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PubMed1994

Interactions between the renin-angiotensin system and prostanoids in modulating renal function in potassium-depleted healthy women.

Plasma renin activity (PRA) and urinary aldosterone excretion were determined in healthy women with normal potassium balance (N, n = 20) or experimental potassium depletion (KD). KD was induced by natriuretic treatment--associated with replacement of net NaCl and water losses--and low dietary potassium intake (< or = 10 mmol/d). By using different depletion patterns, three groups were obtained with cumulative potassium deficits (mean +/- SEM) of 160 +/- 43 (KD1, n = 8), 198 +/- 22 (KD2, n = 6) and 215 +/- 54 mmol (KD3, n = 6). The renal function by the clearance (cl.) method and urinary concentrations of prostaglandin E2 (PGE2), 6-keto-PGF1 alpha (6KPGF), and thromboxane B2 (TXB2) by the RIA method were estimated during hypotonic polyuria (oral water load) and subsequent moderate antidiuresis induced by low-dose infusion of lysine-8-vasopressin (LVP). 1. In all KD groups the depletion treatment significantly reduced both potassium plasma concentration (PK) and urinary potassium excretion while it increased basal PRA; the basal urinary aldosterone excretion was not significantly different from normokalemic controls. In the KD3 vs KD1 group the P kappa value was significantly lower. 2. In both KD2 and KD3 groups as compared to the N group, several hypokalemic-like renal dysfunctions--absent in the KD1 group--occurred. Particularly, in the KD2 + KD3 vs N group the renal ability in both urine diluting (water load) and concentrating (LVP infusion) was significantly impaired.(ABSTRACT TRUNCATED AT 250 WORDS)

6-Ketoprostaglandin F1 alpha↗
PubMed2005

[Pituitary tuberculosis: a case report].

Through a case of sellar and suprasellar tuberculoma which presented with central diabetes insipidus, the authors report the frequency of pituitary tuberculoma, its physiopathology, clinical presentation hormonal and radiological findings thus management and evolution. A 42 years old woman, with a history of erythema nodosum, presented with polyuria polydipsia (PUPD), amenorrhea and galactorrhea. Endocrine investigations showed central diabetes insipidus, elevated serum prolactin levels and cortisol failure. Magnetic resonance imagining scans (MRI) revealed a nodular thickening of the pituitary enlargement and loss of posterior pituitary hypointensity signal. Etiologic inquiry has removed the diagnosis of sarcoidosis, Langerhan's histosis, autoimmune hypophysitis and sellar metastasis. The history of erythema nodosum, the positivity of tuberculin skin test and the presence of koch bacillus in the bronchial fluid after culture led to a diagnosis of tuberculosis. Treatment was started with four drug antitubercular chemotherapy regimen for 2 months, and tow drug antitubercular chemotherapy regimen for 16 months. This treatment is associated with hydrocortisone, desmopressin nasal spray and bromocriptine. Under treatment, there was an improvement in clinical condition, disapearence of headache, PUPD and galactorrhea thus normalization of prolactin. A follow-up MRI, 8 months later, showed that pituitary lesion has been completely removed, suggesting our clinical and biology presumption. Pituitary tuberculosis is rare, however, when encountered, they may present a diagnostic difficulty. Accurate diagnosis and management is important because pituitary tuberculoma is curable.

Adult↗
PubMed1997

A comparison of polydipsia prevalence among chronic psychiatric patients using three measurement approaches.

