCO3 loading blunted the ability of XPT to decrease renal function. The change in renal function induced by XPT in the various groups was paralleled by corresponding changes in the levels of XPT-like substances in the kidney and by the amount of crystal deposition. Thus, XPT injection induces crystal nephropathy, the severity of which can be modulated by dietary salt intake, urine pH, and urine flow rate.

Acute Kidney Injury↗