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Solubilization of thiazide diuretic receptors from rat kidney membranes.

Thiazide-type diuretics act at receptors to inhibit NaCl transport in the renal distal tubule. We solubilized high-affinity [3H]metolazone binding sites from rat kidney membranes with Triton X-100, which was more effective than several other detergents. Phosphatidylcholine and a mixture of proteinase inhibitors were needed to stabilize binding so that 57% of solubilized binding remained after 72 h at 4 degrees C. The affinities of solubilized (Kd = 11.4 +/- 0.5 nM) and membrane-bound receptors (Kd = 12.0 +/- 1.7 nM) were similar. The maximal number of binding sites/mg protein of solubilized receptors was 46 +/- 3% (n = 5) of membrane-bound receptors. Diuretics with a wide range of affinities had similar affinities for the solubilized and membrane-bound sites. Chloride inhibited and sodium stimulated the binding of [3H]metolazone to solubilized receptors, as they do with membrane-bound receptors. These studies demonstrate that, as judged by ligand binding, thiazide receptors can be solubilized in an active conformation and provide the basis for future purification and reconstitution.

Animals↗

Effects of peroral magnesium on plasma and skeletal muscle electrolytes in patients on long-term diuretic therapy.

Twenty patients on long-term diuretic therapy for arterial hypertension and/or congestive heart failure were given a supplementary dose of 15 mmol magnesium aspartate hydrochloride per day for 6 months. Nineteen patients, fulfilling the same admission criteria as the treatment group, served as controls. The addition of magnesium aspartate hydrochloride resulted in a significant rise of the cellular potassium and magnesium content and in a significant decrease of both systolic and diastolic blood pressure. It is concluded that supplementation with magnesium aspartate hydrochloride may effectively prevent the diuretic induced disturbances of electrolyte balance.

Administration, Oral↗

Effects of enoximone in patients with heart failure uncontrolled by captopril and diuretics.

Ten patients with severe heart failure, symptomatic despite treatment with diuretics and captopril, completed a study of the effect of adding enoximone to their normal treatment. Enoximone or matching placebo was given for 4 weeks in randomized double-blind order following a single-blind placebo run-in period. Exercise capability was measured with two different treadmill protocols, a corridor walk test and by step-counting with body-worn pedometers. Cardiac output and limb blood flow were assessed non-invasively by measuring respiratory gases and by venous occlusion plethysmography. Measurements were made at rest and in response to treadmill exercise. The mean exercise tolerance measured using the modified Bruce treadmill protocol was increased from the placebo value (498 +/- 91 seconds) after both 2 weeks (573 +/- 94 seconds, P = 0.051) and 4 weeks of enoximone (572 +/- 100 seconds, P = 0.057). Enoximone increased exercise duration in fixed workload tests from the placebo value (252 +/- 75 seconds) after 2 weeks' treatment (431 +/- 98 seconds, P = 0.011) and after 4 weeks (381 +/- 85 seconds, (P = 0.01). The percentage improvement with the fixed workload test was greater than with the modified Bruce protocol at week 2 (P = 0.03) and at week 4 (P = 0.051). Enoximone increased the speed of walking 100 m at self-selected slow, normal and fast paces. It had little effect on customary activity of the patients. Enoximone increased cardiac output measured at rest and during submaximal exercise (P = 0.001). It also improved blood flow to the calf muscle at rest and after exercise (P = 0.01). Enoximone has a beneficial effect in chronic heart failure symptomatic despite treatment with diuretics and captopril. The magnitude of its effect, however, depends upon the technique used to assess it.

Aged↗

A randomised prospective trial comparing daily paracentesis and intravenous albumin with recirculation in diuretic refractory ascites.

We report a randomised trial in 40 consecutive patients with diuretic refractory ascites comparing our standard therapy of ascites recirculation (Rhodiascit apparatus) with the newly proposed method of daily paracentesis (3-4 litre) and intravenous albumin infusion. A mean of five (range 2-13) paracenteses removed 13.3 (2.0-36.0) l of ascites. 12 (5-32) h of recirculation produced 6.0 (2.0-12.0) l of waste. A significant diuresis occurred in 14 recirculation patients compared to four treated by paracentesis. No significant changes in electrolyte levels or renal function occurred. Complications were commoner with paracentesis (12) than with recirculation (5). Following recirculation, 18 patients were discharged after 7 (2-21) days; significantly (p less than 0.04) shorter than after paracentesis (11 (4-34) days, 16 discharges). Ascites reaccumulation and survival were identical in both groups. Fewer complications, shorter hospital stay and lower consumables costs (recirculation 240 pounds, paracentesis 400 pounds) make ascites recirculation an attractive therapeutic option to daily paracentesis and intravenous albumin in diuretic refractory ascites.

