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Effects of lumbar sympathetic block on kidney function in cirrhotic patients with hepatorenal syndrome.

We studied the effects of unilateral lumbar sympathetic block on kidney function in eight patients with cirrhosis and hepatorenal syndrome. In five patients with basal glomerular filtration rate (GFR) below 25 ml/min, sympathetic block induced a significant increase in GFR, osmolal clearance, urinary sodium excretion, fractional excretion of filtered sodium (FENa) and effective renal plasma flow (ERPF) and a decrease in plasma renin activity. In the three patients with basal GFR greater than 25 ml/min, sympathetic block produced no significant change in renal function. We conclude that sympathetic block might improve renal function in cirrhotics with hepatorenal syndrome, particularly those with more impaired GFR.

Adrenergic Fibers↗

The effects of dopamine on kidney function of rats.

The dose-response effects of dopamine on kidney function were studied in rats. Th arterial blood pressure was increased only transiently, after continuous intravenous infusion of dopamine for 2 hr, while heart rate was elevated throughout. Drastic diuresis was usually observed during the early phase of infusion especially when the dose of dopamine was greater than 46 micrograms/min-kg BW. Natriuresis was also found to be dose-dependent but its duration was much more prolonged than diuresis. Both, the increase in glomerular filtration rate (GFR) and reduction in tubular salt reabsorption may be responsible for this elevation in the rate of sodium excretion. Dopamine, at low dose, insignificantly increased the GFR but at a higher dose (90 micrograms/min-kg BW), a 16% increment was observed. This elevation in GFR may not be due to a concomitant increase in the renal blood flow, since phenoxybenzamine, an alpha-adrenergic blocking agent, which would further reduce the renal vascular resistance, abolished the effects of dopamine on GFR, diuresis and natriuresis. It was suggested that the increase in GFR may be due to the differences in the responsiveness of the afferent and the efferent arterioles to dopamine, in the presence of normal alpha-adrenergic receptors. Dopaminergic receptors in the kidney of rat, if present, may not play a significant role in determining the renal function.

Animals↗

Liver and kidney function and histology in rats exposed to cadmium and ethanol.

AIMS: The present study was performed to assess the function and histology of the liver and kidney in rats exposed to 50 mg Cd/l (as cadmium chloride) and/or 10% (w/v) ethanol (EtOH) for 12 weeks. METHODS: The activities of alanine aminotransferase (ALAT) and asparate aminotransferase (AspAT) in serum were measured as indicators of the liver function. As parameters of the kidney function, creatinine, total protein and urea concentrations in serum and urine, as well as urinary alkaline phosphatase (ALP) activity were determined, and creatinine clearance was calculated. Both organs were subjected to histopathological analysis. RESULTS: Daily Cd intake ranged from 3.17 to 4.28 mg/kg body weight and from 2.41 to 3.17 mg/kg body weight in the Cd and Cd + EtOH groups, respectively. The daily intake of 10% EtOH ranged from 47.5 to 86.9 g/kg body weight in the EtOH and from 47.3 to 63.4 g/kg body weight in the Cd + EtOH-exposed rats. Cd and EtOH, independently of separate or combined application, changed liver and kidney function and histology. Rats treated with Cd alone and those co-exposed to both substances showed qualitatively similar, but different magnitudes of changes, in liver and kidney histology. Blurred trabecular structure, vacuolar degeneration and increased density of nuclear chromatin with very compact nuclear structure were found in hepatocytes of zones 2 and 3. Moreover, mononuclear cell infiltrations and necrosis of single cells were evident in zone 1. In the kidney tubules, degeneration and hypertrophy of epithelial cells and dilation in the glomeruli were also observed. Some functional (increased serum AspAT and urinary ALP, decreased urinary urea) and structural changes in the liver and kidney were more evident in the case of combined exposure, while others were more evident after single exposure. However, a decrease in creatinine clearance, noted only in the animals treated with Cd and EtOH, shows that functional changes indicating renal insufficiency are more serious in the co-exposed group. CONCLUSIONS: Due to lower Cd and EtOH intake (resulting from a stronger aversion to drinking water containing both substances) in the co-exposed rats, as compared to the Cd- and EtOH-treated groups, it is difficult to draw a definite conclusion from this study. The findings, however, seem to indicate that EtOH increases Cd nephrotoxicity in rats, and thus may suggest a higher risk of kidney damage in alcoholics exposed to Cd. Unfortunately, this study does not provide clear evidence if, and to what extent, EtOH influences Cd hepatotoxicity.

