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PubMed1996

Differential effects of fedotozine compared to other kappa agonists on diuresis in rats.

The aim of our study was to test the effect of fedotozine (0.1-30 mg/kg, s.c.), a novel kappa opioid agonist, on water diuresis in the conscious hydrated rat. Its effect was compared to that of morphine (2.5-10 mg/kg), a mu opioid agonist and to some of the recognized kappa agonists described in the literature: bremazocine (0.3-30 micrograms/kg), tifluadom (0.1-3 mg/kg), Cl 977 1-1000 micrograms/kg), (-)-cyclazocine (0.01-1 mg/kg), PD 117,302 (0.03-3 mg/kg), U-50,488h (0.25-10 mg/kg) and U-69,593 (0.3-3 mg/kg). The effect of fedotozine was also tested after intracerebroventricular administration (100 micrograms/kg) and compared to that of U-50,488h (10-30 micrograms) and dynorphins A(1-17), A(1-13) and B(1-13) (2.5-10 micrograms). All the reference kappa agonists administered by the s.c. route induced water diuresis, whereas morphine inhibited diuresis and electrolyte excretion. However, fedotozine (0.1-30 mg/kg s.c.) had no effect on diuresis, even after low doses of naloxone (0.1 mg/kg s.c.) or nor-BNI (10 mg/kg s.c.), and at 1 mg/kg had inconsistent effects on electrolyte elimination. When administered in the lateral ventricle of the brain, U-50,488h and dynorphin A(1-17) induced water diuresis, unlike fedotozine (100 micrograms), DYN A(1-13) and DYN B(1-13) that had no effect on urine output. Furthermore, fedotozine did not alter the diuretic effects of U-50,488h. These results suggest that fedotozine is an atypical kappa agonist, lacking activity on the kappa receptor subtypes regulating diuresis.

Animals↗

PubMed2004

Evaluation of dilated upper renal tracts by technetium-99m ethylenedicysteine F+O diuresis renography in infants and children.

AIM: To evaluate the feasibility of modifying diuresis renography by the simultaneous administration of Tc-99m ethylenedicysteine and furosemide in the investigation of hydronephrosis and hydroureteronephrosis in infants and children. Parameters assessed were the diuretic response in normal kidneys and the ability of the F+0 study to differentiate between renal obstruction and nonobstruction. METHODS: One hundred and thirty-three children (93 males, 40 females; mean age 35.2 months) with sonographic diagnoses of hydronephrosis or hydroureteronephrosis underwent F+0 diuresis renography. Tc-99m ethylenedicysteine (3.7 MBq/kg body weight) and furosemide at an appropriate dose were administered intravenously at the start of the study. Posterior imaging of the kidneys and bladder was performed for 20 min followed by imaging after voiding. All patients were followed-up for 12 months, and the results of the initial F+0 diuresis renography were compared with the final diagnoses. Final diagnosis was based on the pediatric urologist's decision of either surgery or conservative management. RESULTS: A renal unit was defined as a kidney and its ureter. There were 262 renal units with 4 patients having a solitary kidney. 90 normal and 172 abnormal renal units on sonography were assessed by F+0 diuresis renography. The furosemide clearance half time for the 90 normal renal units was 5.8 +/- 1.4 min. Of the 172 abnormal renal units, 100 were classified as nonobstructed and 72 as obstructed on diuresis renography. All 100 nonobstructed renal units were correctly classified with no false-negative studies; of the 72 renal units classified as obstructed, there were 43 true-positive studies and 29 false-positive studies. The sensitivity was 100%, specificity was 78% and accuracy was 83%. CONCLUSION: Tc-99m ethylenedicysteine F+0 diuresis renography is a valid method for the investigation of hydronephrosis and hydroureteronephrosis in infants and children.

Child, Preschool↗

PubMed1989

Effect of diuresis versus therapeutic paracentesis on ascitic fluid opsonic activity and serum complement.

