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Biomedical subjects

R M Stein

Publications and source records attributed to R M Stein.

At least 55 records · Page 3Linked to original sources

Extrarenal potassium transport and the beta 2-adrenergic system.

The distribution of a short-term potassium load was quantitated in three groups of acutely nephrectomized rats infused with KCl at 0.75, 1.50, and 2.25 mEq/kg/hr for 90 minutes. The rate of net potassium transfer from the extracellular fluid compartment to the intracellular fluid compartment was stable from 30 to 90 minutes and proportional to the rate of infusion, with no evidence of saturation of transport mechanisms. In the period 60 to 90 minutes, the calculated increments in intracellular potassium concentration over 10-minute intervals were similar to the respective increments in extracellular potassium concentration. The apparent volume of distribution of the infused potassium over this period was similar to total body water. At the termination of the infusions, the net potassium transfer rates rapidly fell to very low levels. Our studies support the view that the extrarenal modulation of short-term potassium load is dependent on changes in plasma potassium concentration that conform to a first-order linear kinetic model. The infusion of the selective beta 2-adrenergic blocker butoxamine without potassium administration to acutely nephrectomized rats resulted in a net efflux of potassium from the intracellular fluid compartment. The addition of butoxamine to three groups of rats receiving KCl at the previous rates resulted in a fixed decrement in net potassium transfer to the intracellular fluid compartment that was not significantly different from the net efflux of potassium seen with butoxamine alone. Despite beta blockade, the net transfer of potassium remained proportional to the infusion rate. Thus, in our studies, beta 2-adrenergic blockade had a relatively fixed influence on decreasing net potassium transfer, both under basal conditions and during short-term potassium administration.

Adrenergic beta-Antagonists↗

Effects of chronic sodium depletion on renal tubular sodium and water reabsorption in man.

In order to assess the effects of sodium depletion on tubular Na and H2O transport in man, renal clearance studies were performed under control conditions and after sodium depletion in 7 normal subjects. The control diet contained 250 mEq of Na daily. Sodium depletion was induced by placing subjects on a 20-mEq/day na diet and administering furosemide (40 mg) dialy for 3 days. Balance studies revealed that the subjects were in Na balance under control conditions, and that after sodium depletion had been established they were in a sodium-retaining state. Subjects were studied under both conditions, after H2O hydration and during a subsequent hypotonic mannitol infusion. After H2O hydration the minimal urinary osmolality averaged 61 and 67 mosm/kg in the sodium depletion and control states, respectively. Sodium depletion was associated with a significant reduction in C inulin, sodium clearance (CNa), urine flow (V), fractional urine flow (V/GFR), free water (CH2O), and fractional free water clearance (CH2O/GFR). During hypotonic mannitol infusion indices of absolute and fractional delivery of Na from the proximal tubule (CH2O + CNa; CH2O/GFR + CNa/GFR) were consistently reduced after sodium depletion and rose more slowly as absolute and fractional distal sodium chloride supply (CH2O + CNa; CH2O/GFR + CNa/GFR) were increased. These data are consistent with the view that modest sodium depletion in man provokes an increase in fractional sodium chloride reabsorption in both the proximal and distal tubules.

Absorption↗

The relationship between the metabolism of procainamide and sulfamethazine.

The metabolism of sulfamethazine (SMZ), which is acetylated by a binodally distributed enzyme, and procainamide (PA) was compared in 21 normal volunteers, each given a single oral dosted metabolites, N-acetyl-procainamide (NAPA) and Ac-SMZ, were measured. Subjects with less than 64% Ac-SMZ in the 0-8 hour collection were termed "slow" and those with more than 64% were termed "fast" SMZ acetylators. Slow SMZ acetylators had 9.8 to 43.8% (24.1 +/- 10.13) NAPA recovered, and fast SMZ acetylators, 22.0 to 42.6% (33.7 +/- 7.29) NAPA, P less than 0.01. In addition, the calculated half-life of PA metabolism for slow SMZ acetylators was 9.0 to 33.8 hours (18.4 +/- 8.82) and for fast SMZ acetylators was 8.1 to 14.4 hours (10.9 +/- 2.19), P less than 0.01. For four subjects, SMZ acetylation phenotype did not correlate with the half-life of SMZ or PA metabolism; and in two, SMZ acetylation phenotype and half-life of metabolism did not correlate with the same PA indices. Even though slow SMZ acetylators have less NAPA recovered than fast SMZ acetylators, it is not yet clear that procainamide is metabolized by a bimodally distributed enzyme as is sulfamethazine.

