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At least 811 records · Page 45Linked to original sources
PubMed1996

[Urodilatin (INN: ularitide). A new peptide in the treatment of acute kidney failure following liver transplantation].

UNLABELLED: Acute renal failure (ARF) is a serious complication following liver transplantation. Many therapeutic regimens have been used so far but with limited success. Urodilatin (URO) is a new member of the atrial natriuretic peptide (ANP) family. When administered intravenously, URO induces strong diuresis and natriuresis with tolerable hemodynamic side effects. Preliminary non-controlled clinical studies demonstrate beneficial effects using URO as a therapeutic agent in patients suffering from ARF following heart and liver transplantation (HTx, LTx). These results prompted us to initiate this first controlled clinical trial to investigate whether URO infusion can improve renal function in patients with emerging ARF following LTx. METHOD: We initiated a randomized, double-blind, placebo-controlled study comparing five patients receiving i.v. URO infusion (20 ng/kg bw/min) with four placebo patients after informed consent was obtained. Optional inclusion criteria were oliguria/anuria ( < 0.5 ml/kg/h), refractory to conventional treatment including administration of furosemide and dopamine, increase of serum creatinine to a least 200% of preoperative values, and BUN levels > or = 25 mmol/l. The primary parameters for efficacy was the frequency of hemodialysis/hemofiltration. RESULTS: The frequency of hemodialysis/hemofiltration during URO or placebo infusion was significantly reduced (P = 0.03) in the URO-treated patients in comparison with placebo. BUN levels did not differ between two groups, but serum creatinine levels were consistently lower in the URO group. Diuresis tended to be stronger in the URO group, maintaining high levels despite a significant reduction in the administration of furosemide in comparison with placebo. CONCLUSION: We conclude that URO seems to be a new approach for the treatment of therapy-resistant postoperative ARF following LTx.

Acute Kidney Injury↗
PubMed1999

Shortcomings of diuresis scintigraphy in evaluating urinary obstruction: comparison with pressure flow studies.

BACKGROUND: In at least 15 % of dilated urinary tracts, diuresis renography fails to assess the presence or absence of urinary obstruction. OBJECTIVE: To determine the shortcomings of (99 m)Tc-DTPA frusemide diuresis renography by reference to pressure flow studies. MATERIALS AND METHODS: Thirty-four patients, aged 1 month to 20 years, with questionable obstruction were evaluated by diuresis renography and pressure flow studies (the Whitaker test) as the reference method during the same short period of time. Discrepancies were analysed. RESULTS: In patients with type I or IIIa renographic response, pressure flow studies never led to any change in management. Poor function, major dilatation and prior surgery were found to be risk factors of inaccurately obstructive pattern (type II) on renography (n = 6). In patients with type IIIb response, pressure flow studies could show low-grade (n = 3) or intermittent obstruction (n = 2). Intermittent obstruction was also demonstrated in two patients with type II response. CONCLUSION: In patients with risk factors, type II response was sometimes inaccurate, and urodynamic evaluation showed absence of obstruction and led to conservative management. Type IIIb response should be considered equivocal rather than partially obstructive, and pressure flow studies could be considered in such patients.

Adolescent↗
PubMed1999

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↗
PubMed2006

A randomized controlled trial comparing hydration therapy to additional hemodialysis or N-acetylcysteine for the prevention of contrast medium-induced nephropathy: the Dialysis-versus-Diuresis (DVD) Trial.

Contrast medium-induced nephropathy (CIN) is a serious complication with increasing frequency and an unfavorable prognosis. Previous analyses of surrogate parameters have suggested beneficial effects of hemodialysis that are assessed in this randomized clinical trial. We performed a prospective single-center trial in 424 consecutive patients with serum creatinine concentrations between 1.3- 3.5 mg/dl who underwent elective coronary angiography. Patients were randomized to one of three treatment strategies with all patients receiving pre- and postprocedural hydration: One group received no additional therapy, patients in the second group were hemodialyzed once, and the third group received oral N-acetylcysteine. The frequency of CIN (defined as an increase in serum creatinine>or=0.5 mg/dl) from 48 to 72 h after catheterization was 6.1% in the hydration-only group, 15.9% with hemodialysis treatment, and 5.3% in the N-ACC group (intention-to-treat analysis; P=0.008). There were no differences between the treatment groups with regard to increased (>or=0.5 mg/dl) serum creatinine concentrations after 30-60 days (4.8%, 5.1%, and 3.1%, respectively; P=0.700). Analyses of long-term follow-up (range 63 to 1316 days) by Cox regressions models of the study groups found quite similar survival rates (P=0.500). In contrast to other (retrospective) studies, long-term survival of patients with vs those without CIN within 72 h was not different, but patients who still had elevated creatinine concentrations at 30-60 days suffered from a markedly higher 2-year mortality (46% vs 17%, P=0.002). In conclusion, hemodialysis in addition to hydration therapy for the prevention of CIN provided no evidence for any outcome benefit but evidence for probable harm. Increased creatinine concentrations at 30-60 days, but not within 72 h, were associated with markedly reduced long-term survival.

Acetylcysteine↗
PubMed1996

Changes in the countercurrent system in the renal papilla: diuresis increases pH and HCO3- gradients between collecting duct and vasa recta.

