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Biomedical subjects

T S Chu

Publications and source records attributed to T S Chu.

At least 19 recordsLinked to original sources

Candida tropicalis-associated bilateral renal papillary necrosis and emphysematous pyelonephritis.

Although the kidney is often involved in disseminated and localized candidiasis, bilateral emphysematous pyelonephritis (EPN) is infrequently reported. Renal papillary necrosis (RPN) caused by fungi is also rare. We describe a patient with bilateral RPN and EPN caused by Candida tropicalis, who suffered from recurrent hematuria, flank pain, acute fulminant renal failure, and obstruction by a sloughed papilla. He was treated successfully with antifungal therapy and percutaneous nephrostomy (PCN). This is the first case report of C. tropicalis-associated EPN and RPN.

Adult↗

Expression and localization of human dopamine D2 and D4 receptor mRNA in the adrenal gland, aldosterone-producing adenoma, and pheochromocytoma.

Aldosterone secretion is evidently regulated by a dopaminergic inhibitory mechanism. Pharmacological characterization and autoradiographic studies revealed D2-like receptors in the adrenal cortex, especially in the zona glomerulosa. However, the subtype of the dopamine receptors involving this regulation has not been elucidated. To investigate which subtype of receptors expresses in the adrenal cortex, we examined the messages of D2-like receptors, D2, D3, and D4, by RT-PCR and in situ hybridization of adrenal glands and adrenal neoplasm. Both D2 and D4 receptors were expressed in normal adrenal glands, pheochromocytoma, and aldosterone-producing adenoma. However, the D2 receptors were not universally expressed, in contrast with the D4 receptors that were detected in all cases of aldosterone-producing adenoma and adrenal remnant. No D3 receptor message was detected by RT-PCR in any adrenal sample. Both D2 and D4 receptors were expressed in significant amounts in the adrenal medulla and pheochromocytoma. In the adrenal cortex, the expression of the D2 receptors was in the zona glomerulosa and zona reticularis, with no different signal intensities between the two zones. D4 receptors were mainly localized in the zona glomerulosa and, to a lesser extent, in the zona reticularis. Both receptors were expressed at low levels in the zona fasciculata. In aldosterone-producing adenoma, the expression of D2 and D4 was especially found in nonzona fasciculata-like cells. To elucidate which dopamine receptor regulates aldosterone secretion, the effects of specific D2 and D4 antagonists, raclopride and clozapine, respectively, were examined in cultured NCI-H295 cells. Dopamine further increased angiotensin II-induced aldosterone secretion by 20%. In the presence of 1 microM dopamine and angiotensin II, 10(-5)-10(-7) M clozapine decreased aldosterone levels by 40-55%. The decrease in aldosterone secretion by clozapine was completely reversed when raclopride was added simultaneously. These data suggest that dopamine exerts dual effects on aldosterone secretion in NCI-H295 cells. Activation of D4 receptors can increase aldosterone secretion, whereas an inhibitory effect is mediated via D2 receptors. In summary, we demonstrated the existence of both D2 and D4 receptors in the human adrenal gland and adrenal neoplasm. Both receptors play significant roles in the modulation of aldosterone secretion, but in opposite directions.

Adenoma↗

Preoperative diagnosis and localization of aldosterone-producing adenoma by adrenal venous sampling after administration of metoclopramide.

