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Biomedical subjects

J G Ledingham

Publications and source records attributed to J G Ledingham.

At least 55 records · Page 3Linked to original sources
PubMed1989

Abnormal sodium handling occurs in the isolated perfused kidney of the nephrotic rat.

1. In order to examine the handling of sodium by the nephrotic kidney when separated from the immediate influences of renal nerves and humoral factors, kidneys were taken from nephrotic rats (puromycin aminonucleoside) and studied over a range of perfusion pressures using the isolated perfused kidney technique. 2. When perfused with medium containing 6.7 g/dl albumin, the nephrotic kidneys performed differently from controls with a reduction in sodium excretion at all pressures [(mean +/- SEM) 1.14 +/- 0.43 vs 4.20 +/- 0.69 mumol/min at 105 mmHg (14 kPa); 6.32 +/- 1.56 vs 44.60 +/- 5.30 mumol/min at 150 mmHg (20 kPa)]. Renal vascular resistance, inulin clearance, fractional sodium excretion and fractional lithium excretion were also reduced. 3. When kidneys were perfused without oncotic agent these differences between nephrotic and control kidneys remained. Perfusion with medium containing 10 g/dl albumin, designed to prevent glomerular filtration, abolished the difference in vascular resistance between the two groups. Captopril had no effect on the sodium retention or vascular resistance of nephrotic kidneys. 4. It was concluded that (a) the isolated nephrotic kidney demonstrates increased avidity for sodium, (b) the abnormality of sodium handling is not dependent on the presence of altered oncotic forces, and (c) the alteration in vascular resistance is conditional upon glomerular filtration.

Animals↗
PubMed1989

Correlation of blood pressure in normotensive and hypertensive individuals with platelet but not lymphocyte intracellular free calcium concentrations.

1. Fifty-two normotensive and essential hypertensive subjects were studied. Intracellular free calcium concentration [( Ca2+]i) was measured in lymphocytes (37 subjects) and platelets (18 subjects) by means of the fluorescent indicators, quin 2 and fura-2. In 31 subjects, plasma ionized calcium concentration was also measured. 2. There was a positive correlation between platelet [Ca2+]i and systolic blood pressure (r = 0.485, P less than 0.05), diastolic blood pressure (r = 0.542, P less than 0.02) and mean blood pressure (r = 0.534, P less than 0.02). 3. No statistically significant relationship was observed between plasma ionized calcium and blood pressure. 4. No relationship was found between lymphocyte [Ca2+]i and blood pressure, or between lymphocyte [Ca2+]i and plasma ionized calcium. 5. There was no relationship between [Ca2+]i of lymphocytes and platelets measured simultaneously from the same subject. 6. These findings reconcile previous conflicting reports and show a relationship between platelet but not lymphocyte [Ca2+]i and blood pressure in man.

Adult↗
PubMed1989

Sodium handling in the isolated perfused kidney of the cirrhotic rat.

1. In cirrhosis the kidney tends to retain salt and water abnormally. Two theories have been proposed to account for this: the 'underfilling' theory, in which sodium retention is thought to occur secondary to perceived underfilling of the circulation, and the 'overflow' theory, in which sodium retention is considered to be due to a primary renal defect. 2. Using the model of cirrhosis produced by carbon tetrachloride administration in the rat, the ability of the kidney to excrete sodium has been examined in vivo and during isolated perfusion. 3. Cirrhotic animals demonstrated a reduced ability to excrete an acute sodium load: 6 h after 2 mmol of sodium was given by gavage, 27.5 +/- 10.5% had been excreted by the cirrhotic rats and 62.5 +/- 7.0% by control rats (P less than 0.025). 4. In contrast, during isolated perfusion, kidneys from cirrhotic animals excreted the same amount of sodium as control animals over a range of perfusion pressures from 90 to 150 mmHg (12 to 20 kPa). 5. The data are consistent with the view that in cirrhosis the kidney retains sodium in response to immediate external factors.

Animals↗
PubMed1989

Sodium excretion during elevation of renal venous pressure: modulation by dDAVP.