Alcoholic Intoxication↗

Percutaneous transluminal angioplasty for renal artery stenosis in a solitary functioning kidney.

In five patients with hypertension and marked impairment of renal function due to renal artery stenosis in a solitary functioning kidney, a nonsurgical technique, percutaneous transluminal angioplasty, was used to dilate the stenotic renal artery. Blood pressure improved in all five patients, and renal function improved in three. One patient subsequently died of multiple cardiovascular complications, and in one patient the procedure resulted in acute renal failure requiring hemodialysis. Although preliminary, this experience suggests that percutaneous transluminal angioplasty may provide an attractive alternative to surgery in severely ill patients at high surgical risk.

Aged↗

[Effect of chemotherapy on kidney function in pyelonephritis due to calculi with kidney insufficiency].

In patients with stone pyelonephritis the behaviour of the renal function under the influence of chemotherapy was examined at the stage of the compensated retention. 24 cures carried out on clinical conditions on 10 patients with an average age of 52 years (14--71) were evaluated. By means of chemotherapy in connection with the treatment of anaemia and the compensation of acidosis the renal function could favourably be influenced and the terminal stage of the renal insufficiency could be shifted. The author adopts a definite attitude to the long-term prophylaxis.

Adolescent↗

Kidney function and lithium concentrations of rats given an injection of lithium orotate or lithium carbonate.

A recent study by Kling et al (1978) noted the finding of higher lithium concentrations in serum and brain of rats after an intraperitoneal injection (2 mmol lithium kg-1) of lithium orotate as a slurry than of lithium carbonate in solution. The authors suggested that lithium orotate might offer advantages in the treatment of patients. We repeated the experiments of Kling et al but in addition examined the kidney function of the rats. Glomerular filtration rate and urine flow were markedly lower in rats given lithium orotate than in rats given lithium carbonate, sodium chloride or a sham injection. The renal lithium clearance was significantly lower, the kidney weight and the lithium concentrations in serum, kidney and heart significantly higher after injection of lithium orotate than after injection of lithium carbonate. The higher lithium concentrations could be accounted for by the lower kidney function. It seems inadvisable to use lithium orotate for the treatment of patients.

Animals↗

Quantitative microscopic approaches for studying kidney functions.

Intravital ratiometric microscopy is a powerful method for quantitative study of kidney functions. As demonstrated in the examples, both the generalized polarity and direct ratio imaging approaches allow investigators to address basic and important questions such as those related to filtration, permeability and reabsorption. Both approaches have similar advantageous for in vivo imaging. However, they have different sensitivities and responses to the component intensity changes. Therefore, investigators must design their experiments based on the characteristics of the generalized polarity function and direct ratio approach.

Absorption↗

[Nuclear medicine diagnosis of kidney function in unilateral urinary tract dilatation in childhood].

Ultrasound accurately detects hydronephrosis in infants and children, while nuclear medicine techniques quantify relative renal function in addition to characterize the urodynamic relevance of hydronephrosis. Because ultrasound fails to estimate the potential reduction of relative kidney function with more severe hydronephrosis and moreover, renal function is not necessarily affected by hydronephrosis, renal scintigraphy is indicated to assess the functional status of hydronephrotic kidneys for both, split renal function and postrenal urine drainage without and, if necessary, with furosemide intervention.

Adolescent↗

Effect of pancreas transplantation on life expectancy, kidney function and quality of life in uraemic type 1 (insulin-dependent) diabetic patients.