BACKGROUND AND PURPOSE: Adrenal venous sampling is the most reliable test to distinguish aldosterone-producing adenoma (APA) from idiopathic hyperaldosteronism (IHA). The diagnostic accuracy can be improved by administration of adrenocorticotropin to minimize pulsatile secretion of aldosterone. Metoclopramide (MCP), a dopamine antagonist, can increase aldosterone secretion promptly without affecting cortisol secretion. This study investigated the diagnostic accuracy of adrenal venous sampling after MCP injection for the preoperative diagnosis and localization of APA. METHODS: Prospective diagnosis and adrenalectomy was based on adrenal venous sampling in 23 patients with a diagnosis of primary aldosteronism. Plasma aldosterone concentrations from adrenal veins and the inferior vena cava were measured before and 30 minutes after intravenous administration of 10 mg MCP. The ratio of bilateral adrenal venous aldosterone concentrations after MCP was used for diagnosis as follows: a ratio greater than 5 indicated APA, less than 3 indicated IHA, and 3-5 indicated an intermediate diagnosis. RESULTS: Catheterization of the right adrenal vein was unsuccessful in three patients. Twelve of 13 patients with an aldosterone ratio greater than 5 after MCP underwent unilateral adrenalectomy, and APA was confirmed in 11 of these patients. One patient with an intermediate diagnosis also had surgically confirmed APA. Six patients had a ratio less than 3. Before MCP administration, 10 of 13 patients with APA had a ratio greater than 5, and three patients had a ratio between 3 and 5; one patient with IHA had a ratio greater than 5. MCP improved the diagnosis of APA to an accuracy of 92% (12/13). Correct diagnosis of APA based on computerized tomography (CT) was 85% (11/13). There was discordance between the findings of adrenal venous sampling and CT in four of 20 patients. CONCLUSIONS: Administration of MCP to stimulate aldosterone secretion during adrenal venous sampling can improve the accuracy of differential diagnosis between APA and IHA.

Adenoma↗

Endothelin-1 chronically inhibits Na/H exchanger-3 in ET(B)-overexpressing OKP cells.

Endothelin-1 (ET-1) acutely increases Na/H antiporter activity in OKPET(B)6 cells, an opossum kidney proximal tubule cell line transfected with ET(B) receptor cDNA. The purpose of the present study was to examine the chronic effect of ET-1 on Na/H antiporter activity in OKP cells and to examine whether Na/H exchanger (NHE)-3 mRNA and protein abundance are regulated by ET-1. Quiescent OKPET(B)6 cells were treated with 10 nM ET-1 for 3, 6 or 24 h and Na/H antiporter activity was assayed. The Na/H antiporter activity in 3-h ET-1-treated cells was not different from controls. However, Na/H antiporter activity was significantly decreased by 29% at 6 h and 72% at 24 h. The effect of ET-1 on Na/H antiporter activity was blocked by BQ788, an ET(B) receptor antagonist, but not BQ123, an ET(A) receptor antagonist. The NHE-3 mRNA abundance in ET-1-treated cells was not different from controls at 3 h. However, there was a significant decrease in NHE-3 mRNA abundance at 6 and 24 h. There was also a significant decrease in NHE-3 protein abundance at 6 and 24 h. In summary, ET-1 chronically inhibits NHE-3 in OKPET(B)6 cells.

Animals↗

Dimethylacetamide, ethylenediamine, and diphenylmethane diisocyanate poisoning manifest as acute psychosis and pulmonary edema: treatment with hemoperfusion.

CASE REPORT: A 27-year-old man, employed by a synthetic fiber company, had been exposed to dimethylacetamide, ethylenediamine, and diphenylmethane diisocyanate in a confined space continuously for 4-6 hours per day for 3 days before admission. Hallucinations and delusions were noted at admission; pulmonary edema developed subsequently. The electroencephalogram showed diffuse moderate cortical dysfunction and slow waves at 4-7 Hz, 20-80 microV. Seizures, liver injury, and rhabdomyolysis were noted on the 4th hospital day. The patient was treated by hemoperfusion with a decrease in urine dimethylacetamide from 3,265 mg/g to 4 mg/g creatinine over 4 days. Serial urinary dimethylacetamide and electroencephalogram correlated with the clinical condition.

Acetamides↗

Idiopathic multicentric osteolysis with nephropathy.

Idiopathic multicentric osteolysis is a rare syndrome that manifests with progressive loss of carpal and tarsal bones in childhood. Affected children have arthritic-like episodes, followed by progressive deformities, radiographic osteolytic changes, and variable degrees of disability. A rare form of this disease (type III, sporadic) is associated with serious nephropathy. We present the first reported case of type III idiopathic multicentric osteolysis in a Chinese woman. The patient, a 34-year-old woman with normal mental development and no family history of bone or kidney disease, presented with a 4-day history of nausea and vomiting. She had shortening and swelling of the hands, which had occurred in childhood and persisted at the time of admission. X-ray studies showed disappearance of the carpal bones, and multiple osseous erosions of the tarsal bones. Hypertension, severe azotemia, and metabolic acidosis were also noted. Advanced renal disease was documented after a series of investigations, including renal biopsy. She is now dialysis-dependent. This case illustrates the importance of early diagnosis and management of idiopathic multicentric osteolysis with nephropathy.

