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Biomedical subjects

M M Popovtzer

Publications and source records attributed to M M Popovtzer.

At least 127 records · Page 7Linked to original sources

Evaluation of iron status in patients on chronic hemodialysis: relative usefulness of bone marrow hemosiderin, serum ferritin, transferrin saturation, mean corpuscular volume and red cell protoporphyrin.

The diagnostic usefulness of bone marrow hemosiderin, serum ferritin, transferrin saturation, mean corpuscular volume (MCV) and red cell protoporphyrin (EPP) in the evaluation of iron status in patients on chronic hemodialysis was studied in 39 subjects. The correlation between serum ferritin and the number of transfusions received per month was slightly higher (r = 0.717; p less than 0.001) than the correlation between bone marrow hemosiderin and transfusions (r = 0.685; p less than 0.01). Serum ferritin was useful in identifying subjects with both increased or reduced iron stores. In contrast, transferrin saturation could only be used for indicating iron overload. MCV for indicating iron deficiency, and EPP was not useful in either case. The abnormal increase of EPP in chronic uremia has not been previously described. It is unrelated to iron deficiency and is most probably explained by the known reduction in red cell ferrochelatase activity associated with chronic uremia. Serum ferritin is clearly the most useful diagnostic aid for assessing iron stores in patients on chronic hemodialysis. Whether ferritin is also the best predictor of response to iron therapy, cannot be determined on the basis of the present data.

Adolescent↗

Effect of chronic salt loading on renal Na-K-ATPase activity in the rat.

The effect of chronic salt loading in rats fed regular chow diet on renal Na-K-ATPase was studied. The high salt intake was associated with increased filtered load of sodium (control: 126 +/- 3.9 mueq/min, salt loaded: 146 +/- 2.5, mueq/min, P less than 0.001), increased net reabsorption of sodium (control: 125.3 +/- 3.9 mueq/min, salt load: 134.8 +/- 2.4 mueq/min, P less than 0.05), increased urinary excretion of potassium (control: 2.4 +/- 0.09 mueq/min/min; salt loaded: 3.0 +/- 0.1 mueq/min, P less than 0.001) and increase in single kidney weight (control: 0.798 +/- 0.010 g, salt loaded: 0.937 +/- 0.015 g, P less than 0.001). The above mentioned changes were associated with significant increase in renal microsomal and whole homogenate medullary Na-K-ATPase activity in the salt loaded group (microsomes: control 74.1 +/- 4.9 mumole Pi/mg prot/hr, salt loaded 112.7 +/- 6.0 mumole Pi/mg prot/hr, P less than 0.001; whole homogenate: control 22.7 +/- 1.0 mumole Pi/mg prot/hr, salt load 29.4 +/- 1.6 mumole Pi/mg prot/hr, P less than 0.005), while cortical and papillary Na-K-ATPase activity remained unchanged. Taken together, these results show that increased filtered and reabsorbed load of sodium, which follows high salt intake, is associated with an increased renal Na-K-ATPase activity. The preferential rise in medullary enzymatic activity may be interpreted as suggesting that these changes may stem from increased delivery and reabsorption of sodium in the ascending limb of Henle's loop.

Adenosine Triphosphatases↗

Renal function and Na-K-ATPase in rats after suprarenal ligation of inferior vena cava.

To assess the effects of altered renal function on Na-K-ATPase, the following groups of rats were studied: 1. rats with suprarenal vena cava ligation (SVCL), la. DOCA-treated rats with SVCL, 2. rats with infrarenal vena cava ligation (IVCL), 3. rats with glycerol-induced acute renal failure, 4. rats with bilateral ureteric ligation, and 5. K-exalate-treated rats with SVCL. In group 1, acute renal failure with hyperkalemia developed and medullary Na-K-ATPase increased from 95 +/- 5 in control to 155 +/- 7 mumol Pi/mg prot/h, P less than 0.001, DOCA did not prevent the increase of Na-K-ATPase. In group 2, medullary Na-K-ATPase decreased from 130 +/- 10 in control to 88 +/- 7, P less than 0.01, in rats with IVCL. In group 3, cortical Na-K-ATPase decreased from 55 +/- 5 to 27 +/- 6, P less than 0.02. In group 4, Na-K-ATPase was unchanged. In group 5, maintenance of normokalemia prevented the rise in Na-K-ATPase. These experiments demonstrated a K-dependent activation of medullary Na-K-ATPase after SVCL but not in other forms of renal failure. Because SVCL diminishes drastically GFR per nephron, the present findings imply that increased loads of Na and K per nephron are not a prerequisite for an increase in medullary Na-K-ATPase. Hyperkalemia in presence of increased renal venous pressure seems to be causally related to the rise in medullary Na-K-ATPase activity.