Adult↗

Isolation and characterization of a diuretic peptide common to the house fly and stable fly.

An identical CRF-related diuretic peptide (Musca-DP) was isolated and characterized from whole-body extracts of the house fly, Musca domestica, and stable fly, Stomoxys calcitrans. The peptide stimulates cyclic AMP production in Manduca sexta Malpighian tubules and increases the rate of fluid secretion by isolated Musca domestica tubules. The 44-residue peptide, with a mol.wt. of 5180, is amidated, and has the primary structure: NKPSLSIVNPLDVLRQRLLLEIARRQMKENTRQVELNRAILKNV-NH2. Musca-DP has a high percentage of sequence identity with other characterized CRF-related insect diuretic peptides.

Amino Acid Sequence↗

Relationship of renal prostaglandins to three diuretics.

The effects of amiloride, a potassium-sparing diuretic, and of acetazolamide, a carbonic anhydrase inhibitor, were compared to those of triamterene, a potent prostaglandin stimulator which may result in acute renal failure after indomethacin pretreatment. Eighteen normal subjects on a constant sodium diet were given triamterene 200 mg/d, or amiloride 15 mg/d, or acetazolamide 750 mg/d for 3 days. Plasma potassium rose after triamterene and amiloride, and fell after acetazolamide. Natriuresis was increased after amiloride and acetazolamide, but not after triamterene. Plasma renin activity and urinary aldosterone were stimulated by the three diuretics. Triamterene induced a 4-fold increase in urinary prostaglandins E2 and F2 alpha and acetazolamide a 2-fold increase in prostaglandin E2 only, whereas amiloride showed no effect. No relationship was found between plasma or urinary electrolytes and urinary prostaglandins. Renal function was preserved in all cases. These results which show that amiloride, unlike triamterene, does not stimulate prostaglandins, suggest that nonsteroidal anti-inflammatory drugs (NSAID) which unmask triamterene nephrotoxicity may not constitute a hazard in association with amiloride. The prostaglandin response to acetazolamide may be indicative of adverse reactions during concomitant NSAID administration.

Acetazolamide↗

Treatment of patients with IVCS and gross oedema and ascites with diuretic combination and ACE-inhibitors: relation to baseline PRA and PAC.

OBJECTIVE: (1) To assess plasma renin activity (PRA) and plasma aldosterone concentration (PAC) in patients with inferior vena cava syndrome (IVCS). (2) To study in an open fashion the efficacy of loop diuretic treatment, single, or in combination with an ACE-inhibitor or with spironolactone. METHODS: In 13 patients PRA and PAC were measured and related to urinary sodium excretion (UNa). RESULTS: Highly elevated PRA and PAC were found in recently developed IVCS. The correlation coefficient between PAC and UNa was -0.61, p < 0.05. In 10 patients the influence of captopril (C)] at maximum tolerable doses with or without furosemide (F) was evaluated. Mean tolerated dose of C amounted to 8.8 mg t.i.d. (range 2-25), achieving a PAC reduction of 26%. Efficacy of F was severely blunted when PAC exceeded the low-normal range. Spironolactone addition at 100 mg/day in non-responders to F or to F and C, induced immediate natriuretic responses except in a patient with 7-70 fold increase in PAC. CONCLUSIONS: (1) In IVCS loop diuretic efficacy is attenuated by aldosterone activation; (2) complete aldosterone suppression with captopril is difficult to achieve due to dose restriction; (3) spironolactone is favoured for a synergistic response.

Adult↗

Screening for diuretics in human urine by gas chromatography-mass spectrometry with derivatisation by direct extractive alkylation.