Adult↗

Adrenal cancer with hypertension but low plasma renin and aldosterone.

Patients with malignant lesions of the adrenal gland may present with a syndrome of excess mineralocorticoids. Both primary hyperaldosteronism and excess mineralocorticoids other than aldosterone resulting from adrenal carcinoma have rarely been reported. In most patients with adrenal tumors secreting mineralocorticoids other than aldosterone, distant metastasis had already occurred at the time of diagnosis and the prognosis was poor. We present a rare case of adrenal cancer with hypertension in a patient with low plasma renin activity and a low plasma aldosterone concentration. The patient's blood pressure returned to normal after removal of the tumor. The patient is still alive and without recurrence 6 years after surgery. This case illustrates the value of thorough evaluation of hypertension and prompt surgical treatment for patients with adrenal cancer.

Adrenal Cortex Neoplasms↗

Urinary endothelin-1 in patients with renal disease.

The purpose of this study was to investigate the usefulness of urinary endothelin-1 (ET-1) as a marker of renal disease. We measured urinary excretion of ET-1 in 28 patients with glomerulonephritis (GN), 22 patients with chronic renal failure (CRF), 40 patients with end-stage renal disease (ESRD), and 17 healthy volunteers. There was no significant difference in 24-hour urinary ET-1 excretion among the four groups (mean +/- SEM, 0.49 +/- 0.22 ng in controls, 0.79 +/- 0.37 ng in GN patients, 0.39 +/- 0.18 ng in CRF patients, and 0.28 +/- 0.11 ng in ESRD patients). The 24-hour urinary excretion of ET-1 in patients with GN or CRF showed significant correlation with the urinary excretion of sodium (r = 0.27, p < 0.05). The 24-hour urinary beta 2-microglobulin (beta 2M) excretion in patients with CRF (18.4 +/- 2.6 mg) or ESRD (9.7 +/- 1.1 mg) was significantly higher than in normal control subjects (0.23 +/- 0.11 mg). Serum creatinine concentration was positively correlated with the 24-hour urinary excretion of beta 2M in patients with GN or CRF (r = 0.50, p < 0.001). These findings indicate that urinary ET-1 is not as good a marker of renal disease as urinary beta 2M. However, it may be responsible for urinary sodium excretion in patients with GN or CRF.

Biomarkers↗

Endothelin(B) receptor activates NHE-3 by a Ca2+-dependent pathway in OKP cells.

To examine the mechanisms by which endothelin (ET) regulates the Na/H antiporter isoform, NHE-3, OKP cells were stably transfected with ET(A) and ET(B) receptor cDNA. In cells overexpressing ET(B), but not ET(A) receptors, ET-1 increased Na/H antiporter activity (JNa/H). This effect was inhibited by a nonselective endothelin receptor blocker and by a selective ET(B) receptor blocker but was not inhibited by an ET(A) selective receptor blocker. In ET(B)-overexpressing cells, 10(-8) M ET-1 inhibited adenylyl cyclase, but protein kinase A inhibition and pertussis toxin pretreatment did not affect Na/H antiporter activation by ET-1. ET-1 caused a transient increase in cell [Ca2+], followed by a sustained increase. Increases in cell [Ca2+] were partially inhibited by pertussis toxin. ET-1-induced increases in J(Na/H) were 50% inhibited by clamping cell [Ca2+] low with BAPTA, and by KN62, a Ca-calmodulin kinase inhibitor. Inhibitors of protein kinase C, cyclooxygenase, lipoxygenase, and cytochrome P450 and cyclic GMP were without effect. In ET(A)-overexpressing cells, ET-1 increased cell [Ca2+] but did not increase JNa/H. In summary, binding of ET-1 to ET(B) receptors increases Na/H antiporter activity in OKP cells, an effect mediated in part by increases in cell [Ca2+] and Ca-calmodulin kinase. Increases in cell [Ca2+] are not sufficient for Na/H antiporter activation.