Adenosine Triphosphatases↗

Improved renal function in patients with primary renal disease after control of severe hypertension.

Renal function and life expectancy can be improved by aggressive antihypertensive therapy in severe hypertension. However, most reports of severe hypertension and renal failure concern primary hypertensive states. 3 cases of primary renal disease, 1 glomerular, 1 obstructive and 1 of chronic pyelonephritis, are described here. In all 3 cases, severe hypertension and renal failure were present. Adequate reduction in blood pressure resulted in substantial improvement in renal function.

Adult↗

Unmasking of isolated hypoaldosteronism after renal allotransplantation in familial Mediterranean fever.

A patient with familial Mediterranean fever and renal amyloidosis was maintained on intermittent hemodialysis for chronic renal failure. After renal allotransplantation, he became weak, lost 12 kg in weight over 7 wk, and developed marked orthostatic hypotension. His symptomatic volume depletion responded dramatically to i.v. 0.9% NaCl. Metabolic balance studies showed that he was in negative Na balance (on a 44 mEq/24 h Na diet, he excreted 71 mEq/24 h in his urine), which was corrected by mineralocorticoid therapy. Renin-aldosterone studies demonstrated a hyperreninemic hypoaldosteronism with normal glucocorticoid secretion. The patient probably suffered from amyloidosis selectively involving the glomerulosa zone of his adrenal cortices. While on dialysis he was anuric and therefore not volume depleted, but after successful renal allotransplantation the diuresis of the functioning kidney unmasked his mineralocorticoid deficiency which manifested as symptomatic volume depletion.

Adult↗

Evidence for interference of 25(OH)vitamin D3 with phosphaturic action of glucagon.

The effect of 25(OH)vitamin D3 [25(OH)D3] on the phosphaturic action of glucagon was studied using clearance techniques in the following groups of rats: group 1, parathyroidectomized (PTX) glucagon-infused rats receiving intravenous 25(OH)D3; group 2, PTX 25(OH)D3-pretreated rats receiving intravenous glucagon; and group 3, the thyroparathyroidectomized glucagon-infused rats receiving intravenous 25(OH)D3. The effect of 25(OH)D3 on glucagon-induced increase of cAMP in kidney slices and glucagon-activated adenylate cyclase (AC) in kidney membrane fractions was studied in vitro. In group 1, 25(OH)D3 suppressed the glucagon-induced phosphaturia by reducing fractional excretion of phosphorus (CP/CIn) from 0.175 +/- 0.02 (mean +/- SE) to 0.112 +/- 0.12 (P less than 0.05); this was associated with a reduction of urinary cAMP from 1,830 +/- 230 to 660 +/- 120 pmol/min (P less than 0.01). In group 2, pretreatment with 25(OH)D3 reduced CP/CIn from 0.221 +/- 0.025 to 0.108 +/- 0.012 (P less than 0.005). In group 3, 25(OH)D3 reduced CP/CIn from 0.165 +/- 0.012 to 0.075 +/- 0.011 (P less than 0.005). In vitro, 25(OH)D3 blunted the glucagon-induced activation of the AC/cAMP system by reducing AC from 570 +/- 30 to 325 +/- 28 pmol cAMP.mg protein-1.h-1 (P less than 0.01) and the cAMP level from 11.2 +/- 0.9 to 8.5 +/- 0.7 pmol cAMP/g wet tissue (P less than 0.05). These results show that 25(OH)D3 blunts the phosphaturic action of glucagon and suggest that this response may be mediated through suppression of the AC/cAMP system.

Animals↗

Hypophosphatemia in a patient with lymphoma in leukemic phase.