Many previous prevalence studies of polydipsia (PD) have utilized single and often non-biologic measures. In this study we estimated prevalence using specific gravity of urine (SPGU), normalized diurnal weight gain (NDWG), and staff identification (staff ID). Agreement between these two biologic and one behavioral measure was assessed. A total of 572 psychiatric inpatients were assessed for SPGU and NDWG. Unit staff were asked to identify PD patients. Positive and negative PD groups were formed separately based on the SPGU, NDWG, and staff ID data. All three measures were collected on the same day. Prevalence data for the biologic measures varied. The estimate for PD by SPGU (< 1.009 cutoff) was higher (43.4% of sample) than that of NDWG (> 2.5%; 25.4%) or staff ID (21.4%). These prevalence rates did not change substantially after exclusion of medical causes of polyuria. Agreement, assessed by the kappa statistic, was uniformly low among the measures. Weak association between the measures reflects their multidetermined, nonspecific nature, and highlights the lack of a diagnostic standard in the field. The observed prevalence rates must be considered rough approximations. Associations between the measures and certain subject characteristics suggest the measures may identify different types of potential PD patients. These different types of patients are discussed, as are other issues in the measurement of PD. The data suggest estimates of PD are a function of the type of measure used as even biologic measures vary greatly.

Adult↗
PubMed2003

Enhanced effects of central angiotensin II on cardiovascular and drinking responses in inbred polydipsic (STR/N) mice.

STR/N, an inbred strain of mice, is known to exhibit extreme polydipsia and polyuria. The objective of this study was to investigate the possible reasons for polydipsia. First, comparisons were made between STR/N mice and control mice from the Institute of Cancer Research (ICR) concerning daily drinking, urinary excretion, and basal cardiovascular function. Then, since angiotensin II (ANG II) is a potent stimulus for drinking behavior, we investigated the effects of intracerebroventricular (i.c.v.) administration of ANG II on cardiovascular and water intake responses. Daily water intake, food intake, urinary volume, and urinary electrolytes (Na and K) excretion were larger in STR/N mice than in ICR mice, and the basal blood pressure was significantly lower in STR/N mice than in ICR mice. The i.c.v. administration of ANG II (10 pmol/per mouse) resulted in increased mean arterial blood pressure (MAP) and water intake in both STR/N and ICR mice, but the changes in MAP were significantly larger in STR/N mice than in ICR mice. These results suggest that polydipsia in STR/N mice is at least partially attributable to high sensitivity of central ANG II receptors and low MAP.

Angiotensin II↗
PubMed1996

Conn syndrome in a child, caused by adrenal adenoma.

Hyperaldosteronism owing to aldosterone-producing adenoma (Conn syndrome) is a rare but potentially curable form of pediatric hypertension. The authors report on a 5-year-old girl who had symptoms of polyuria, polydipsia, and fatigue, and for whom the diagnosis of hyperaldosteronemia was suggested by a low serum potassium level and persistent hypertension. The diagnosis was confirmed by increased levels of plasma aldosterone and decreased levels of plasma renin. The tumor was localized with ultrasonography and computed tomography, which showed a 2-cm mass in the left adrenal gland. The left adrenal gland was excised, and pathological assessment showed an adenoma. Only 14 other pediatric cases (< 16 years of age) have been reported in the English-language literature.

Adenoma↗
PubMed1988

Polyuric urinary tract dilatation with renal damage.

Polyuria of diabetes insipidus and psychogenic polydipsia can produce massive dilatation of the urinary tract in the absence of any mechanical obstruction. Renal failure in these cases is rare. We report the second case of nephrogenic diabetes insipidus with nonobstructive hydronephrotic renal damage. Temporary suprapubic drainage restored renal function to normal and decreased the upper tract dilatation. Renal function has been preserved for more than 10 years. Surgical intervention beyond temporary vesical drainage is unnecessary.

Child↗
PubMed2002

Relation between nocturnal voiding frequency and nocturnal urine production in older men:a population-based study.

