Estimation of Free Water Back Diffusion during Water Diuresis in Man Using Lithium Clearance and Furosemide Effect: Some Unresolved Questions

Author(s):  
E. J. Dorhout Mees ◽  
W. H. Boer ◽  
H. A. Koomans
1987 ◽  
Vol 252 (3) ◽  
pp. F382-F386 ◽  
Author(s):  
W. H. Boer ◽  
H. A. Koomans ◽  
E. J. Dorhout Mees

Lithium clearance (CLi) has been advanced as an indicator of Na delivery from the proximal tubules. We studied CLi in eight healthy males before and after mineralocorticoid escape, a maneuver that may induce suppression of fractional proximal Na reabsorption (FPRNa). FPRNa was also estimated from changes in maximal free water clearance (CH2O). According to the latter method, FPRNa dropped from 85.7 +/- 2.2 to 81.3 +/- 3.4%, whereas inulin clearance rose from 125 +/- 11 to 149 +/- 15 ml/min. The changes in CLi were surprisingly large, from 40.6 +/- 7.6 to 75.8 +/- 18.4 ml/min. If lithium is a valid marker of Na handling in the proximal tubule in humans, this change would imply a fall in FPRNa from 67.5 +/- 3.9 to 49.7 +/- 9.0%, suggesting a much larger shift in tubular Na reabsorption in escape than hitherto suspected. In addition, it would suggest that the inevitable back diffusion of a part of the solute-free water in the distal nephron, and thus overestimation of FPRNa by the CH2O method, increases importantly during escape. Alternately, lithium may not be a good marker of proximal tubular Na handling. For instance, both lithium reabsorption and escape may take place beyond the proximal tubule, or lithium may be excreted in the distal nephron in certain conditions. Present methods do not permit further analysis of these options in the human model.


1977 ◽  
Vol 232 (1) ◽  
pp. F16-F19
Author(s):  
G. Nomura ◽  
T. Takabatake ◽  
S. Arai ◽  
D. Uno ◽  
M. Shimao ◽  
...  

The effects of acute denervation of the kidney on renal tubular sodium and water excretion were studied in anesthetized, hypophysectomized, and cortisone-treated mongrel dogs during stable water diuresis produced by the infusion of 2.5% dextrose. In all experiments, denervation natriuresis, and diuresis were observed without significant change in glomerular filtration rate (GRF) and renal plasma flow (RPF). Fractional sodium delivery to the distal nephron (CNa + CH2O/100 ml GFR) and fractional free water clearance (CH23/100 ml GFR) was significantly greater in the denervated kidney compared with the innervated kidney (9.6+/-1.2 vs. 6.7+/-0.9% and 8.8+/-1.2 vs. 6.5+/-0.8%, respectively). Distal tubular sodium reabsorption (CH2O/(CNa + CH2O)) was not significantly different. We conclude that renal denervation primarily affects the proximal tubule as manifested by a decrease in the reabsorption of sodium and water. A small effect of denervation on the distal nephron is not completely ruled out.


1989 ◽  
Vol 66 (4) ◽  
pp. 1744-1748 ◽  
Author(s):  
T. J. Rabelink ◽  
H. A. Koomans ◽  
W. H. Boer ◽  
J. van Rijn ◽  
E. J. Dorhout Mees

Lithium clearance (CLi) has been advanced as a measure of sodium delivery from the proximal tubules. Because information on the intrarenal effects of water immersion is only limited, and available data are conflicting with respect to the effects on the proximal tubule, we examined the effects of 3 h of water immersion on renal functional parameters, including CLi, in eight healthy subjects. Studies were carried out during maximal water diuresis. Water immersion resulted in a significant increase in sodium excretion, from preimmersion values of 74.0 +/- 9.6 to 155.4 +/- 12.0 mumol/min at the third immersion hour (P less than 0.01). This natriuresis was accompanied by an increase in CLi from 26.3 +/- 1.9 (preimmersion) to 37.0 +/- 3.1 ml/min (P less than 0.01). Fractional lithium reabsorption (FRLi) decreased from 76.4 +/- 1.0 to 69.6 +/- 1.3% (P less than 0.01). None of these changes was found in eight healthy subjects undergoing a time-control study without water immersion. The large fall in FRLi found during immersion is compatible with a major resetting of the proximal glomerulotubular balance. In this regard the renal response to water immersion resembles saline expansion rather than mere intravascular expansion. The lithium data suggested a large rise in distal delivery accompanied by an almost as large rise in distal reabsorption. The free water clearance data were in agreement with this interpretation. However, no changes were found in fractional excretion of phosphate and uric acid. Therefore such a major resetting of proximal glomerulotubular balance can be doubted.(ABSTRACT TRUNCATED AT 250 WORDS)