Studies were performed to determine the effects of elevation of renal venous pressure on sodium excretion by the isolated perfused rat kidney in the presence and absence of a specific V2-receptor agonist, 1-des-amino-8-D-arginine vasopressin (dDAVP), at a concentration (1 ng/ml) expected to have maximal antidiuretic activity but minor vasopressor action. In either the presence or absence of dDAVP, increments in venous pressure led to falls in perfusate flow rate and glomerular filtration rate, which became significant at an imposed pressure greater than or equal to 18.75 mmHg. In the absence of dDAVP, absolute sodium excretion fell as venous pressure increased, and there was a negative correlation between fractional sodium excretion (FENa) and renal venous pressure (RVP) within each experiment and when all data points were combined: FENa = 3.46-0.072RVP (r = -0.608, P less than 0.01). In contrast, in the presence of dDAVP, absolute sodium excretion was unchanged, and in four of five experiments FENa rose as venous pressure increased (in one it remained unchanged). Linear regression analysis of all data points showed a positive correlation between FENa and RVP: FENa = 1.27 + 0.127RVP (r = 0.392, P less than 0.05). The slopes of the two regression lines were significantly different (P less than 0.001). It is postulated that this effect of dDAVP may be mediated via changes in the distal tubular pressure response to elevation of RVP. Such an effect of vasopressin could explain the observation that the response to renal vein constriction in vivo is dependent on volume status.

Animals↗
PubMed1989

Timing of the onset of changes in renal energetics in relation to blood pressure and glomerular filtration in haemorrhagic hypotension in the rat.

The timing and circumstances of changes in renal energetics during the gradual induction of haemorrhagic hypotension were studied in anaesthetised rats by phosphorus-31 nuclear magnetic resonance. Animals were bled at a constant rate of 0.1 ml/min via the femoral artery. Whenever changes in renal energetics were seen, a similar pattern was observed. A decrease in adenosine triphosphate occurred rapidly and was always associated with accumulation of inorganic phosphate and tissue acidosis. Profound oliguria, reflecting a markedly decreased rate of glomerular filtration preceded the changes in metabolite levels. Such a fall in glomerular filtration rate and consequently in the energy requirement for tubular reabsorption could be viewed as a mechanism by which energy demands of the kidney are reduced before a critical limitation of energy supply is reached. During uncomplicated haemorrhage in Wistar rats, mean arterial pressures as low as 25-40 mm Hg were reached before changes in renal energetics developed. In contrast, spontaneously hypertensive rates subjected to uncomplicated haemorrhage, and Wistar rats subjected to haemorrhage during concurrent stimulation of the ipsilateral sciatic nerve, developed changes in renal energetics at higher and more variable blood pressures and in response to the withdrawal of lesser but more variable quantities of blood. The sudden onset and severe degree of energy depletion at varying blood pressures during bleeding and its more ready occurrence in animals in which sympathetic nervous activity could be expected to be increased, suggests that sudden renal vasoconstriction is responsible for the unpredictable occurrence of tubular ischaemia in haemorrhagic hypotension.

Adenosine Triphosphate↗
PubMed1989

Direct nephrotoxicity of Russell's viper venom demonstrated in the isolated perfused rat kidney.

Envenoming by Russell's Viper (Vipera russelli) is an important cause of acute renal failure. The mechanism of renal damage is unresolved. It is difficult to obtain evidence of a direct nephrotoxic action because of the coincidental disturbance to the systemic circulation. We studied the action of Russell's Viper venom on the function of the isolated perfused rat kidney. Direct nephrotoxic action was indicated by a dose dependent decrease in inulin clearance and an increase in fractional excretion of sodium seen at venom concentrations down to 50 ng/ml, a concentration likely to be achieved in the human circulation after envenoming. The isolated perfused kidney was also used to assess the efficiency of antivenom and for a comparison with snake venoms from the Thai cobra (Naja kauothia) and the Nigerian Saw-Scaled Viper (Echis ocellatus).

Animals↗
PubMed1988

Endothelin: an important factor in acute renal failure?

Very low concentrations of the vasoconstrictor peptide endothelin cause intense long-lasting renal vasoconstriction. In the isolated perfused rat kidney, the concentration of endothelin required to reduce blood-flow by 50% is 200 pmol/l, compared with 1000 pmol/l angiotensin II (previously the most potent known vasoconstrictor). Whereas angiotensin II has little effect on the glomerular filtration rate (GFR), a rise in endothelin from 100 to 800 pmol/l reduces GFR by 90%. Endothelin is probably present in the circulation at low concentrations in vivo; events associated clinically with acute renal failure would tend to increase this concentration. Endothelin may be a mediator in the pathogenesis of acute renal failure.

Acute Kidney Injury↗
PubMed1988

Raised venous pressure: a direct cause of renal sodium retention in oedema?