A rapid, sensitive and reliable gas chromatographic-mass spectrometric (GC-MS) screening procedure for diuretics in human urine has been developed. The procedure uses derivatisation by extractive methylation directly from the urine. The suitability of a number of phase transfer reagents and solvents were studied for the detection of sixteen diuretics. The results obtained indicate that the screening procedure employing tetrahexylammonium hydrogensulphate at pH 12 with methyl iodide in toluene at room temperature was the most effective. This method gives selectivity and sensitivities down to 0.03-0.1 microgram/ml and provides a substrate suitable for GC-MS confirmation without further manipulation. The application of the method is demonstrated by the screening of urine for bumetanide, ethacrynic acid, acetazolamide, chlorothiazide and hydrochlorothiazide.

Acetazolamide↗

High-performance liquid chromatographic determination of diuretics in urine by micellar liquid chromatography.

The use of micellar liquid chromatography for the determination of diuretics in urine by direct injection of the sample into the chromatographic system is discussed. The retention of the urine matrix at the beginning of the chromatograms was observed for different sodium dodecyl sulphate (SDS) mobile phases. The eluent strengths of a hybrid SDS-methanol micellar mobile phase for several diuretics were compared and related to the stationary phase/water partition coefficient with a purely micellar mobile phase. The urine band was appreciably narrower with a mobile phase of 0.05 M SDS-5% methanol (v/v) at 50 degrees C (pH 6.9). With this mobile phase the determination of bendroflumethiazide and chlorthalidone was adequate. Acetazolamide, ethacrynic acid, furosemide, hydrochlorothiazide and probenecid were overlapped by the urine matrix, and the retention of amiloride and triamterene was too long.

Acetazolamide↗

Improved detection limits for screening of diuretics by coupled liquid chromatography and ultraviolet-visible spectrophotometry.

Experimental conditions have been studied in order to improve the sensitivity for the analysis of diuretics and probenecid in urine samples by high-performance liquid chromatography with ultraviolet detection. Sample clean-up and chromatographic parameters have been optimized to obtain a suitable sensitivity for the detection or quantification of each diuretic using an HP-Hypersil ODS-C18 column (5 microns, 250 mm x 4 mm I.D.), taking into account the pharmacological properties of each compound. The reliability of this method was tested by analysing urine samples after a minimum single-dose administration of chlorthalidone and probenecid.

Chlorthalidone↗

Sidedness of action of loop diuretics and ouabain on nonsensory cells of utricle: a micro-Ussing chamber for inner ear tissues.

It is known that nonsensory tissues of the utricle produce a lumen-positive transepithelial electrical potential difference (VT). This potential has been shown previously to be inhibited by ouabain and bumetanide applied to the bathing medium in vitro. In order to more fully characterize the origin of this potential we mounted the utricle as a flat sheet in a newly designed Ussing chamber and measured the VT and transepithelial resistance (RT) while perfusing the endolymphatic and perilymphatic surfaces independently with identical solutions. The aperture of the chamber was 1.5 X 10(-4) cm2. VT averaged 5.6 +/- 0.46 mV and RT was 24.0 +/- 2.43 omega X cm2 (n = 45). Ouabain and loop diuretics of the furosemide family were found to inhibit the VT only from the serosal side. The KI for ouabain was 7.63 X 10(-5) M. The loop diuretics tested inhibited the VT in the same order as in other tissues known to contain a Na/2 Cl/K cotransporter (KI: 2-benzylamino-4-cyclohexylsulfonyl-5-sulfamoylbenzolsulfonate++ + (BCSB), 1.72 X 10(-7) M; bumetanide, 1.10 X 10(-6) M; piretanide, 5.67 X 10(-6) M; furosemide, 4.14 X 10(-5) M). It is concluded that this tissue produces a lumen-positive VT (i) in the absence of a transepithelial chemical gradient; the generation of which is dependent upon the activity of (ii) Na,K-ATPase and (iii) a Na/2 Cl/K cotransporter; (iv) in the basolateral membranes of the nonsensory cells; (v) which is not depressed by luminal application of inhibitors of these transporters.

Animals↗

Diuretic activity of plants used for the treatment of urinary ailments in Guatemala.