1975 ◽  
Vol 49 (5) ◽  
pp. 409-417 ◽  
Author(s):  
J. G. Kleinman ◽  
M. L. Levin

1. The effects of pent-4-enoic acid, an inhibitor of fatty acid oxidation, were studied in dogs undergoing water diuresis and acetazolamide diuresis. Free water excretion and distal solute delivery were increased when infusion of pent-4-enoic acid was superimposed on an increasing mannitol diuresis. 2. Bicarbonate excretion increased significantly when infusion of pent-4-enoic acid was superimposed on maximum acetazolamide diuresis. 3. Phosphate excretion exceeded 90% of filtered load when pent-4-enoic acid was administered under stable free water conditions and increased significantly when pent-4-enoic acid was superimposed on stable acetazolamide diuresis. 4. The results are interpreted as indicating inhibition of proximal tubular reabsorption by pent-4-enoic acid, emphasizing the importance of fatty acids as a major fuel for proximal tubular metabolism.


1966 ◽  
Vol 52 (2) ◽  
pp. 239-254 ◽  
Author(s):  
Günther Vogel ◽  
Ingrid Stoeckert ◽  
Ruth Winkler

ABSTRACT To clarify the significance of vasopressin on various parameters of renal function, clearance and »stop-flow« tests on intact rats and those with induced diabetes insipidus were carried out during water and osmotic (mannitol) diuresis. With regard to renal clearance, urinary concentration and renal output, water diuresis in the intact and diabetic insipidus rats was the same: low urine osmolarity, low electrolyte concentration, positive free water clearance and low rate of electrolyte excretion. The concentration patterns taken 3 minutes after ureteral occlusion showed for Na+ and Cl−: low free flow values and proximal maximum; osmolarity: low free flow values with a distal maximum below the plasma concentration; creatinine: distal maximum; urea: high free flow values with distal maximum. In the osmotic diuresis of intact animals, the electrolyte concentration was substantially higher; correspondingly, excretory output was much increased as compared to water diuresis, with negative free water clearance. The »stop-flow« patterns for Na+ and Cl− – starting with 70–100 mmol/l – showed a distal minimum, for osmolarity a distal maximum; and the same for creatinine and urea. The measured parameters obtained from diabetic insipidus animals in osmotic diuresis showed a marked approximation – up to equivalence – to that of intact and diabetic insipidus animals in water diuresis. When diabetes insipidus animals in osmotic diuresis were administered arginine-vasopressin as a continuous infusion, the results completely matched those of the measured parameters in the osmotic diuresis of intact animals. The importance of vasopressin on renal transports can thus be demonstrated not only by clearance and excretory tests, but also by the concentration patterns after ureteral occlusion.


PEDIATRICS ◽  
1985 ◽  
Vol 75 (3) ◽  
pp. 575-579
Author(s):  
Carl-Johan Spak ◽  
Ulla Berg ◽  
Jan Ekstrand

Renal function and fluoride excretion have been studied in 38 children. The children were divided into three groups according to their glomerular filtration rate: normal (92 to 136 mL/min/1.73 m2 of body surface area [BSA]), low (< 92 mL/min/1.73 m2 BSA, and super-normal (> 136 mL/min/1.73 m2 BSA). Standard clearance technique with infusion of inulin and p-aminohippuric acid during water diuresis was used. Mean renal fluoride clearance was 45.0 ± 9.8 (SD) mL/min in the group of children with normal glomerular filtration rates and 31.4 ± 8.8 mL/min in the group with low glomerular filtration rates. This difference was statistically significant. There was a close linear relationship between renal fluoride clearance and glomerular filtration rate, urinary flow, and free water clearance. The fractional fluoride excretion did not differ between the groups. About 60% of the filtered fluoride was reabsorbed. No evidence for tubular secretion exceeding the reabsorption could be found. The results suggest that children have lower renal fluoride clearance rates than adults and indicate that a moderate impairment of the renal function could lead to increased retention of fluoride.


1980 ◽  
Vol 239 (4) ◽  
pp. F388-F392 ◽  
Author(s):  
Géza Fejes-TÓth ◽  
Tibor Zahajszky ◽  
János Filep

In an attempt to investigate a possible interaction between vasopressin and the renal kallikrein-kinin system, renal function and urinary kallikrein excretion were monitored in trained conscious dogs and in anesthetized rats in water diuresis and in vasopressin-induced antidiuresis. Vasopressin elevated urinary kallikrein excretion in a dose-dependent way in both species, with concomitant increases in urinary osmolality and electrolyte excretion. A significant increase in kallikrein excretion was observed with a dose of vasopressin as low as 2 mU·kg-1·h-1 in the dog and 3 mU·kg-1·h-1 in the rat without a change in renal hemodynamics. In the rat vasopressin-induced changes in kallikrein excretion were positively correlated with changes in sodium and potassium excretion and negatively correlated with changes in free water clearance. It is concluded that vasopressin over its normal physiological range of concentration stimulates renal kallikrein secretion. Note: With the Technical Assistance of Klára Peres and Edit Spitzár water diuresis; antidiuresis; natriuresis; kinins; dog; rat Submitted on October 8, 1979 Accepted on May 21, 1980