Contemporary theories of oedema formation are often based on the idea that "effective" blood volume is reduced, and that sodium retention and oedema are a result of the kidney responding, as in haemorrhage, to a perception by receptors in the circulation that blood volume is inadequate. This idea has enhanced understanding of the pathophysiology of such conditions as cardiac failure and cirrhosis, but has obscured the fact that blood volume is almost always increased in oedematous states. Evidence is presented that an increase in renal venous pressure can cause sodium retention by a direct action on the kidney: a rise in venous pressure could thereby initiate a vicious circle by causing sodium retention, expansion of plasma volume, and further increase in venous pressure. This sequence of events may be crucial in the pathophysiology of cor pulmonale, and an exacerbating factor in other oedematous states.

Animals↗
PubMed1988

31P nuclear magnetic resonance study of steady-state adenosine 5'-triphosphate levels during graded hypoxia in the isolated perfused rat kidney.

1. A model of controlled hypoxia in the isolated perfused rat kidney has been used to compare the extent of reduction in the steady-state level of adenosine 5'-triphosphate (ATP) from that initially observed with alterations in renal function and with the development of tubular cell injury. 2. ATP depletion was observed in response to decreased total oxygen delivery even when delivery greatly exceeded consumption and the venous oxygen tension remained in excess of 150 mmHg. 3. Increases in the fractional excretion of sodium occurred progressively below an apparent threshold value of whole kidney ATP of approximately 80% of the baseline. 4. With modestly decreased oxygen delivery, cellular injury was confined to deep proximal tubule and medullary thick ascending limb of Henle's loop. Severely decreased oxygen delivery rates were associated with cellular damage spreading throughout the cortex. 5. Even the smallest reductions in whole kidney ATP were associated with morphological damage to tubular cells. The extent of reduction in whole kidney ATP was closely correlated and approximately equivalent to the calculated volume of injured cells. 6. Our results indicate that reduction in whole kidney ATP during decreased oxygen delivery is a valid marker of the extent of injurious cellular hypoxia and are consistent with the view that cellular ATP concentrations in hypoxia are markedly inhomogeneous. They support the hypothesis that specific regions of the perfused kidney become critically hypoxic and develop cellular injury while overall oxygen delivery remains high. Areas at risk include deep proximal tubule as well as the medullary thick ascending limb of Henle's loop.

Adenosine Triphosphate↗
PubMed1988

Low concentrations of ANP cause pressure-dependent natriuresis in the isolated kidney.

The effect of alteration in renal perfusion pressure on the response of the isolated perfused rat kidney to concentrations of alpha-human atrial natriuretic peptide (ANP) within the pathophysiological range has been examined. At a perfusion pressure of 90 mmHg ANP concentrations of 50, 200, and 1,000 pmol/l were without effect on any parameter tested. At a perfusion pressure of 130 mmHg 50 pmol/l ANP produced an increase of 3.13 +/- 0.68 mumol/min in sodium excretion (UNa V), compared with a fall of 0.33 +/- 1.04 mumol/min in controls (P less than 0.02); fractional excretion of sodium (FENa) rose by 1.45 +/- 0.36% vs. -0.12 +/- 0.47% (P less than 0.05); glomerular filtration rate (GFR) was unchanged. At 200 and 1,000 pmol/l larger changes in UNa V and FENa were seen; only at 1,000 pmol/l was a significant effect on GFR observed. In contrast, frusemide (furosemide) at concentrations of 10 and 100 mumol/l was natriuretic at both 90 and 130 mmHg, with lesser absolute but greater proportional changes being seen at the lower pressure. It was concluded 1) the response of the isolated kidney to ANP is critically dependent on perfusion pressure, 2) at elevated levels of perfusion pressure the isolated kidney can respond to levels of ANP within the upper physiological and pathophysiological range.

Animals↗
PubMed1987

Effect of symptomless bacteriuria in childhood on subsequent pregnancy.

The outcome of 52 pregnancies in 34 women who had had bacteriuria in childhood was compared with that of normal control pregnancies. The prevalence of bacteriuria at the first antenatal visit was significantly higher (p less than 0.001) in previously bacteriuric women (35%) than in controls (5%), and acute pyelonephritis developed in 10% compared with 4% of controls. Pre-eclampsia (arterial pressure above 140/90 mm Hg with proteinuria above ++) developed in 4 of 12 previously bacteriuric women known to have renal scarring (5 of 16 pregnancies), in only 1 of 22 previously bacteriuric women without scars (1 of 36 pregnancies), and in 1 of 52 controls (p less than 0.001). Women with renal scars were also more likely to undergo induction of labour (44% of pregnancies) and operative delivery (57% of pregnancies) than previously bacteriuric mothers without scars (17%, 22%) or control mothers (16%, 20%). The infants of previously bacteriuric mothers were not significantly smaller than those of healthy control mothers, but Apgar scores were lower among offspring of previously bacteriuric mothers with scarred or normal kidneys (p less than 0.001). Fetal outcome was, however, satisfactory in all cases.

