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PubMed1987

[Stress sonography of the lower urinary tract].

Mild caliectasis in patients with occult ureteropelvic obstruction can cause difficulties in the decision on operative or non-operative measures. In such situations diuresis renography, diuretic radionuclide urography and perfusion pressure flow studies (Whitaker test) can be very useful. Furosemide-sonography is a new, non-invasive method demonstrating functional subpelvic obstruction. Standardised conditions before and after application of furosemide are necessary. This new diagnostic method is demonstrated based on a evaluation in 22 patients presenting radiological evidence of minor ureteropelvic obstruction.

Female↗
PubMed1996

[The diuresis urogram in patients with a bladder replacement].

PURPOSE: To differentiate between urodynamically relevant obstruction and functionally unimportant dilation of the upper urinary tract in patients with neobladder using a modified furosemide urogram. METHOD: An excretory urogram with furosemide loading was carried out in 19 patients with neobladder and sonographically and urographically confirmed dilation of the upper urinary tract. Once strong contrasting of the renal pelves and calyces has been achieved, 20 mg of furosemide were applied and late radiographs were obtained at 15 min and 30 min, respectively. An obstruction was defined as increasing dilation of the renal pelves and calices during forced diuresis and lack of washout effect of the contrast medium. RESULTS: In 32 cases, the renoureteral unit (RUU) was dilated on ultrasound. Of these, 25 RUU's showed good emptiness of contrast medium upon stimulation of diuresis, six RUU's returned a borderline findings, while one RUU was found to exhibit a decompensated anastomotic stenosis, which was dilated. Two further patients with borderline findings were later treated surgically due to their pain symptoms. No patient required further preoperative diagnostic procedures. CONCLUSIONS: The modified furosemide urogram represents a cost-effective diagnostic orientation strategy in patients with neobladder and dilated renal pelves and calyces and is both well-tolerated by patients and meets with broad acceptance from the urologic staff.

Adult↗
PubMedDate not supplied

[Effect of dexamethasone and spironolactone therapy on diuresis and creatine clearance in premature infants with a birth weight below 1,500 g].

BACKGROUND: The aim of the study was to examine the influence of dexamethasone and spironolactone on diuresis and creatinine clearance in 8-40 day old premature infants with a birth weight less than 1500 g. PATIENTS: 85 preterm infants were included in this study. Median birth weight was 1195 g (range 560-1495), mean gestational age was 28 (range 25-34) weeks. 31 infants were given dexamethasone if bronchopulmonary dysplasia was diagnosed and 32 infants received spironolactone. Indication for spironolactone was persistent ductus arteriosus or bronchopulmonary dysplasia. METHOD: The multivariate variance analysis (MANOVA) was performed to investigate the influence of spironolactone and dexamethasone on diuresis and creatinine clearance. Additional influence of gestational age, postnatal age and fluid intake wa eliminated by the multivariate variance analysis. RESULTS: Spironolactone therapy resulted in no differences for diuresis and creatinine clearance. Dexamethasone therapy increased creatinine clearance (p < 0.05) and diuresis (p < 0.005). CONCLUSIONS: Spironolactone is not very effective in the therapy of persistent ductus arteriosus and bronchopulmonary dysplasia. Diuresis and creatinine clearance are not increased. In conclusion spironolactone is more effective in clinical conditions associated with high circulating levels of aldosterone. Dexamethasone, on the other hand, has a high effect on diuresis and creatinine clearance. The pathomechanism for the increase of parameters studied is not completely understood.

Birth Weight↗
PubMed1988

Hemodynamic and renal effects of atrial natriuretic factor (99-126) in volume expanded sheep.

The renal and hemodynamic effects of atrial natriuretic factor 99-126 (ANF) were examined in hypervolemic sheep and the results compared to responses previously observed in normal isovolemic sheep. Infusion of 500 ml dextran over 60 min increased blood pressure by 6 +/- 2 mmHg, associated with increases in cardiac output and stroke volume. No change was seen in heart rate nor total peripheral resistance. Subsequent infusion of ANF at 100 micrograms/h for 60 min reduced blood pressure by 6 +/- 1 mmHg and decreased stroke volume and cardiac output. There was no change in heart rate. Total peripheral resistance decreased slightly, to a similar degree to that seen after control infusion of 500 ml dextran. Moderate increases in urine volume, sodium and chloride excretion were seen after infusion of dextran and subsequent infusion of ANF markedly enhanced these renal effects. The renal changes produced by ANF in volume expanded sheep were significantly greater than those observed in normal sheep. Although normal sheep are more sensitive to the hemodynamic than to the renal effects of ANF, after dextran pretreatment there was enhancement of the renal responses with little change in the effects on blood pressure.