Therapeutic paracentesis has recently been reported to eliminate ascites in patients with cirrhosis more rapidly than diuresis. However, diuresis has been shown to increase ascitic fluid opsonic activity. Patients with adequate ascitic fluid opsonic activity have been reported to be protected from spontaneous bacterial peritonitis. In this randomized controlled trial, 19 patients with cirrhotic ascites were treated with diuresis versus daily therapeutic paracenteses during 20 hospitalizations. Serum and ascitic fluid complement concentrations and ascitic fluid opsonic activity were measured at the beginning and end of treatment. Although opsonic activity increased significantly (p less than 0.01) in patients treated with diuresis, this parameter was stable in the paracentesis group. The stability of the ascitic fluid opsonic activity and complement concentration in the paracentesis group were maintained at the expense of a decrease in serum complement, whereas serum and ascitic fluid complement increased in the diuresis group. Diuresis may have the advantage over therapeutic paracentesis of providing better protection from spontaneous bacterial peritonitis. Study of larger numbers of patients will determine if these changes in complement concentrations and opsonic activity translate into an increased risk of spontaneous bacterial peritonitis in vivo.

Ascites↗

PubMed2005

Response of the ECG to short-term diuresis in patients with heart failure.

BACKGROUND: Increase in the amplitude of electrocardiogram (ECG) QRS complexes has been observed in patients treated for heart failure (HF), but the underlying mechanism has not been delineated. Also, correlation of augmentation of the QRS potentials with loss of weight has been noted in patients recovering from anasarca of varying etiology, or after hemodialysis. We assessed the effect of diuresis-based fluid loss in patients treated for HF on the amplitude of ECG QRS complexes. METHODS: This is a cohort study based on ECG and other data from a previously published investigation of patients with HF conducted at a university affiliated hospital, which used new measurements and analysis, performed by a totally blinded investigator based at another institution. Twenty-one patients (10 men) aged 70.5+/-12.7 years, 13 with ischemic, and 8 with nonischemic cardiomyopathy, were admitted to the hospital for management of exacerbated HF and were observed for 48 hours. The patients received diuresis, and had routine laboratory testing, documentation of the net fluid lost, and recording of ECGs prior to the initiation of therapy and at 24 and 48 hours. Percent change (%Delta) over the course of observation in the sums of the amplitude of QRS complexes from 12 leads (SigmaQRS12), 6-limb leads (SigmaQRS6), and leads 1+2 (SigmaQRS2) in mm of standard ECGs were correlated with net fluid loss corrected for admission weight in mL/kg. RESULTS: Fluid loss amounted to 3204.9+/-1399.5 mL in the course of 40+/-23 hours of diuresis. SigmaQRS12 was 160.9+/-42.3 mm before and 170.0+/-50.7 mm after diuresis (P=0. 024). Percent change in SigmaQRS12, SigmaQRS6, and SigmaQRS2 correlated well with the net fluid loss (r=-0.70, -0.82, -0.61, and P=0.002, 0.0005, 0.001) correspondingly. CONCLUSION: Changes in sums of the amplitude of QRS complexes of the standard ECG correlates well with net fluid loss in response to short-term diuresis in patients with HF. Change in the SigmaQRS12, SigmaQRS6, and SigmaQRS2 from ECGs before and after diuresis can be used as an easily obtainable and universally available bedside index of the net fluid loss experienced by bedridden patients with HF undergoing therapy.

Aged↗

PubMed1982

Diuresis or urinary alkalinisation for salicylate poisoning?

Forty-four adults with aspirin poisoning were treated with oral fluids only, standard forced alkaline diuresis, forced diuresis alone, or sodium bicarbonate (alkali) alone. Alkali alone was at least as effective and possibly more effective than forced alkaline diuresis in enhancing salicylate removal. Unlike the diuresis regimens it did not cause fluid retention or biochemical disturbances. The renal excretion of salicylate depends much more on urine pH than flow rate, and forced diuresis alone had little useful effect. In overdosage aspirin causes sodium and fluid retention and may impair renal function. Attempts to force a diuresis are potentially hazardous and the spurious fall in plasma salicylate concentration caused by haemodilution gives a false impression of efficacy. Further studies are required to determine the optimum treatment for salicylate poisoning.