OBJECTIVES: To describe the normal values for nocturnal urine production and its determinants, as well as the relation between nocturnal urine production and voiding frequency. METHODS: Data were collected from 1688 men aged 50 to 78 years without bladder or prostate cancer, radical prostatectomy, neurogenic bladder dysfunction, or negative advice from their general practitioner. Measurements included self-administered questionnaires, a 3-day frequency-volume chart, transrectal ultrasonography of the prostate, uroflowmetry, and postvoid residual urine volume measurement. The mean nocturnal urine production was computed from the frequency-volume charts. Linear regression analyses were performed to determine associated factors for nocturnal urine production. Areas under the receiver operating characteristic curves were used to describe the discriminative value of nocturnal urine production on nocturnal voiding frequency. A cutoff value for "increased" nocturnal urine production was defined using logistic regression analysis. RESULTS: The nocturnal urine production was 60.6 mL/hr for the total study population; it increased with age and was significantly higher in men with 24-hour polyuria. Nocturnal urine production was on average higher in men with increased nocturnal voiding frequency, but had only a reasonable discriminative value on nocturnal voiding frequency (areas under receiver operating characteristic curve of 0.71 and 0.76). Nocturnal urine production exceeding 90 mL/hr is suggested as abnormal. CONCLUSIONS: On average, nocturnal voiding frequency is indicative of nocturnal urine production. However, nocturnal urine production is only a modest discriminator for increased nocturnal voiding frequency. Therefore, the use of nocturnal urine production as an explanatory variable for nocturnal voiding frequency in daily practice is of little value.

Age Factors↗
PubMed1985

Plasma atrial natriuretic peptide in cardiac disease and during infusion in healthy volunteers.

Plasma concentrations of immunoreactive atrial natriuretic peptide (ANP) were low or undetectable in 8 healthy subjects and 9 control patients without cardiac disease, and raised in 17 patients with congestive heart failure (CHF). Highest concentrations were measured in patients with severe CHF. High plasma ANP levels were also found in 2 patients with paroxysmal supraventricular tachycardia and associated transient polyuria. Infusion of synthetic human alpha-ANP, 110-125 micrograms over 30 min, to 3 healthy males resulted in a 2.3-fold increase in natriuresis and diuresis but had no effect on kaliuresis. Plasma levels of renin activity, aldosterone, and antidiuretic hormone did not change significantly. ANP infusion gave plasma ANP levels of the same magnitude as those found in severe CHF; levels returned to baseline within 15 min of stopping the infusion. Thus ANP appears to be a circulating hormone in man, at least in severe CHF and supraventricular tachycardia.

Adult↗
PubMed1997

Renal side-effects of long-term lithium treatment.

The beta 2-Mg (beta 2-microglobulin) and GAG (glycosaminogyclan) excretions in 107 patients with bipolar disorder who had been on lithium treatment for 1-15 years were compared with 29 matched psychiatric control patients. 24-h urine volume, urine beta 2-Mg, GAG values were significantly higher, and maximal urinary osmolality was significantly lower in patients on lithium than in controls. No relationship was found between creatinine clearances and duration of illness, duration of lithium treatment and daily lithium dosages. Duration of lithium treatment was not related to the concentrating capacity. The beta 2-Mg excretion rates were significantly higher in patients with manifest polyuria and with severe concentration defect.

Adult↗
PubMed1987

Indomethacin in streptozocin-induced nephrogenic diabetes insipidus.

A 14-year-old female patient with metastatic carcinoid developed streptozocin-induced glomerular, proximal, and distal tubular dysfunction. The latter was in the form of nephrogenic diabetes insipidus, with urine volumes in excess of 11 L/24 h. The prostaglandin synthetase inhibitor, indomethacin, rapidly corrected the polyuria both initially and on rechallenge, independent of change in glomerular filtration rate.

Administration, Oral↗
PubMed2000

Potentiation of mercury-induced nephrotoxicity by endotoxin in the Sprague-Dawley rat.