This study was designed to elucidate the acid-base balance local to the collecting duct urine (CD) and vasa recta blood (VR) in the rat renal papilla in diuresis. The pH changes were measured in both a furosemide-induced and a volume-load-induced diuresis, whereas the PCO2 (i.e., CO2 tension) and HCO3- concentration were measured only in a furosemide-induced diuresis. In an antidiuresis, the pH of the VR was more acidic than that of the systemic arterial blood (DeltapH = 0.44-0.73). Additionally, the pH of the ascending VR was significantly lower than that of the descending VR (DeltapH = 0.14-0. 16). In diuresis, the pH of the CD decreased (DeltapH = 0.81-0.97), while the pH of the descending and the ascending VR increased; however, the increase was only significant in the ascending VR (DeltapH = 0.23-0.30). Consequently, the significant difference in the pH gradient between the descending and the ascending VR was eliminated. The PCO2 values in the CD and the ascending VR were not different from those in antidiuresis, while the HCO3- concentration in the CD and the ascending VR, respectively, decreased and increased significantly. Thus, in diuresis, the decrease in the pH of the CD and the increase in the pH of the ascending VR result, respectively, from the decrease and the increase in the HCO3- concentration, with no changes in the PCO2 values.

Animals↗
PubMed2000

Chronic furosemide treatment alters renal responses to furosemide in conscious lambs.

Despite the widespread chronic use of furosemide in the clinical management of a variety of fluid and electrolyte disorders in human infants, the physiological responses to furosemide in the newborn after chronic furosemide treatment are not known. The present experiments were conducted to determine the effects of chronic furosemide treatment on renal responses to acute furosemide challenge in conscious, chronically instrumented lambs. Experiments were carried out on day 1 (before chronic treatment) and on day 7 (after chronic treatment) in lambs given intravenous injections of either furosemide (1 mg/kg per 12 h for 5 days, n=9) or vehicle (0 mg/kg per 12 h for 5 days, n=4). Furosemide-treated animals responded to acute furosemide challenge on day 7 with attenuation of natriuresis and diuresis, and augmentation of kaliuresis compared with responses on day 1. Baseline renin production was elevated, although the renin response to furosemide was similar in chronic furosemide-treated and vehicle-treated lambs. Baseline aldosterone levels were not altered by chronic furosemide treatment, but the aldosterone response to acute furosemide injection was decreased after chronic furosemide treatment. Therefore, chronic furosemide treatment alters renal responses to furosemide in conscious lambs, and alters the aldosterone response to acute furosemide challenge.

Aldosterone↗
PubMed1995

Efficacy of prolonged infusion of urodilatin [ANP-(95-126)] in patients with congestive heart failure.

Urodilatin [ANP-95-126] is a new natriuretic peptide of renal origin not subjected to tolerance in experimental congestive heart failure (CHF). To evaluate its therapeutic potentials in CHF, we investigated the efficacy of a prolonged infusion of urodilatin (15 ng/kg/min for 10 hours) in 12 patients with CHF (New York Heart Association functional classes II and III) in a randomized, double-blind, placebo-controlled study. Urodilatin elevated plasma cyclic guanosine monophosphate (cGMP) concentrations and increased urinary cGMP excretion. Systolic blood pressure (121 +/- 9 mm Hg to 111 +/- 7 mm Hg) and central venous pressure (7.4 +/- 3.3 mm Hg to 5.2 +/- 3.4 mm Hg) decreased significantly, and diastolic blood pressure and heart rate remained unchanged. Urine flow (0.7 +/- 0.6 ml/min to 1.5 +/- .6 ml/min) and urinary sodium excretion (48 +/- 16 mumol/min to 180 +/- 97 mumol/min) were significantly increased. Plasma norepinephrine, renin, aldosterone, and vasopressin were unaltered. The substance was well tolerated. Thus prolonged infusion of urodilatin lowers preload and increases diuresis and natriuresis without neurohumoral activation or adverse side effects, demonstrating a profile of effects that may be beneficial in patients with CHF.

Aged↗
PubMed1986

Disposition of bumetanide in the isolated perfused rat kidney: effects of probenecid and dose response.

The isolated perfused rat kidney was used to study the pharmacokinetic-pharmacodynamic relation of bumetanide and furosemide. Diuresis, as indicated by the concomitant increase in urine volume and fractional excretion of sodium, was produced with both drugs. The action of furosemide was dependent on a high clearance resulting from combined glomerular filtration and tubular secretion. The site of furosemide action was the luminal side of the nephron and a large amount of drug was required in the tubular lumen to produce diuresis. A bidirectional transport of bumetanide was indicated. Although tubular secretion of bumetanide was demonstrated, the action of bumetanide was not dependent on secretion and the highest response was achieved when bumetanide was filtered and partially reabsorbed. The lack of dependency on secretion to produce a response may be indicative of bumetanide reaching its site of action from the luminal as well as the vascular side of the nephron. In the isolated perfused rat kidney, although both drugs had the same pharmacodynamic endpoint, each drug had a different pharmacokinetic profile that characterized its response.

Animals↗
PubMed1986

New approach to disturbances in the plasma sodium concentration.

Hyponatremia and hypernatremia are among the most common electrolyte disorders. Since the plasma sodium level is determined by the ratio between the total quantity of effective solutes (primarily sodium and potassium salts) and the total body water, abnormalities in the plasma sodium level must be produced by a change in one or more of these parameters. In most patients, alterations in body water are of primary importance because the plasma sodium level is normally regulated by changing water intake and water excretion. Measurement of free water excretion has traditionally been calculated by using a formula that includes the urine osmolality. However, urea is a major urinary solute but does not contribute to regulation of the plasma sodium level, since it is an ineffective osmole. As a result, urinary solute excretion is best expressed as 2 X UNa+K. Making this important correction allows solute and water intake and excretion to be compared, thereby leading to a better understanding of both the development and correction of disturbances in the plasma sodium level.

Body Water↗