Adolescent↗

PubMed1994

Simultaneous measurement of cystometry and diuresis renography during full and empty bladder in neurogenic bladder patients: a preliminary report.

In 9 patients (4 male and 5 female; mean 24.7 years old) with neurogenic bladder dysfunction, diuresis renography and water filling cystometry were simultaneously monitored with a full and empty bladder, and findings of diuresis renography with a full bladder were compared with those of diuresis renography with an empty bladder. According to O'Reilly's classification, findings of diuresis renography with a full bladder were significantly worse than those of diuresis renography with an empty bladder, regardless of cystometry patterns and bladder compliances. Although every kidney without hydronephrosis on intravenous pyelogram showed normal diuresis renography with an empty bladder, some kidneys with hydronephrosis showed an obstructive pattern even with an empty bladder. These results suggest that in some patients with neurogenic bladder dysfunction, deterioration of the upper urinary tract occurs more easily with a full than with an empty bladder, regardless of bladder pressure and bladder compliance.

Adult↗

PubMed1994

Correlation of upper and lower urinary tract function in patients with neurogenic bladder: evaluation using simultaneous measurement of cystometry and diuresis renography with full and empty bladder.

Diuresis renography and water filling cystometry were simultaneously performed with the bladder full and with the bladder empty. The findings of diuresis renography with a full bladder were compared with those of diuresis renography with an empty bladder, in 9 patients (4 male and 5 female, mean 24.4 years old) with neurogenic bladder dysfunction. According to O'Reilly's classification, the findings of diuresis renography with a full bladder were significantly worse than those of diuresis renography with an empty bladder, regardless of cystometry patterns and bladder compliance. These results suggest that in patients with neurogenic bladder dysfunction, a full bladder in itself can cause deterioration of the upper urinary tracts, regardless of bladder pressure and bladder compliance.

Adolescent↗

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↗

PubMed1989

Norepinephrine-induced diuresis in chronically ethanol-treated rats.

Previous research from this laboratory indicated that noradrenergic mechanisms might mediate ethanol diuresis. Experiments described here examined changes in sensitivity of noradrenergic mechanisms in animals chronically treated with ethanol. Norepinephrine hydrochloride (0-12 micrograms intracerebroventricularly) produced dose-dependent diuresis in control (dextrin maltose) and ethanol (8-11 g/kg/day) treated rats on the first day of treatment. Tolerance to ethanol diuresis was present after 10 days of ethanol treatment. Lack of responsiveness to norepinephrine-induced diuresis was evident only on the 20th day of treatment in both the ethanol and dextrin-maltose groups of rats. These results indicate a temporal dissociation between the tolerance to ethanol-induced and norepinephrine-induced diuresis and suggest that norepinephrine may not play a primary role in the development of tolerance to the diuretic action of ethanol.

Animals↗

PubMed1990

Alkaline diuresis for acute poisoning with chlorophenoxy herbicides and ioxynil.

The relation between blood chlorophenoxy herbicide and ioxynil concentrations and toxicity, and the effect of alkaline diuresis on outcome, have been studied in 41 patients. More than one herbicide was found in 38 cases. 6 of 30 patients who had ingested chlorophenoxy compounds alone died; 16 patients (mostly in grade 3-4 coma) had alkaline diuresis and 15 survived. 7 of 11 patients who had co-ingested ioxynil died; 3 had alkaline diuresis and all survived. Alkaline diuresis reduced plasma chlorophenoxy half-lives to values observed after doses that had no adverse effects (ie, below 30 h), but did not influence ioxynil clearance. Alkaline diuresis should be used to treat acute poisoning with chlorophenoxy herbicides or ioxynil in the presence of coma or other poor prognostic indicators, such as acidaemia, or if plasma total chlorophenoxy concentrations are 0.5 g/l or more.

2,4,5-Trichlorophenoxyacetic Acid↗

PubMedDate not supplied

The alpha 1-blocker dapiprazole inhibits diuresis but not drinking and feeding induced by U-50,488H.

