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Sodium magnetic resonance imaging of diuresis: spatial and kinetic response.

Renal function is highly correlated with the sodium concentration gradient along the corticomedullary axis. The application of 3D high-resolution sodium magnetic resonance imaging (MRI) provided a means to quantify in vivo the spatial and temporal changes in renal tissue sodium concentration under normal and diuretic conditions. A detailed, pixel-by-pixel analysis of the intact rat kidney sodium MR images yielded a quantitative measure of the corticomedullary sodium gradient before and at early and later times after the administration of two distinct diuretic agents, furosemide and mannitol. Furosemide, a loop diuretic, induced a fivefold reduction in the cortical-outer medullary sodium gradient, whereas mannitol, an osmotic diuretic, did not affect this gradient. Both diuretics induced a 50% decrease in the sodium concentration of the inner medulla; however, mannitol exerted its effect twice as fast as furosemide with a 2.5-min exponential decay constant. These specific changes were attributed to the different mechanism of action and site of activity of each diuretic agent. Thus, high-resolution (23)Na MRI offers a unique, noninvasive tool for functional imaging of the kidney physiology.

Analysis of Variance↗

The role of renal kallikrein-kinin system and prostaglandins in diuresis and natriuresis following saline infusion in normotensives and essential hypertensives.

In order to clarify the significance of the renal kallikrein(KAL)-kinin(KIN) system and prostaglandins (PG) in exaggerated natriuresis in essential hypertensives, the effect of acute sodium load on urinary KAL, KIN, PG, and renal water and sodium handling were investigated in normotensives (NT) and patients with essential hypertension (EHT). Nine NT and seven EHT were studied following acute physiological saline infusion (1000 ml/2 hrs). Urine volume (UV), urinary sodium excretion (UNaV), fractional excretion of sodium (FENa), and fractional excretion of inorganic phosphorus (FEP) were measured by the clearance method. Urinary KAL and KIN were determined by direct-RIA. Urinary kininase (total, I and II) activities were measured by the kinin destroying capacity. Urinary PGE was measured by RIA. Following saline infusion, UV, UNaV, FEP, KAL, KIN and PGE significantly increased in both NT and EHT. The increases of UV, UNaV, FENa, FEP and KAL were remarkably greater in EHT than each in NT, while no significant difference was found in the increment of PGE between NT and EHT. Significantly positive correlations were observed between PGE and KAL or KIN in NT (r = 0.889, p less than 0.005; r = 0.574, p less than 0.05, respectively), but not in EHT. From these results, it was concluded that the exaggerated natriuresis observed in EHT following infusion may be significantly related to the augmentation of renal KAL-KIN system, but was not directly related to PGE.

Diuresis↗

The interstitial cells in the renal medulla of rat, rabbit, and gerbil in different states of diuresis.

The inner zone of the renal medulla of rats, gerbils, and rabbits was investigated to determine whether or not there are any characteristic ultrastructural differences between the interstitial cells of these species. The effects on the interstitial cells of water deprivation and water loading were also investigated. In all three species, the Type 1 interstitial cells, the lipid containing cells, were abundant and their distribution and topographical relations as well as their general ultrastructure were similar. The previously reported significantly higher frequency in desert rats could not be confirmed. Although the lipid droplets of the interstitial cells were smaller in gerbils and rabbits when compared to rats, their fine structure was similar. Their electron dense outer zone was sometimes associated with a granular material and/or a lamellar material with a periodicity of about 40 A resembling phospholipid "myelin figures". Water-loaded rats showed a considerable increase in the number of lipid droplets when compared to dehydrated or untreated animals. In contrast, the interstitial cells of waterloaded gerbils and rabbits were depleted of lipid droplets.

Animals↗

Pharmacokinetics of high-dose intravenous melphalan in children and adults with forced diuresis. Report in 26 cases.

The pharmacokinetic parameters of the alkylating agent melphalan were determined in 15 children and 11 adults with advanced malignant solid tumors. High IV bolus doses of 140 mg/m2 were given under standard hyperhydration conditions and followed by autologous bone marrow grafting. In all cases the time-concentration curves could be best fitted to a biexponential pattern. A high scattering of drug concentrations was observed in our patients, the disposition half-lives ranging in the whole group from 17.8 to 71.2 min. The areas under the curves also showed a wide variation, ranging from 175 to 682 mg 1(-1) min-1. In all patients, melphalan levels in plasma were unmeasurable at 8 h or earlier, indicating that bone marrow can be safely reinfused at that time. No difference was apparent between children and adults regarding the drug pharmacokinetics. In each of 11 cerebrospinal fluid samples drawn 45-150 min after melphalan administration, drug levels were unmeasurable.

Adolescent↗

Renal digoxin clearance: dependence on plasma digoxin and diuresis.

The renal handling of digoxin in animals involves glomerular filtration, tubular secretion and tubular reabsorption, while only glomerular filtration and tubular secretion have been described in humans. The influence of plasma digoxin and urine flow on the renal handling of digoxin was investigated in 6 healthy volunteers. Non-glomerular renal excretion of digoxin (tubular secretion minus tubular reabsorption) was inversely correlated with plasma digoxin concentration and directly with urine flow. Hence, the present study demonstrated the occurrence of tubular reabsorption in addition to glomerular filtration and tubular secretion of digoxin. The results suggest that renal clearance of digoxin should be increased by increased urine flow, which might be of importance during digoxin toxicity.

Adult↗