Adult↗
PubMed1987

Functional and biochemical subtypes of the haplotype HLA-DR3 in patients with celiac disease or idiopathic membranous nephropathy.

HLA class II beta-chain polymorphism was investigated in the haplotype HLA-DR3 to determine if patients with HLA-DR3-associated diseases express normal or variant class II polymorphisms. Analysis was carried out by two-dimensional gel electrophoresis of immunoprecipitated HLA class II molecules, DNA hybridization with DR beta and DQ beta gene probes on Taq 1, Bam H1, or Rsa 1 digests, and mixed lymphocyte culture. Two subtypes of HLA-DR3 were identified in normal homozygous DR3 individuals on the basis of polymorphism in one of two DR beta chains detected, corresponding to differences in DR beta restriction fragment patterns. These polymorphisms exhibited significant linkage disequilibrium with the A1,B8,DR3 and B18,DR3 haplotypes, respectively. In proliferative experiments, cells with the B18,DR3-associated polymorphism strongly stimulated cells from donors with the B8,DR3-related polymorphism, suggesting that a T-cell epitope recognized by B8,DR3 cells lies on the B18,DR3-associated DR beta chain. In seven HLA-DR3 homozygous patients with celiac disease and three HLA-DR3-homozygous patients with idiopathic membranous nephropathy, only the normal patterns of HLA class II molecules were displayed, the B8,DR3 type occurring in all patients and the B18,DR3 type in one patient. These data suggest that celiac disease and idiopathic membranous nephropathy are not related to disease-specific HLA-DR beta or -DQ beta gene variants within the DR3 population that are revealed by these methods.

Adult↗
PubMed1987

Altered water excretion in healthy elderly men.

The renal and vasopressin (AVP) response to a standard oral water load (20 ml/kg) was examined in a group of water-replete healthy elderly men (n = 6). Two groups, respectively, of water-replete and water-deprived young healthy volunteers acted as controls. After 2 h, the old group had excreted 41 +/- 2.4% (mean +/- SEM) of the water load compared to 100.7 +/- 8.8% in the water-replete young group and 70 +/- 3.8% in the water-deprived young group (P less than 0.01). Similarly, peak diuresis (7.01 +/- 0.48 ml/kg) and peak free-water clearance (5.7 +/- 0.48 ml/min) as determined from hourly sampling in the old group were delayed and significantly less than both young groups (P less than 0.01) (peak diuresis, young water-replete, 10.86 +/- 0.56 ml/kg, young water-deprived, 10.2 +/- 0.64 ml/kg, peak free-water clearance, young water-replete 8.4 +/- 0.72 ml/min, young water-deprived 9.5 +/- 0.88 ml/min). When these indices were adjusted for reduced creatinine clearance (Ccr) in the elderly, there was no significant difference between the young and old groups. Plasma AVP decreased similarly in all three groups following ingestion of water but there was no significant difference in mean plasma AVP between the young and old subjects throughout the study period. We therefore conclude that ability to excrete excess water promptly is impaired in healthy elderly men. This defect is due, at least in part, to an age-related reduction in glomerular filtration rate.

Adult↗
PubMed1987

Severe hypertension--is there a drug of choice?

Severity of hypertension may be defined in terms of the height of the arterial pressure, or the degree of organ damage present or the resistance to drug therapy. These definitions do not necessarily overlap in the individual case. A variety of drugs is now available for treatment of the severe case however defined, but results of current treatment of such cases in practice have not reduced the risk of stroke or of myocardial infarction to that of the age- and sex-matched normotensive population. Data from which to select drugs with favourable effects on left ventricular hypertrophy, glomerular hyperfiltration or the cerebral circulation are scanty and need amplification. Choice of drug therapy in current circumstances remains empirical, although there are probable advantages in the use of converting enzyme inhibitors or calcium antagonists in the treatment of severe hypertension.

Angiotensin-Converting Enzyme Inhibitors↗