1959 ◽  
Vol 14 (1) ◽  
pp. 116-120 ◽  
Author(s):  
John W. Boylan ◽  
Dorothy E. Antkowiak

The diuresis associated with negative pressure breathing in moderately hydrated man is found to be due chiefly to an increase in the excretion of free water; solute excretion rises slightly and consistently. Simultaneous clearance studies do not reveal a characteristic pattern in renal hemodynamics for diuresis is observed to attend an increase, decrease or absence of change in RPF and GFR. There is, moreover, no effect on the peripheral venous hematocrit nor on the osmolar concentration of the plasma. Negative pressure breathing is without effect on urine flow when performed during maximal water diuresis or during the antidiuresis produced by infused Pitressin. These observations are in accord with the theory that the effective mechanism for the diuresis of negative pressure breathing is a reflex inhibition of antidiuretic hormone secretion. Submitted on September 19, 1958


1989 ◽  
Vol 256 (2) ◽  
pp. R531-R540
Author(s):  
S. P. Bagby ◽  
E. Fuchs

To assess angiotensin (ANG II) dependence of evolving neonatally induced coarctation hypertension (NICH) in inbred pups, we randomized sex-matched littermates to high-dose converting enzyme inhibitor (CEI: MK-421, 3 mg/kg) or placebo from the time of neonatal aortic banding (coarcted) vs. no banding (control). During phase 1 studies over 4 mo postbanding during ad libitum Na+ intake (Bagby and Fuchs, Hypertension Dallas in press). CEI failed to prevent evolution of proximal blood pressure (BP) excess or to impair renal function. Phase 2 studies examine, in the same pups, responses to low Na+ (LS) diet superimposed on chronic CEI at 4 mo, timed to allow development of BP increase in untreated NICH. The present report details metabolic handling and balances of Na+, K+, and fluid for 3 days before (normal Na+ intake) and daily for 11 days after initiation of LS diet, a companion paper describes BP, renin-angiotensin (RA), and renal functional responses. In no case did metabolic responses of coarcted pups to LS diet differ from those of controls, whether on CEI or placebo, whereas responses to LS diet and to CEI reveal positive findings of independent interest. LS diet induced expected renal and fecal Na+ conservation, no net effect on K+ balance, and, despite unexpected free-water diuresis, mild hyponatremia. Chronic CEI impaired maximal renal (but not fecal) Na+ conservation during LS diet, caused exaggerated free-water diuresis but no change in fluid balance, and thus, with the larger Na+ deficit, accounted for greater hyponatremia. CEI caused no net effect on K+ balance. Results indicate normal renal handling of fluid, Na+, and K+ in evolving NICH and provide no evidence for selective intrarenal RA activation or exaggerated ANG II dependence. Findings also suggest that, during LS diet, ANG II is 1) essential for maximum renal Na+ conservation and normal free-water handling, and 2) not essential for fecal Na+ and water conservation or for maintenance of normal water and K+ balances. Results are also compatible with a CEI-induced thirst stimulation and/or osmotic insensitivity and with functional vasopressin deficiency during LS diet.


1990 ◽  
Vol 259 (5) ◽  
pp. F839-F846 ◽  
Author(s):  
G. L. Pennington ◽  
M. J. McKinley

The effect of lowering cerebrospinal fluid (CSF) Na concentration on renal Na excretion (UNaV) was investigated in conscious sheep undergoing mineralocorticoid escape induced by intravenous infusion of aldosterone (20 micrograms.ml-1.h-1) for 3 days. On the 3rd day of aldosterone administration, when plasma and CSF Na concentration and mean arterial blood pressure (MABP) were increased as a result of the mineralocorticoid treatment, a reduction in the CSF Na concentration was induced by infusing a Na-free solution of 300 mmol/l mannitol (1 ml/h) into a lateral cerebral ventricle. This caused significant reductions in UNaV and MABP and a significant increase in renal free water clearance (CH2O). There was no significant change in glomerular filtration rate or plasma atrial natriuretic peptide concentration, but renal lithium clearance decreased. Simultaneous intravenous infusion of vasopressin (0.03 microgram/h) and lowering of CSF Na concentration also caused significant reductions in UNaV and MABP, but CH2O did not increase. We propose that increased Na concentration of brain fluid may initiate natriuretic and pressor mechanisms contributing to the process of mineralocorticoid escape. Reduced UNaV may have been due to reduced MABP, but it is unlikely to have been due to reduced plasma vasopressin levels.


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