A patient with histiocytic lymphoma had abdominal masses, hypophosphatemia, normocalcemia, and a normal serum parathyroid hormone value. After chemotherapy, transient hyperphosphatemia ensued, the abdominal masses resolved, and other manifestations of the disease were suppressed. One week after discontinuation of the chemotherapy, the abdominal masses and other signs indicative of reactivation of the malignant disease reappeared. During the relapse, the serum phosphorus level fell to 0.7 mg/dL, and urinary excretion of phosphorus became negligible. After resumption of chemotherapy, serum concentration and urinary excretion of phosphorus increased. These observation suggest that severe hypophosphatemia may be a complication of hematologic neoplasia. It is proposed that this abnormally may be caused by a shift of excessive amounts of extracellular phosphorus into the rapidly replicating malignant cells.

Antineoplastic Combined Chemotherapy Protocols↗

Delayed response to a alpha-hydroxycholecalciferol therapy in a case of hypoparathyroidism during anticonvulsant therapy.

A patient with idiopathic hypoparathyroidism and a six-year history of a convulsive disorder was treated with 1 alpha-hydroxycholecalciferol and anticonvulsants. The calcemic response to 1 alpha-hydroxycholecalciferol was incomplete. However, normocalcemia was later attained during treatment with dihydrotachysterol. This delayed response suggests that the anticonvulsant therapy interfered with the peripheral effect of the vitamin D metabolite.

Adolescent↗

Antiphosphaturic action of 25 (OH) vitamin D3 in experimental Fanconi syndrome.

Renal handling of phosphorus was studied in the following groups of parathyroidectomized rats with maleate-induced Fanconi syndrome: 1) 6 rats receiving intravenous parathyroid hormone, 2) 6 rats receiving intravenous dibutyryl cyclic AMP (DBcAMP), 3) 6 rats undergoing volume expansion with saline, 4) 12 rats receiving intravenous 25 (OH)vitamin D3, 5) 12 rats with acute hypercalcemia induced by intravenous CaCl2, 6) 6 rats with phosphate deprivation, and 7) 6 rats receiving intravenous calcitonin. Parathyroid hormone and calcitonin failed to increase the urinary excretion of both cAMP and phosphorus. Likewise, DBcAMP failed to increase the urinary excretion of phosphorus. Extracellular volume expansion and hypercalcemia (serum calcium 12.9 +/- 0.7 mg/100 ml) did not alter the tubular reabsorption of phosphorus. In phosphate-deprived animals, the fractional excretion 0.16 +/- 0.05 (mean +/- SE) was lower than that in the control animals (maleate-treated without phosphate depletion), 0.46 +/- 0.04 (P less than 0.001). 25 (OH)vitamin D3 decreased the fractional excretion of phosphorus from 0.39 +/- 0.03 in the control (maleate-treated not receiving 25 (OH)vitamin D3) to 0.23 +/- 0.02 (P less than 0.001) in the experimental animals. The present study demonstrated an antiphosphaturic effect of 25(OH)vitamin D3 in experimental Fanconi syndrome; the mechanism of this action is not well understood.

Animals↗

Evidence for interference of 25 (OH) vitamin D3 with phosphaturic action of calcitonin.

The present study evaluated the effect of 25(OH)vitamin D3[25(OH)vit D3] on the phosphaturic action of calcitonin in anesthetized parathyroidectomized rats. In group 1, calcitonin was given intravenously over six clearance periods. In group 2, after three periods of calcitonin given intravenously, 25(OH)vit D3 was added and given together with calcitonin for three additional periods. During calcitonin infusion, Cp/CIn 0.18 +/- 0.02 (mean +/- SE) in group 1 was not different from the corresponding Cp/CIn 0.18 +/- 0.03 in group 2; but when 25(OH)vit D3 was added, Cp/CIn 0.12 +/- 0.01 in group 2 was lower (P less than 0.001) than the corresponding Cp/CIn 0.26 +/- 0.02 in group 1. With intravenous calcitonin the urinary excretion of cycle AMP (UcAMP) 97 +/- 29 in group 1 did not differ from the corresponding UcAMP 86 +/- 27 pmol/min in group 2, but when 25(OH)vit D3 was added UcAMP 41 +/- 12 in group 2 was lower (P less than 0.001) than the corresponding UcAMP 131 +/- 14 pmol/min in group 1. This study demonstrated that 25(OH)vit D3 blocks the phosphaturic action of calcitonin. The associated fall in Uctamp suggests that25 (OV)vit D3 acts possibly by inhibiting the calcitonin-induced activation of adenylate cyclase in the kidney. However, other alternative mechanisms of action have not been excluded.

Animals↗