Through ethnobotanical surveys in Guatemala, about 250 plants were identified for use in the treatment of urinary ailments. From 67 of these, aqueous extracts were prepared to investigate their oral diuretic activity in albino rats after a dose equivalent to 1 g/kg of dried plant material. The trials demonstrated that in 33 cases urinary excretion was not significantly increased (less than 90%), in 20 cases intermediate activity was seen (90-189%) and in 14 cases high diuretic activity was noted (greater than 189%). Control treatment increased urine output an average of 36% while 25 mg/kg hydrochlorothiazide treatment increased urine output by 286%. In a select group of the most used local plants, ethanol extracts were tested for their effect on urinary excretion of uric acid and electrolytes. Of these, three plants significantly increased uric acid excretion as did the reference drug, probenecid, 25 mg/kg.

Animals↗

Pharmacologic properties of Moringa oleifera. 2: Screening for antispasmodic, antiinflammatory and diuretic activity.

Hot water infusions of flowers, leaves, roots, seeds and stalks or bark of Moringa oleifera were screened to detect three pharmacologic activities in experimental models in rats. The antispasmodic activity was demonstrated using isolated duodenum, oral anti-inflammatory activity by carrageenan-induced hindpaw edema and oral diuretic activity by urine output in metabolic cages. The seed infusion showed a significant inhibition of acetylcholine-induced contraction with an ED50 of 65.6 mg/ml bath concentration, inhibition of carrageenan-induced edema at 1000 mg/kg and diuretic activity at 1000 mg/kg. Some activity was also demonstrated in the roots. All doses expressed here are as equivalents of dried starting plant material.

Animals↗

ACTH secretion from mouse pituitary tumor cells is inhibited by loop diuretic drugs.

Stilbene disulfonate and phenylanthranilic acid derivatives block Cl- transport and ACTH secretion from mouse AtT-20 clonal corticotrophs. This study was to determine whether antagonism of Na+/K+/Cl- co-transport by loop diuretics (furosemide or bumetanide) and thereby Cl- entry could block ACTH secretion. Activity of the Na+/K+/Cl- co-transporter (symport) was measured as ouabain-insensitive, loop diuretic-sensitive uptake of 86Rb. Ouabain-insensitive uptake (80% of total 86Rb uptake) was linear over 10 min and was markedly reduced by furosemide. Substitution of Na+ by choline or Cl- by gluconate resulted in an 82 and 55% decrease, respectively, in 86Rb uptake. Furosemide and bumetanide incompletely inhibited 86Rb uptake (maximal inhibition of 60% and 69%, respectively; IC50: 1.6 x 10(-5) and 3 x 10(-6) M, respectively). Forskolin did not affect the activity of the Na+/K+/Cl- co-transporter but both basal and forskolin-stimulated secretion of ACTH were inhibited by furosemide (IC50 of 5 x 10(-4) M; maximal inhibition: 50%). Bumetanide did not affect forskolin-induced cAMP synthesis. Use of cyclamate or gluconate in place of Cl- also resulted in the inhibition of basal and forskolin-stimulated ACTH secretion. The data support the belief that inhibition of Cl- entry into AtT-20 cells by way of an Na+/K+/Cl- co-transporter can result in the inhibition of ACTH secretion but that other anion entry mechanisms may also be coupled to the secretory response in these cells.

Adrenocorticotropic Hormone↗

Use of a novel ultrafiltration device as a treatment strategy for diuretic resistant, refractory heart failure: initial clinical experience in a single center.

BACKGROUND: The System 100 UF device allows ultrafiltration (UF) via peripheral access and is approved for use in heart failure (HF), although clinical trials defining optimal target population and clinical utility are lacking. We report our initial experience with clinical use of this system in very advanced, diuretic resistant HF patients. METHODS AND RESULTS: Eleven HF patients (mean age 70 years) underwent 1 to 5 UF treatments each (total 32 UF). The goal was to remove 4 liters of fluid per 8-hour UF. Baseline creatinine averaged 2.2 mg/dL (range .9-3.2) while estimated glomerular filtration rates (GFRs) averaged 38 mL/min (range 20-87). Nine patients (82%) had moderate (GFR 30-59; n = 3) or severe (GFR <30; n = 6) renal dysfunction. Nine patients (82%) had documented right ventricular dysfunction, 6 with severe tricuspid regurgitation. Average daily intravenous furosemide dose prior to UF was 258 mg (range 80-480). Patients had received nesiritide (n = 4), dopamine (n = 4), and zaroxylyn (n = 7) prior to UF. Of the 32 UF treatments, 13 (41%) removed >3500 mL, 11 (34%) removed 2500-3500 mL, and 8 (25%) removed <2500 mL. Only one UF treatment (3%) was aborted due to hypotension. There were no significant complications related to UF. Five patients (45%) experienced an increase in creatinine of >.3 mg/dl. Five patients required dialysis for persistent diuretic resistant volume overload or uremic symptoms. Six-month mortality was 55%. CONCLUSIONS: Peripheral UF safely but variably removed fluid. In this very high-risk, advanced HF population, 45% of patients developed worsening renal function during UF therapy. Controlled studies are needed to determine the impact of UF on renal function and outcomes in high-risk populations such as this.