To further explore the interaction between opiates and catecholamines in the control of water balance, we studied the effects of the alpha 1-adrenoceptor antagonist dapiprazole on the modifications in drinking and diuresis produced by U-50,488H (a selective kappa-opiate agonist), morphine, naloxone, and amphetamine in rats. Because animals were maintained in a free-feeding paradigm and water intake is also controlled by feeding (prandial drinking), food intake was also measured. At doses administered (3-6 mg/kg, IP), dapiprazole had no effect on basal food and water intake or on diuresis. Nor did it modify changes in feeding and drinking produced by U-50,488H, morphine, naloxone, and amphetamine. It did, however, antagonize the diuretic effect of both U-50,488H and amphetamine. In addition, suppression of diuresis was obtained by combining doses of dapiprazole and morphine or naloxone that were devoid of antidiuretic effects when administered independently. A further experiment showed that diuresis produced by water load was also prevented by dapiprazole. alpha 1-Adrenoceptors thus appear to play a role in the regulation of water balance in a condition of free access to water, inhibiting diuresis without affecting drinking.

3,4-Dichloro-N-methyl-N-(2-(1-pyrrolidinyl)-cycloh↗

PubMed1998

The effects of diuresis on the pharmacokinetics of the loop diuretics furosemide and torsemide in patients with heart failure.

PURPOSE: To evaluate the pharmacokinetics of furosemide and torsemide before and after diuresis in patients presenting with marked fluid overload. SUBJECTS AND METHODS: We studied 44 patients with New York Heart Association class III or IV heart failure, ejection fraction < or =40%, and an estimated excess fluid body weight > or =6.8 kg. Oral furosemide or torsemide was administered before and after diuresis. Pharmacokinetic parameters were assessed before and after diuresis. RESULTS: Following diuresis, maximum plasma concentration increased from 11.0+/-5.0 microg/mL to 13.9+/-6.8 with torsemide (P <0.05) and from 3.1< or =1.5 to 3.9+/-1.9 with furosemide (P=0.16). Maximum concentration increased by more than 30% in only one third of the patients. Total absorption (by area under the curve method) increased 6% among patients on torsemide (P=0.38) and 7% among patients on furosemide (P=0.63) and increased >30% in only 1 torsemide and 2 furosemide patients. The time to maximum concentration decreased from 1.40+/-.82 h to 0.81+/-0.36 with torsemide (P <0.01). There were no differences between furosemide and torsemide in the effects of edema on absorption. CONCLUSION: Marked diuresis altered the pharmacokinetics of both furosemide and torsemide in only a small percentage of patients. The use of adequate doses of oral diuretics in edematous patients may be successful, thereby permitting home treatment with oral diuretics and avoiding the cost of hospitalizations or home intravenous administration services.

Aged↗

PubMed1993

The effect of furosemide-induced diuresis on rabbit micturition and bladder contractile function.

The morphology and contractile function of the urinary bladder can be significantly altered in response to specific forms of physiological and pathophysiological stress placed upon it. For example, partial outlet obstruction results in a marked increase in bladder mass (weight) with associated alterations in the contractile response to specific forms of stimulation. Diabetes and its associated diuresis also induce significant alterations in bladder weight and contractile function. The current study was designed to determine if the increase in bladder weight induced by diuresis is associated with contractile alterations similar to those observed following partial outlet obstruction. Diuresis was induced by continual slow-infusion of furosemide using osmotic pumps. The results can be summarized as follows: 1) After two weeks of furosemide treatment the bladder mass was significantly greater than in the controls. 2) Furosemide-treated rabbits consumed and excreted three times more fluid than did the controls. 3) In vivo cystometric capacity and bladder compliance of the furosemide-treated rabbits were significantly increased. 4) Diuresis induced a significant increase in the contractile response of isolated bladder body strips to field stimulation, ATP, bethanechol, and KCl. 5) Furosemide treatment had no effects on the contractile responses of bladder base strips to any form of stimulation. Diuresis resulted in a significant increase in bladder weight and an associated increase in the contractile state of the bladder body, presumably through an increase in smooth muscle.

