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Biomedical subjects

M Ketteler

Publications and source records attributed to M Ketteler.

8 recordsLinked to original sources
PubMed1991

[Significance of hyponatremia in patients with oropharyngeal tumors].

We observed 29 patients with hyponatremia associated with oropharyngeal carcinoma. In 19/29 the hyponatremia was attributable to a decreased effective arterial blood volume whereas in the remainder (10/29) the presence of SIADH could be demonstrated. These etiologies of hyponatremia were best differentiated by the plasma urea concentration (less than 30 mg/dl in SIADH), urate concentration (less than 4,0 mg/dl in SIADH) and creatinine concentration (less than 0,9 mg/dl in SIADH). Furthermore, SIADH patients had a spontaneous natriuresis. The mainstay of therapy in either form of hyponatremia is fluid restriction (less than 1 l/d).

Carcinoma, Squamous Cell↗
PubMed1989

[Kidney function in heart failure].

Congestive cardiac failure is a syndrome in which a decrease of cardiac output triggers a series of neuro-humoral compensatory mechanisms in part involving the kidney. In this response, dysfunction of atrial volume receptors as well as disturbances of the autonomic nervous system have recently been demonstrated and are held responsible for excessive stimulation of angiotensin II, followed by adverse regulatory effects. Renal hemodynamic compensation for heart failure primarily involves constriction of efferent arterioles thereby defending glomerular filtration. In this setting, the occurrence of prerenal insufficiency is indicative of a far advanced reduction in renal blood flow. Apparent diuretic resistance in the treatment of heart failure is usually caused by iatrogenic vascular compromise or by the use of a single diuretic rather than an appropriate combination. Hyponatremia, vasopressin stimulation and elevation of plasma N-epinephrine concentration have been found to be the most reliable indicators of a poor prognosis of heart failure. Atrial natriuretic peptide is stimulated in proportion to the degree of atrial distension in heart failure, however its intrarenal effects are markedly blunted or may even be absent in this particular disease.

Atrial Natriuretic Factor↗
PubMed1989

Natriuretic factors and lithium clearance in patients with the syndrome of inappropriate antidiuretic hormone (SIADH)

Because the syndrome of inappropriate antidiuretic hormone (SIADH) is a state of disturbed body fluid volume regulation and altered sodium balance we sought to determine if recently described volume regulatory factors were stimulated in SIADH. We measured atrial natriuretic peptide (ANP), endogenous digitalis-like natriuretic factor (EDNF) and urinary free dopamine in SIADH (n = 27). We also determined fractional clearance of lithium (FCLi). The data obtained in SIADH were compared with similar measurements performed in sodium retaining hyponatremias, such as those of heart failure (n = 26), liver cirrhosis (n = 19) and volume contraction (n = 28). We observed: ANP was 19.5 +/- 2.7 fM/ml in SIADH; it was significantly lower than ANP in cardiac failure, but no different from ANP in volume contraction. Urinary free dopamine was 2.2 +/- 0.8 microM/24 h in SIADH; this was significantly higher than in volume contraction and liver cirrhosis. EDNF (259 +/- 42 nM/24 h) and FCLi (21.4 +/- 2%) were both numerically higher in SIADH than in other hyponatremic disorders; however, the differences did not achieve significance. In conclusion, our observations did not establish a specific role of ANP in chronic stable SIADH. As to the importance of EDNF, dopamine and proximal tubular fluid reabsorption (FCLi) additional work using acute volume changes may demonstrate their participation in the renal sodium handling of SIADH more clearly than our study did.

Aged↗
PubMed1988

Role of diuretics, hormonal derangements, and clinical setting of hyponatremia in medical patients.