The aim of our study was to evaluate the effects of haemodialysis, kidney transplantation and simultaneous kidney and pancreas transplantation on survival of diabetic subjects and on kidney function. 40 Type 1 (insulin-dependent) diabetic patients received a kidney transplantation: in 31 cases the kidney was transplanted simultaneously to a pancreas graft from the same donor (KP group), while in 9 cases the pancreas was not available (K group). 44 uraemic Type 1 (insulin-dependent) diabetic patients on dialysis and in waiting list for kidney transplantation, constituted the control group (HD group). Patient survival rate 1, 3 and 5 years following transplantation was better in KP group (93%, 89%, 89%, respectively) and in K group (88%, 88%, 73%, respectively) and in HD group (88%, 62%, 51%, respectively). Kidney graft survival at 1, 3 and 5 years post-transplant was better in KP group (93%, 72%, 72%, respectively) than in K group (76%, 61%, 31%, respectively). 1 year after transplantation, patients of the KP group who had lost the pancreas for technical reasons (thrombosis) were included in the K group so as to evaluate the effect of the transplanted pancreas on long-term patient and kidney survival. Patient survival rate in the KP group (17 patients) at 2 and 4 years was 100%, while at the same intervals it was 78% in the K group (13 patients). Kidney graft function rate at 2 and 4 years was 93% in the KP group (17 grafts) and 54% and 27% respectively in the K group (14 grafts).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

The effect of beta-blockade and angiotensin converting enzyme inhibition on kidney function in diabetic nephropathy.

Diabetic nephropathy is characterized by persistent albuminuria, a decline in glomerular filtration rate (GFR) and elevated blood pressure. About 40% of all insulin-dependent diabetic patients will develop nephropathy, thus increasing their morbidity and mortality. The effect of early aggressive antihypertensive treatment with metoprolol, frusemide or thiazide in insulin-dependent diabetic patients with nephropathy has shown a significant reduction in albuminuria and in the rate of decline in the GFR (from 0.94 to 0.29 and 0.10 ml/min per month over 72 months of antihypertensive treatment). The effect of angiotensin converting enzyme (ACE) inhibition on kidney function in diabetic nephropathy showed that the GFR is not dependent on angiotensin II (Ang II), and that ACE inhibition diminished albuminuria, probably by lowering glomerular hypertension. In conclusion, antihypertensive treatment with ACE inhibitors or beta-blockers combined with a diuretic protects kidney function and reduces albuminuria in diabetic nephropathy. Angiotensin converting enzyme inhibitors can be considered as first-line drugs for hypertensive patients with diabetic nephropathy.

Adrenergic beta-Antagonists↗

[Study of the changes in kidney function in acute obstruction of the arteries of the extremities].

The kidney function was studied in postischemia period in 80 patients with acute arterial occlusion,using the methods of radioisotope renography and effective renal blood flow. For the purpose of prophylaxis agains renal complications in addition to regional perfusion and venesection the method of regional inhibition of toxic products in the ischemia focus is suggested. In increased myoglobinuiea the stimulation of diuresis, alkalization of the organism would be a necessity. Renal complications were observed in 13 of 80 patients (16.25%). In 6 patients myoglobinuric tubular nephrosis was noted with lethal issues; in the remaining 7 patients due to early establishment of the diagnosis and intensive therapy myoglobinuria showed an abortive character.

Acid-Base Equilibrium↗

Kidney function in normal man during short-term growth hormone infusion.

Kidney function was studied in 9 normal males before and during a 2 h growth hormone (GH) infusion of 50 ng/kg/min. The following variables were measured during each 20 min clearance period: glomerular filtration rate, GFR, effective renal plasma flow, RPF (steady state infusion technique with urinary collections using [125I]iothalamate and [131I]iodohippurate), and urinary albumin and beta2-microglobulin excretion rates (radioimmunoassays). The GH infusion resulted in a 10-fold increase in plasma GH concentration. All the above mentioned variables remained practically unchanged during the infusion except for a small (-5%) but significant decrease in renal plasma flow (P less than 0.01). Our negative results contrast to the findings of increased GFR and RPF during prolonged GH administration and suggest that GH requires several hours or days for its renal effects to become manifest.

Adult↗