Animals↗
PubMed1990

Effects of atrial natriuretic factor in conscious rhesus monkeys with acute volume expansion.

The renal and hemodynamic responses to intravenous anaritide, a human atrial natriuretic factor [102-126] at 0.3 to 20 micrograms/kg in conscious rhesus monkeys with and without acute extracellular hypervolemia were analyzed and compared. Acute isotonic saline loading (intravenous bolus at 10 mL/kg plus continuous infusion at 0.25 mL/kg/min 30 min prior to and maintained throughout experiment) significantly augmented urine output (UV) and urinary Na+ excretion rate (UNaV) by 31% and 91%, respectively. Radial mean arterial pressure (MAP) and heart rate (HR) were not affected by volume expansion. Anaritide at doses higher than 0.3 micrograms/kg reduced MAP in a dose-dependent fashion in euvolemic monkeys. In contrast, reduction in MAP was observed only at the highest dose (20 micrograms/kg) of anaritide in hypervolemic monkeys. The hypotensive responses to anaritide at 20 micrograms/kg in euvolemic and hypervolemic animals were similar (-26 +/- 5 v -24 +/- 5 mm Hg, respective maximum changes in MAP). UV and UNaV were increased by anaritide at 3 to 20 micrograms/kg in both euvolemic and hypervolemic monkeys; however, the increases at each effective dose of anaritide were greater or tended to be greater in hypervolemic rhesus monkeys compared with euvolemic rhesus monkeys. Compared to vehicle responses, HR was not affected by anaritide in either group of animals. In conclusion, acute extracellular hypervolemia potentiates the renal but suppresses the hypotensive responses to anaritide in conscious rhesus monkeys.

Animals↗
PubMed1993

Mechanisms of ozolinone-induced renin release and diuresis.

Dextrorotatory (+) and levorotatory (-) ozolinone (ozo) were injected directly into the left renal artery of volume-expanded anesthetized dogs. (+)Ozo (40 micrograms/kg/min) had no effect on urine flow and fractional excretion of Na+, Cl-, or K+ when compared with the basal period. Comparison of (-)ozo to (+)ozo revealed the following: urine flow 4.0 +/- 0.3 v 0.9 +/- 0.1 mL/min (P < .001); FENa+ 29.8 +/- 3.0 v 5.6 +/- 0.3% (P < .001); FECl- 35.7 +/- 4.1 v 5.8 +/- 0.4% (P < .001); FEK+ 87 +/- 4 v 49 +/- 5% (P < .001). Glomerular filtration rate (GFR) and renal plasma flow (RPF) did not change. The renin secretory rate (RSR) was significantly higher with (-)ozo than with (+)ozo (498 +/- 113 v 210 +/- 53 ng A I/mL/hr.mL/min). Moreover, (-)ozo significantly increased urine PG excretion compared to basal values: 466 +/- 63 v 263 +/- 30 pg/min (P < .05). Indomethacin (2 mg/kg) markedly blunted the effects of (-)ozo on PG and RSR, and completely abolished the rise in PRA. (+)Ozo had no significant effect on urine PG excretion. Neither (-)ozo nor (+)ozo had an effect on renin production in isolated glomeruli. By contrast, (-)ozo but not (+)ozo increased PGE2 synthesis in papillary and medullary slices. The data are consistent with the proposal that the effect of (-)ozo on renin secretion and PRA is through a PG-dependent mechanism, and that it requires an intact macula densa mechanism.

Animals↗
PubMed2000

Clinical efficacy of peritoneovenous shunting for the treatment of severe ovarian hyperstimulation syndrome.

We investigated prospectively the clinical efficacy of a newly developed continuous autotransfusion system of ascites (CATSA) without protein supplement in patients with severe ovarian hyperstimulation syndrome (OHSS). Peritoneovenous shunting was used to recirculate ascites. The CATSA was performed for 5 h at a rate of 100-200 ml/h once a day. Eighteen patients were treated with the CATSA (CATSA group) and 36 were treated with an intravenous 37.5 g/day of albumin supplement (albumin group). Hospital stay was significantly shorter in the CATSA group than in the albumin group (10.0 +/- 5.7 versus 13.9 +/- 6.2 days, P < 0.01). Haematocrit value reached <40% significantly earlier in the CATSA group (on hospital days 3.9 +/- 3.2 versus 5.9 +/- 2.5, P < 0.01). Using a single procedure, haemoconcentration, urinary output and pulse pressure were markedly improved in the CATSA group compared with the albumin group. Discomfort due to massive ascites diminished promptly and did not recur in nine of 18 CATSA group patients, whereas it persisted in all 36 patients in the albumin group. The serum concentration of protein was maintained in the CATSA group, whereas it did not increase in the albumin group despite daily supplementation with 37. 5 g of albumin. Apparent adverse effects of each procedure were not observed in either group. The mean values of several parameters in the serum pertinent to the coagulation-fibrinolysis system did not change significantly in either group after the procedure. It was concluded that the CATSA procedure expanded circulating plasma volume without exogenous albumin and appeared to lead to a prompt recovery from severe conditions of OHSS.