Aged↗

Micellar versus hydro-organic mobile phases for retention-hydrophobicity relationship studies with ionizable diuretics and an anionic surfactant.

Logarithm of retention factors (log k) of a group of 14 ionizable diuretics were correlated with the molecular (log P o/w) and apparent (log P(app)) octanol-water partition coefficients. The compounds were chromatographed using aqueous-organic (reversed-phase liquid chromatography, RPLC) and micellar-organic mobile phases (micellar liquid chromatography, MLC) with the anionic surfactant sodium dodecyl sulfate (SDS), in the pH range 3-7, and a conventional octadecylsilane column. Acetonitrile was used as the organic modifier in both modes. The quality of the correlations obtained for log P(app) at varying ionization degree confirms that this correction is required in the aqueous-organic mixtures. The correlation is less improved with SDS micellar media because the acid-base equilibriums are shifted towards higher pH values for acidic compounds. In micellar chromatography, an electrostatic interaction with charged solutes is added to hydrophobic forces; consequently, different correlations should be established for neutral and acidic compounds, and for basic compounds. Correlations between log k and the isocratic descriptors log k(w), log k(wm) (extrapolated retention to pure water in the aqueous-organic and micellar-organic systems, respectively), and psi0 (extrapolated mobile phase composition giving a k = 1 retention factor or twice the dead time), and between these descriptors and log P(app) were also satisfactory, although poorer than those between log k and log P(app) due to the extrapolation. The study shows that, in the particular case of the ionizable diuretics studied, classical RPLC gives better results than MLC with SDS in the retention hydrophobicity correlations.

Chromatography, High Pressure Liquid↗

Diuretic effect of the aqueous extract of Bidens odorata in the rat.

The aerial part of Bidens odorata Cav., are used in Mexican Folk Medicine to treat renal diseases. The aim of this study is to measure the diuretic response to aqueous extract of this plant at doses of 41 and 166 mg/kg and to compare it with that induced by furosemide at 2 mg/kg. Aqueous extracts, furosemide or vehicle were administered orally to adult rats and the effects on sodium, potassium and water balance were assessed. Aqueous extracts at both doses and furosemide produced important and significant increments in urinary excretion of sodium, potassium and water in rats with respect to control group. This increase was dose dependent and aqueous extract at the highest dose induced a more marked sodium and water excretion than furosemide, potassium excretion increased but it was less than the one induced by furosemide. These results suggest that the aqueous extract of Bidens odorata induce diuretic response.

Animals↗

Acute diuretic effect of aqueous extract of Retama raetam in normal rats.

The purpose of this study was to examine the acute diuretic effect of the water extract of the aerial parts of Retama raetam (RR) at a dose of 5 mg/kg/h in normal rats. The aqueous extract was administered intravenously and the diuresis was followed within 4 h after starting the treatment. Intravenous administration of the aqueous RR extract produced a significant increment on diuresis from the second hour (p<0.01) to the fourth hour (p<0.001). Furosemide at a dose of 0.1 mg/kg/h had a similar effect when compared to RR administration. Parallel, the noticed increase of diuresis was associated with an elevation of glomerular filtration rate (p<0.05) and a significant decrease of urinary osmolarity (p<0.001). However, RR extract did not affect plasma urea levels, urine pH, plasma osmolarity and hematocrite. It is then concluded that the water extract of the aerial parts of RR exhibited a significant diuretic effect in normal rat.

Animals↗