Animals↗

Role of tyrosine kinase pathways in ETB receptor activation of NHE3.

Endothelin-1 (ET-1) binding to ETB receptors increases the activity of the apical membrane Na+/H+ antiporter (NHE3) of renal proximal tubule and cultured OKP cells. In OKPETB6 cells, a clonal cell line of OKP cells that overexpresses ETB receptors, ET-1-induced increases in Na+/H+ antiporter activity are mediated 50% by Ca2(+)-dependent pathways and 50% by tyrosine kinase pathways. ET-1 induces tyrosine phosphorylation of proteins of 68, 110, 125, 130, and 210 kDa. ET-1-induced tyrosine phosphorylation is mediated by the ETB receptor and is not dependent on increases in cell Ca2+ or protein kinase C. The 68-, 110-, 125-, and 130-kDa phosphoproteins are cytosolic, whereas the 210-kDa phosphoprotein is an integral membrane protein. Immunoprecipitation studies showed that the 68-kDa protein is paxillin and the 125-kDa protein is p125FAK (focal adhesion kinase). Cytochalasin D, which disrupts focal adhesions, prevented ET-1-induced tyrosine phosphorylation of paxillin, p110, p125FAK, and p130 but did not prevent tyrosine phosphorylation of p210 and did not prevent ET-1-induced increases in Na+/H+ antiporter activity. Thus 50% of ETB receptor-induced Na+/H+ antiporter activation is mediated by tyrosine kinase pathways, possibly involving p210. ETB receptor activation also induces tyrosine phosphorylation of focal adhesion proteins, but this is not required for antiporter activation.

Animals↗

The acute effect of nicardipine on the renin-angiotensin-aldosterone system in salt-sensitive essential hypertension.

To determine the role of the renin-angiotensin-aldosterone (RAA) system in the acute effect of calcium channel blockers, we examined the acute effect of 40 mg nicardipine in 21 essential hypertensive patients. Nine patients whose mean blood pressure (MBP) decreased more than 5% at 2 hours after 20 mg furosemide i.v. were classified as salt-sensitive (SS); the remainder as salt-resistant (SR). The percentage decrease of MBP with nicardipine was not different between the two subgroups (12.4 +/- 2.5% for SS, and 17.7 +/- 4.1% for SR). The percentage decrease of MBP correlated with the pretreatment MBP (r = 0.67, p < 0.001), but not with the basal plasma renin activity (PRA), plasma aldosterone concentration (PAC), or natriuretic response. A significant increase of heart rate was noted in SR (31.2%) but not in SS (6.5%), and was associated with a higher increase of PRA in SR (90.7%) than in SS (25.5%). A correlation between the increase of PRA and the percentage increase of heart rate was noted (r = 0.77 p < 0.001). Decrease of PAC was observed in SS but not in SR until the third hour. The 3-hour sodium excretion was slightly greater in SR than in SS (59.9 +/- 9.1 vs. 35.1 +/- 3.0 mEq; p < 0.05). In summary, the acute hypotensive effect of nicardipine is dependent upon the vascular tone regardless of the status of the RAA system. An increase in PRA by nicardipine resulting from a baroreflex mechanism may counteract the inhibitory effect of aldosterone secretion by nicardipine. The unchanged PRA in SS is due to their blunted baroreflex control of heart rate. Mechanisms other than the change in the RAA system by nicardipine may account for the acute natriuretic effect.

Adult↗

Correlation between renin responsiveness to furosemide and antihypertensive effect of captopril in patients with normal-renin essential hypertension.

The relationship between renin responsiveness to furosemide and the antihypertensive effect of captopril in patients with normal-renin essential hypertension were studied in 23 patients including nine men (mean age, 41 years) and 14 women (mean age, 40 years). Those who had an increment of more than 50% in plasma renin activity (PRA) two hours after an intravenous injection of 20 mg furosemide were classified as group A (n = 13) and the others were classified as group B (n = 10). Baseline PRA, plasma aldosterone and mean blood pressure (MBP) were not different between the two groups. Both groups showed no significant difference in natriuresis following furosemide administration. Significant change in MBP was observed after an oral dose of 100 mg captopril within four hours in group A, but not in group B. These data suggest that renin responsiveness to a single intravenous dose of furosemide can be a useful test for predicting the therapeutic response to captopril in patients with normal-renin essential hypertension. The furosemide test had a sensitivity of 75%, a specificity of 64%, a positive predictive value of 69% and a negative predictive value of 70%.