Acetylation↗

Elimination of glucose interference and improved precision in a continuous-flow analysis for inulin.

A modified fermentation procedure based on one described by Homer Smith in his textbook was used to eliminate glucose interference in the automated detrmination of inulin. The manifold of Fjeldbo and Stamey [J. Lab. Clin. Med. 72, 353 (1968)] was modified to enable us to insert the fermentation procedure without sacrificing precision in continuous-flow analysis for inulin. Analytical recoveries of inulin from plasma and urine with the modified manifold were 100.1 +/- 0.8% (SD) and 99.9 +/- 1.6%. Corresponding recoveries of inulin from specimens of plasma and urine containing 5 g of glucose per liter and treated with yeast were 99.6 +/- 1.5% and 100.0 +/- 1.6%.

Blood Glucose↗

Malignant hypertension and uremia in scleroderma: efficacy of nephrectomy and hemodialysis.

Two cases of scleroderma are presented in which malignant hypertension developed abruptly, accompanied by rapidly progressive renal failure. The malignant hypertension was associated with high plasma renin levels and like other forms of hyperrenninemic hypertension and uremia, was refractory to both antihypertensive medication and extracellular fluid volume control with hemodialysis. Blood pressures became controllable only after bilateral nephrectomy was performed, and in each case resulted in a reversal of a rapidly progressive downhill course. Though both patients had multisystem involvement at the onset of renal failure, the non-renal manifestations of scleroderma have not progressed rapidly. Consequently, when patients with scleroderma develop malignant hypertension and uremia, aggressive therapy with dialysis and nephrectomy may significantly prolong survival.

Adult↗

Prevention of muscle cramps in haemodialysis patients by quinine sulphate.

Nine patients on maintenance haemodialysis with frequent muscle cramps were given 320 mg quinine sulphate or placebo (in an identical gelatin capsule) at the beginning of each dialysis for a period of 12 weeks. The frequency of cramps was significantly reduced during dialysis in patients receiving quinine sulphate. None of the haematological, auditory, or visual disturbances ascribed to quinine sulphate were noted.

Clinical Trials as Topic↗

Pulmonary calcification in chronic renal failure: use of diphosphonate scintiscan as a diagnostic tool.

A patient with end-stage renal failure on maintenance hemodialysis for fifty-five months presented with signs and symptoms of cardiorespiratory failure and chest X-ray evidence of cardiomegaly and persistent bilateral nodular lung densities. A lung scan employing a bone seeking radionuclide, 99 Tc Diphosphonate, revealed active uptake in all areas corresponding to the X-ray densities. It was concluded that these densities represented active calcification. Thus, a diagnosis of pulmonary calcification was established without the need to resort to lung biopsy. It is suggested that bone-seeking radionuclides may be employed effectively to help establish an early diagnosis of pulmonary calcification especially in high risk dialysis patients.

Adult↗

Control of plasma renin activity in chronic stable renal disease.

Plasma renin activity (PRA) was determined on 70 subjects in clinical salt and water balance with stable glomerular filtration rate (GFR) ranging from 4 to 189 ml. per minute. Average 24-hour urine sodium excretion was obtained for 3 to 5 days prior to the study. The relationship between PRA and daily sodium excretion present in the low GFR group (GFR less than 80 ml. per minute) was similar to that obtained in the high GFR group (GFR greater than 80 ml. per minute). Hypertensive and normotensive subjects also demonstrated a relationship between PRA and daily sodium excretion although the values for PRA tended to be lower in the hypertensive subjects. In 32 subjects, following water hydration, a hypotonic saline load was administered. PRA values fell in 26 subjects, remained unchanged in 5, and increased in 1 subject. The decrease in PRA was not related to the level of GFR and was similar in the normotensive and hypertensive low GFR group. The level of PRA before or after the saline load did not relate to the level of distal sodium supply as estimated by CH2O/GFR + CNA/GFR. In subjects with chronic stable renal disease PRA responds appropriately to variations in daily salt intake and acute volume expansion with saline. Hypertensive subjects with impaired renal function appear to be able to vary PRA levels as do normotensive subjects with impaired renal function.

Chronic Disease↗