Endotoxin (lipopolysaccharide; LPS) and mercury are nephrotoxic compounds of food safety concern. Endotoxin is a product of cell walls of gram negative bacteria. Humans are constantly exposed to LPS through food, water and air. Food is the main source of mercury exposure for humans. Endotoxin potentiates the toxicity of a number of xenobiotics, but its interaction with nephrotoxic heavy metals has not been investigated. We tested the hypothesis that endotoxin enhances mercury-induced nephrotoxicity. Thirty-two, 41-43-day-old, male Sprague-Dawley rats were allocated randomly to four groups of eight rats each as follows: group I received 0.9% sodium chloride, group II received 2.0 mg of Escherichia coli 0128:B12 LPS kg(-1) once, group III received 0.5 mg mercuric chloride kg(-1) once, and group IV received 2.0 mg E. Coli 0128:B12 LPS kg(-1) once 4 h before receiving 0.5 mg mercury chloride kg(-1) once. Mercury, LPS and 0.9% sodium chloride were all injected IV through the tail vein. Rats were monitored for 48 h after mercury injection. Serum creatinine, urea nitrogen, and polyuria were significantly increased in rats given LPS plus mercury relative to those given either agent alone or saline (P</=0.05). The most severe morphologic lesions were found in rats given LPS plus mercury, which also had significantly greater renal mercury concentration than those given mercury alone (P < or = 0. 05). In conclusion, LPS potentiated mercury-induced nephrotoxicity.

Animals↗
PubMed1999

Increase of vasopressin mRNA in the hypothalamus of inbred polydipsic mice.

The genetically inbred polydipsic mice, STR/N strain, are characterized by extreme polydipsia and polyuria without arginine vasopressin (AVP) deficiency. The expression of AVP gene in the hypothalamus of polydipsic and non-polydipsic mice was examined by Northern blot analysis and in situ hybridization histochemistry. Northern blot analysis revealed that the total amount of AVP mRNA in the hypothalamus of the STR/N mice was approximately three-fold of that in the control, ICR mice. In situ hybridization histochemistry showed that the signals of AVP mRNA in the paraventricular (PVN) and supraoptic nuclei (SON) of the STR/N were stronger than those in the ICR. Although AVP gene transcripts were detected in the anteroventral parts of the PVN (avPVN) in the STR/N, there was a few AVP transcripts in the same area (avPVN) in the ICR. There were no differences in plasma osmolality and hematocrit between STR/N and ICR mice. These results suggest that upregulation of AVP mRNA in the hypothalamus of STR/N may be involved in the central mechanism responsible for the polydipsia in genetically polydipsic mice.

Animals↗
PubMed1985

Side-effects of lithium at lower therapeutic levels: the significance of thirst.

The prevalence of thirst, subjective polyuria and related side-effects was investigated in 87 patients attending a lithium clinic and in a group of 52 controls. Thirst was surprisingly common, occurring in 67% of patients, in spite of the fact that they had been maintained on relatively low levels of lithium, and was due principally to the lithium rather than to other psychotropic drugs. Urine flow and impaired renal water absorption correlated with the serum lithium level and the length of treatment in the patients, despite the fact that few were clinically polyuric. The pattern of the results confirms previous suggestions that lithium may stimulate the thirst mechanism directly as well as via an increased renal resistance to vasopressin. The possible implications in terms of clinical response are discussed.

Bipolar Disorder↗
PubMed1971

Mithramycin treatment of hypercalcaemia and renal failure in a patient with paratesticular embryonic sarcoma.

A 17-year-old patient with a small paratesticular embryonic sarcoma presented with symptoms of renal failure, polyuria and widespread bone metastases. Investigation revealed hypercalcaemia and uraemia without any evidence of hyperparathyroidism. The hypercalcaemia responded over a period of weeks to administration of mithramycin with initial improvement in the symptoms and metabolic derangements. Control was lost with the necrosis of intra-abdominal tumour deposits and haemorrhagic polypoid deposits in the alimentary tract. The value and hazards of mithramycin are well demonstrated by these rare complications of this type of tumour.

Abdominal Neoplasms↗
PubMed1983

Cortical and papillary absorptive defects in gentamicin nephrotoxicity.