Adult↗
PubMed1996

Synergistic renal protection by combining alkaline-diuresis with lipid peroxidation inhibitors in rhabdomyolysis: possible interaction between oxidant and non-oxidant mechanisms.

BACKGROUND AND PURPOSE: Heme-proteins, besides causing renal tubular obstruction, may contribute to rhabdomyolysis-induced renal injury through a heme-iron-mediated lipid peroxidation process. In the present study, we compared the combined therapy of a lipid peroxidation inhibitor, 21-aminosteroid (21-AS) and fluid-alkaline-mannitol (FAM) diuresis with either of them alone to determine the efficacy of the combination therapy and to delineate the roles of lipid peroxidation and cast formation. METHODS AND RESULTS: Employing Raman spectroscopy, we confirmed in vitro the ability of 21-AS to inhibit iron-induced fatty acid peroxidation. 21-AS was then administered to rats developing renal failure from glycerol-induced rhabdomyolysis. Although 21-AS inhibited rhabdomyolysis-induced plasma and renal lipid peroxidation, renal protection was incomplete. Administration of FAM to inhibit cast formation afforded a better renal protection. However, when these therapies were combined to inhibit both lipid peroxidation and cast formation, there was a synergistic renal functional protection. This was accompanied by a maximum inhibition of renal and plasma lipid peroxidation, as well as, renal tubular necrosis and cast formation. Compared to combination therapy, FAM therapy alone, despite identical volume, was accompanied by a higher tubular necrosis and cast formation. CONCLUSIONS: That combining a lipid peroxidation inhibitor with fluid-alkaline diuresis in rhabdomyolysis further lowers renal lipid peroxidation, tubular necrosis and cast formation and synergistically limits renal dysfunction (i) supports a role for lipid peroxidation in the pathophysiology of rhabdomyolysis ARF, (ii) underscores the role of the intratubular heme retention, a cause for tubular obstruction as well as a source for prodigious amount of iron, likely involved in the lipid peroxidation, and (iii) raises the possibility of interactions between non-oxidant and oxidant mechanisms.

Acute Kidney Injury↗
PubMed2002

Albumin and furosemide therapy in hypoproteinemic patients with acute lung injury.

OBJECTIVE: Hypoproteinemia, fluid retention, and weight gain are associated with development of acute lung injury and mortality in critically ill patients, without proof of cause and effect. We designed a clinical trial to determine whether diuresis and colloid replacement in hypoproteinemic patients with acute lung injury would improve pulmonary physiology. DESIGN: Prospective, randomized, double-blind, placebo-controlled trial. SETTING: All adult intensive care units from two university hospitals. PATIENTS: Thirty-seven mechanically-ventilated patients with acute lung injury and serum total protein </=5.0 g/dL. INTERVENTIONS: Five-day protocolized regimen of 25 g of human serum albumin every 8 hrs with continuous infusion furosemide, or dual placebo, targeted to diuresis, weight loss, and serum total protein. MEASUREMENTS AND MAIN RESULTS: Measured outcomes included change in weight, serum total protein, fluid balance, hemodynamics, respiratory system compliance, and oxygenation. Baseline characteristics were similar between groups (treatment, n = 19; control, n = 18), with trauma being the major cause of acute lung injury. Diuresis and weight loss over 5 days (5.3 kg more in the treatment group, p =.04) was accompanied by improvements in the Pao2/Fio2 ratio in the treatment group within 24 hrs (from 171 to 236, p =.02). Respiratory mechanics were unchanged. Mean arterial pressure increased from 80 to 88 mm Hg (p =.10), and heart rate decreased from 110 to 95 beats/min (p =.008) over time in the treatment group. No difference in mortality was observed, with favorable trends in measures of intensive care. CONCLUSIONS: Albumin and furosemide therapy improves fluid balance, oxygenation, and hemodynamics in hypoproteinemic patients with acute lung injury. Determining the effect of this simple therapy on cost, outcomes, and other patient populations requires further study.

Adult↗