Because hyponatremia is frequently associated with preceding diuretic treatment and unrestricted fluid intake--conditions which have not been addressed sufficiently in published literature--we studied the pathophysiology and the clinical setting of such hyponatremia in a large group of internal medicine patients. We observed: a) Of an initial 310 patients with chemical hyponatremia only 204 (64%) had an associated plasma hypoosmolality. Since a normal plasma osmolality excludes a disturbance of water metabolism only the 204 patients with hypoosmolar hyponatremia were included in the study. This data shows that plasma osmolality is an essential measurement in any evaluation of hyponatremia. b) In 204 consecutive patients with hypoosmolar hyponatremia the electrolyte disturbance was related to advanced congestive cardiac failure in 25%, decompensated liver cirrhosis in 18%, volume contraction in 28%, syndrome of inappropriate antidiuretic hormone secretion in 19% and renal insufficiency in 4%. c) Plasma vasopressin was measurable in 90% of the 204 patients. It is known that radioimmunoassays to measure vasopressin fail to reliably detect low concentrations of circulating vasopressin (less than 0.5 pg/ml). It may therefore be stated that hypoosmolar hyponatremia was generally characterized by a failure of antidiuretic hormone suppression. d) Mean daily fluid intake of hyponatremic patients was 2.35 +/- 0.15 l. In the presence of stimulated vasopressin this large a fluid intake is bound to worsen the severity of hyponatremia. e) Of 204 patients 126 were treated with diuretics at the time of study. In these patients hyponatremia worsened during such treatments and was associated with evidence of prerenal azotemia. However there were no significant differences between diuretic-treated and -untreated patients with respect to plasma vasopressin stimulation and amount of fluid intake.(ABSTRACT TRUNCATED AT 250 WORDS)

Aldosterone↗
PubMed1988

Ionic conductances of cultured principal cell epithelium of renal collecting duct.

The ionic conductive properties were studied of epithelia of collecting duct principal cells which had been grown in primary tissue culture from renal cortex/capsule explants. When pretreated with aldosterone (10(-6) mol/l) and bathed on either surface with isotonic HCO3(-)-free Ringer's solution, the transepithelial voltage, Vte, varied between -21 and -72 mV (apical surface negative) while the transepithelial resistance, Rte, ranged from 0.4 to 1.5 k omega cm2. By 10:1 step-changes in Na+ concentration the apical cell membrane was shown to have a high conductivity for sodium, inhibitable by amiloride, 10(-6) mol/l. However, contrary to observations in natural collecting duct under control conditions, amiloride never reversed the polarity of Vte even at 10(-4) mol/l. Both the apical and the basolateral cell membranes were conductive for potassium and both conductivities were inhibitable by Ba2+ (5 mmol/l). 10:1 reduction of apical Cl- concentration strongly hyperpolarized Vte with a monophasic time course suggesting the presence of a paracellular shunt conductance for Cl-. In addition there may be a small Cl- conductance present in the apical cell membrane since apical application of the chloride channel blocker 5-nitro-2-(3-phenylpropylamino)-benzoic acid (NPPAB) at 10(-7) mol/l produced a minute but significant hyperpolarization. On the other hand, 10:1 reduction of basolateral Cl- concentration caused a biphasic change in Vte (initial depolarization, followed by repolarization) which indicates the presence of a large Cl- conductance in the basolateral cell membrane. The latter was not inhibitable by 10(-7) mol/l NPPAB. Higher concentrations of this and of an other Cl-channel blocker produced non-specific effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

The charted and the uncharted waters of hyponatremia.

It was observed that hyponatremia has been evaluated by many studies of patients and laboratory animals. In virtually all of these the presence of nonosmotic ADH has been shown, but several details of this relationship remain controversial at this time. The role of specific receptor areas for ADH stimulation requires further study, particularly in the hyponatremia of a decreased effective arterial blood volume. In addition, it will be important to define the suspected vascular effects of nonosmotic ADH more specifically. Other areas of uncertainty include: the degree to which the tubular effect of ADH in hyponatremia may be modified by a decreased delivery of fluid to the loops of Henle; the potential stimulation of ADH by stress in clinical hyponatremia; and the meaning of very low or non-measurable concentrations of ADH in hyponatremia. New experimental tools such as vasopressin antagonists and agonists, measurements of baroreceptor input, and tests of proximal fluid reabsorption can be expected to clarify some of these questions in the near future.

Animals↗