Renal function was examined in rats given daily injections of gentamicin (100 to 150 mg/kg) for 10 to 14 days. Whole kidney inulin clearance fell and urine volume increased. Single nephron GFR of surface nephrons varied. Some nephrons had no filtration, some had low rates, and some had high rates. Abnormal renal tubular epithelial inulin permeability was demonstrated by microinjection. Micropuncture of individual nephrons early and later in their course demonstrated reduced fluid reabsorption along the proximal convoluted tubule of superficial nephrons. Rates of fluid delivery to the late proximal and distal tubule were elevated. The rate of fluid reabsorption in the superficial loop of Henle was increased. Maximal urine osmolality and papillary tissue content of urea was reduced. The polyuria, therefore, results from decreased fluid reabsorption by proximal tubules and, probably, by papillary collecting ducts. The decrease in proximal fluid reabsorption is probably secondary to impaired solute reabsorption. A decrease in collecting duct fluid absorption can be attributed to the observed decrease in papillary solute concentration.

Acute Kidney Injury↗
PubMed1987

Renal response to vasopressin and indomethacin in cisplatin-treated rats.

1. Cisplatin [6 mg/kg body weight, in 0.9% (w/v) NaCl] was injected intraperitoneally as a single dose to two groups of rats (Fischer 344 strain). Two further groups of rats, injected intraperitoneally with an equivalent volume of 0.9% (w/v) NaCl, were used as controls. The cisplatin-treated rats developed a pronounced polyuria which did not recover during an 18 week observation period. 2. After 21 weeks, one group of the cisplatin-treated animals received a 6 h infusion of 2.5% D-glucose. Vasopressin (60 mu-units min-1 100 g-1 body weight) was incorporated into the infusate for the final 2 h. A control group of animals received an identical infusion. One week later the other group of cisplatin-treated rats received a 6 h infusion of 0.9% (w/v) NaCl. Indomethacin was incorporated into the infusate for 15 min, at 3 h 52.5 min, to deliver a dose of 10 mg/kg body weight. A control group again received an identical infusion. 3. Cisplatin did not impair the antidiuretic effect of vasopressin, but it reduced the natriuretic effect of vasopressin, and also impaired the ability of the animals to produce concentrated urine. 4. Cisplatin did not alter basal PGE2 excretion, or the reduction in PGE2 excretion induced by indomethacin. However, the urine flow in the cisplatin-treated group did not fall after indomethacin, whereas there was a fall in urine flow in the control group.

Animals↗
PubMed2001

Hypercalcaemia of malignancy: an undiagnosed and undertreated disease.

BACKGROUND: Hypercalcaemia of malignancy, a relatively frequent phenomenon, seems to be insufficiently recognized and treated. Its symptoms are not specific, but they affect the quality of life. METHODS: A prospective study to analyse the influence of symptoms caused by hypercalcaemia on the decision of the admitting physician, the motivation for treatment, and the effect of the treatment on the given symptoms in hospitalized patients with oncologic disease in progression, where confounding causes of similar symptoms such as cerebral metastasis, radiotherapy, treatment with opioids, etc., were excluded. RESULTS: A total of 71 patients, mean age 65 + 11 years, fulfilled the strict inclusion criteria. About 42% were hospitalized because of symptoms caused by hypercalcaemia, but none of the medical reports mentioned hypercalcaemia as reason for hospitalization. Specific antihypercalcaemic therapy was given to only 37% of patients, and only 25% got an adequate rehydratation. Antihypercalcaemic treatment was guided by the severity of hypercalcaemia (>3.00 mmol L(-1)), not by the symptoms. Polyuria-polydipsia, nausea-vomiting and constipation were correlated with hypercalcaemia. These symptoms, as well as confusion-stupor and bone pains improved significantly when calcaemia was normalized. Patients with calcaemia normalized returned home most frequently (P < 0.03). CONCLUSIONS: Malignant hypercalcaemia remains mostly undiagnosed in medical praxis. Specific treatment occurs in too small fractions of the patients. As the normalization of calcaemia significantly improves the symptoms because of hypercalcaemia and the quality of life, rapid rehydration and specific calcium lowering treatments should be part of palliative measures in all patients with malignant hypercalcaemia.

Bone and Bones↗