Adenosine Triphosphate↗

PubMed1999

Sucrose diuresis protects rat bladder from outlet partial obstruction-induced contractile dysfunction.

OBJECTIVES: Evidence is accumulating that bladder dysfunction caused by experimental partial obstruction of the bladder outlet can be reduced or reversed by treatment that results in upregulation of bladder function, even in the presence of obstruction. Inducing diuresis in rats or rabbits results in a significant increase in bladder mass and increased contractility in response to stimulation. The objective of the present study was to determine whether diuresis-induced amplification of bladder function in the rat could protect the bladder from contractile dysfunctions caused by partial outlet obstruction. METHODS: Thirty-two rats were separated into four groups of 8 rats each. Groups 2 and 4 were fed 5% sucrose instead of water; groups 1 and 3 were fed only water. Three weeks later, partial outlet obstructions were created in groups 3 and 4. After 4 weeks of obstruction, all bladders were rapidly excised and cut into longitudinal strips; each strip was mounted in an isolated muscle bath for contractile studies. RESULTS: Sucrose-induced diuresis caused a moderate but significant increase in bladder mass. Partial outlet obstruction stimulated significant increases in bladder mass in both water-drinking and sucrose-drinking groups; the bladder mass of sucrose-drinking rats, however, increased less than that of water-drinking rats. In water-drinking rats, partial outlet obstruction resulted in significantly decreased bladder strip contractility in vitro in response to field stimulation (1 to 32 Hz), carbachol (0.1 to 22 microM), and KCl (120 mM). After 3 weeks of sucrose-induced diuresis, partial obstruction of the rat bladder outlet did not result in decreased in vitro contractile responses to any form of stimulation applied. CONCLUSIONS: Sucrose-induced diuresis caused an increase in bladder mass and an increase in contractile strength, consequently protecting the rat bladder from the contractile dysfunctions that usually follow partial outlet obstruction.

Animals↗

PubMed1976

[Investigations into urea elimination in patients with advanced chronic renal failure during forced diuresis].

Controlled balance studies were performed in 12 oedema-free patients with advanced chronic renal failure with optimal dietary pretreatment. Forced water diuresis did not result in a significantly increased urea excretion as compared with spontaneous diuresis. Furosemide diuresis resulted in a significant increase (P less than 0.05) which was irrelevant therapeutically. The serum urea may even increase slightly under furosemide due to massive fluid loss. During thirst-regulated diuresis of advanced chronic renal failure urea back-diffusion is probably already reduced to a minimum. Normal hydration provided, forced water diuresis (oral or parenteral fluid) is useless and irresponsible as it poses additional risks in such patients. Furosemide in high dosage in over-hydrated patients is an effective diuretic even in advanced renal failure. The slightly significant increase in urea excretion during furosemide treatment does not result in important benefits in dietetically well treated patients.

Adult↗

PubMedDate not supplied

Impact of water-induced diuresis on excretion profiles of ethanol, urinary creatinine, and urinary osmolality.

This article reports the impact of diuresis on urinary excretion of ethanol in seven healthy volunteers who drank 1000 mL of export beer (44 g ethanol) in 30 min and, 120 min later, ingested 500 or 1000 mL of water within 5 min. Urine was voided before drinking started and every 30-60 min for 360 min after the start of drinking. The concentration of ethanol in urine (UAC) was determined by headspace gas chromatography, the creatinine content was determined by Jaffe's method, and osmolality was measured by freezing point depression. Maximum diuresis coincided with the peak UAC and was reached 60-90 min after the end of drinking. The urinary creatinine and osmolality dropped appreciably after drinking beer, and the lowest values coincided with peak diuresis. Creatinine was < 0.2 g/L in 22% of urine specimens, and osmolality was < 200 mOsm/kg in 31% of specimens. Production of urine decreased as UAC entered the postabsorptive phase but increased again after the subjects drank water 120 min after alcohol consumption. The amount of ethanol recovered in urine was 681 mg (standard deviation [SD] 203 mg) corresponding to 1.5% (SD 0.46%) of the dose administered. The concentrations of ethanol in successive voids during the postabsorptive phase were not influenced after subjects drank 500 or 1000 mL of water although diuresis increased and urinary creatinine and osmolality decreased. Measuring UAC provides a reliable way to monitor recent drinking, and unlike the analysis of illicit drugs in urine, the concentrations of ethanol are not influenced by diuresis.

