[Action of furosemid on renal hemodynamics. I. Response to its intravenous injection in normal subjects and patients with renal function disorders].
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Cisplatin, an agent widely used in the chemotherapy of a variety of human malignancies, is often dose-limited owing to its nephrotoxicity. Some of the approaches under consideration, regarding the reduction of cisplatin nephrotoxicity, include the use of hydration and osmotic diuresis, pharmacological diuretics, chelating agents or agents which otherwise react with cisplatin or reverse cisplatin-induced deoxyribonucleic acid cross-links, and antioxidants to destroy free radicals, especially superoxide radicals, produced by cisplatin. The effects of each of these and other interventions on cisplatin-induced nephrotoxicity are delineated, along with their proposed mechanisms and effects on therapeutic efficacy. The current status of development of organoplatinum analogs yielding congeners with less nephrotoxicity and greater efficacy is discussed briefly. Finally, a possible role of endogenous and/or exogenous prostaglandins in protecting against or reversing heavy metal nephrotoxicity is suggested.
Renal clearance studies were performed during anti-diuresis (before and after hypertonic saline infusion) and during water diuresis in three hypertensive patients with normokalemic primary aldosteronism (NPA) and in matched patients with normoreninemic essential hypertension (EH). The NPA patients showed an impaired ability to concentrate urine. By progressively increasing Cosm with saline loading, TcH2O plateaued both in NPA and in EH patients; in the former, however, the plateau occurred earlier and was lower than in the latter. In water diuresis, absolute values of CH2O were higher in NPA due to increased distal delivery secondary to impairment in proximal tubular reabsorption. Fractional CH2O (i.e. the ratio between CH2O and distal sodium delivery), however, was lower in NPA than in EH patients. Both in antidiuresis (after saline loading) and in water diuresis the NPA patients exhibited an enhanced fractional excretion of sodium. In one of NPA patients, clearance studies were repeated after adrenalectomy. In this patient, normalization of BP and reduction of body weight were associated with a rise in Uosm and a reduction in Cosm in antidiuresis; Uosm and Cosm were restored to pre-surgical values by expanding extracellular fluid volume (ECV) with saline loading. In summary our results suggest that ECV expansion is the mechanism by which urine concentration is impaired in patients with NPA.
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The influence of acute diuresis on calcium balance induced by furosemide (FM) and azosemide (AM) was observed and compared in the human body. The treatment resulted in significant diuresis (FM: 2488 +/- 163 ml; AM: 2930 +/- 109 ml for 6 hours) and calciuresis (FM: 132.0 +/- 15.2 mg; AM: 181.0 +/- 16.6 mg for 6 hours). In spite of the urinary calcium loss, the serum calcium concentrations were elevated by both drugs. The elevation was also found even when the correction to serum protein concentrations was performed, and the magnitude of this change was less by AM than by FM. Plasma parathyroid hormone (PTH) concentrations were slightly elevated by AM only at 6 hours, but they remained unchanged by FM. This mild elevation of PTH could not be explained sufficiently by the concentration changes of serum calcium as noted above, and might be caused by factors other than serum calcium. The alkaline phosphatase concentrations corrected by means of serum protein concentrations were unchanged in both drugs, and it was suggested that the calciuresis may not extend to bone calcium remodeling at least in such a short-term experiment.
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