Adult↗

Evaluation of cardiovascular autonomic function tests in dialysis patients.

Autonomic function was studied in 46 hemodialysis (HD) patients (aged 19-62 years, 30 men and 16 women), eight continuous ambulatory peritoneal dialysis (CAPD) patients (aged 29-78 years, five men and three women), and 107 normal adults (aged 21-80 years, 63 men and 44 women) by noninvasive cardiovascular reflex tests. The autonomic function tests included heart rate (HR) response to standing up, during the Valsalva maneuver, deep breathing and diving, and blood pressure response to standing up, during immersion of the hand in ice water, and during a sustained handgrip. The Master 2-step exercise test was also performed in HD patients and in normal controls. The results showed that: 1) HD patients had a significantly smaller R-R interval 30:15 ratio (1.04 vs 1.19), Valsalva ratio (1.27 vs 1.45), and HR change during diving (8.7 vs 19.2) than normal controls; 2) both the 30:15 ratio (1.00) and Valsalva ratio (1.19) in CAPD patients were significantly smaller than those in controls; and 3) the rate pressure product at three minutes for HD patients was significantly greater than that of normal controls (27060 vs 21300). In conclusion, dialysis patients revealed abnormalities in the cardiovascular autonomic function tests, especially in the parasympathetic tests. Exercise intolerance was also evident in these patients.

Adult↗

Hereditary xanthinuria: report of two cases.

Hereditary xanthinuria is a rare disorder characterized by the replacement of uric acid by xanthine and hypoxanthine in urine. Two cases of classic hereditary xanthinuria in Taiwan are herein reported. Case 1: a 30-year-old woman was by chance found to have hypouricemia. Urine and plasma purines were checked through the use of high performance liquid chromatography. Urine excretion of uric acid was 0.029 mumol (0.005 mg)/mg creatinine (30 mumol/24 hr); xanthine 1.9 mumol/mg creatinine (1935 mumol/24 hr); and hypoxanthine 0.58 mumol/mg creatinine (587 mumol/24 hr). Plasma xanthine was 9.3 mumol/L; hypoxanthine 5.8 mumol/L; and uric acid 0.5 mumol/L (0.001 mg/dL). Case 2: a brother of case 1 had a previous history of urolithiasis. Urine excretion of uric acid was 0.15 mumol (0.025 mg)/mg creatinine (189 mumol/24 hr); xanthine 1.3 mumol/mg creatinine (1620 mumol/24 hr); and hypoxanthine 0.22 mumol/mg creatinine (276 mumol/24 hr).

Adult↗

Cardiovascular autonomic dysfunction in non-insulin-dependent diabetes mellitus and its relation to renal dysfunction.

To investigate the relationship between cardiovascular autonomic neuropathy and nephropathy in patients with non-insulin-dependent diabetes mellitus (NIDDM), 45 patients underwent noninvasive cardiovascular reflex tests, including the Valsalva ratio, the 30:15 ratio and postural changes in systolic blood pressure (delta SBP), along with measurement of creatinine clearance (CCr) and daily protein excretion (DPE). Clinical symptoms in 30 patients were also noted and correlated with the results of the autonomic function tests. Thirty-four normal subjects underwent the same cardiovascular reflex tests and served as controls. The results showed that NIDDM patients had a significantly lower 30:15 ratio than normal subjects. However, no significant difference in either the Valsalva ratio or delta SBP was found between diabetic patients and controls. A positive correlation between the 30:15 ratio and CCr, but not DPE, was noted in diabetics. Although abnormal cardiovascular reflex tests appeared in patients who had no autonomic symptoms, abnormal test results were not parallel with the severity of symptoms. These results show that NIDDM patients have poorer cardiovascular autonomic function which may precede the appearance of autonomic symptoms. The 30:15 ratio was weakly correlated with CCr and this suggests that the incidence of cardiovascular dysfunction increases as the renal functional reserve decreases.

Adult↗