Adult↗

PubMed2000

Postnatal changes of extracellular volume, atrial natriuretic factor, and diuresis in a randomized controlled trial of high-frequency oscillatory ventilation versus intermittent positive-pressure ventilation in premature infants <30 weeks gestation.

OBJECTIVES: High-frequency oscillatory ventilation (HFOV) with a high lung volume strategy is an experimental mode of ventilating preterm infants aimed at achieving maximal alveolar recruitment Higher mean airway pressures are used during HFOV than during intermittent positive-pressure ventilation (IPPV), and the intrathoracic volume increase is relatively constant. Both factors increase the risk to depress organ blood flow and diuresis. Our objective was to test the hypothesis that high lung volume HFOV attenuates the postnatal reduction of extracellular volume in preterm infants by reducing plasma atrial natriuretic factor and diuresis. DESIGN: Prospective, randomized, controlled clinical trial. SETTING: University hospital, Level III neonatal intensive care unit. PATIENTS: Premature infants <30 wks gestation requiring intubation for respiratory distress syndrome within the first 6 hrs of life; 15 infants (gestational age, 26 [24-29] wks, birth weight 814 [452-1340] g) were randomized to HFOV, 19 infants (gestational age 27 [24-39] wks, birth weight 930 [644-1490] g) to IPPV. INTERVENTIONS: The randomized mode of ventilation was assigned within 1 hr after intubation. During HFOV mean airway pressure was increased as long as oxygenation improved and no lung overinflation was seen on chest radiograph. IPPV rates were > or =60/min. MEASUREMENTS AND MAIN RESULTS: We measured extracellular volume (sucrose dilution) and atrial natriuretic factor on Day 1 and Day 3. Mean airway pressure, body weight, diuresis, and fluid intake were measured daily. During HFOV mean airway pressure was higher at 12 hrs (median 7 cm H2O vs. 4 cm H2O; p = .001) and 24 hrs (median 6 cm H2O vs. 3 cm H2O; p = .01). In both groups, extracellular volume decreased between Day 1 and Day 3 (HFOV from 428 +/- 126 mL to 344 +/- 145 mL [p = .003], IPPV from 466 +/- 108 mL to 414 +/- 124 mL [p = .01]) and diuresis increased (HFOV, from 2.5 +/- 1.7 to 4.6 +/- 0.9 mL/kg/hr [p = .001]; IPPV, from 2.8 +/- 1.6 to 4.2 +/- 1.0 mL/kg/hr [p = .01]). Plasma atrial natriuretic factor was not decreased in the HFOV group. CONCLUSIONS: High lung volume HFOV as primary mode of ventilation in preterm infants <30 wks gestation did not result in unwanted fluid retention and a decrease in diuresis in the first days of life.

Atrial Natriuretic Factor↗

PubMed1980

Failure of alkaline diuresis to enhance diflunisal elimination.

1 The effects of alkaline diuresis on the elimination of a single oral dose of 750 mg diflunisal were studied in six healthy male volunteers. 2 The plasma concentrations and half-life of diflunisal were not reduced by alkaline diuresis. 3 The 72 h urinary recovery of unchanged diflunisal was more than doubled with alkaline diuresis, but even so, only 5-7% of the administered dose was excreted unchanged. 4 With alkaline diuresis there was a significant increase in the mean renal clearance of diflunisal from 0.27 to 0.46 ml/min, but there was no significant correlation between the renal clearance of diflunisal and urine flow or pH. 5 However, there was a significant increase in the overall mean renal clearance of diflunisal from 0.22 ml/min over the period 0-24 h to 0.73 ml/min from 48-72 h. 6 Forced alkaline diuresis is unlikely to be of value in diflunisal poisoning.

Adult↗