Sodium Conservation in Chronic Renal Failure: Studies Using Oral Diazoxide

1. The defect in sodium conservation shown by patients with advanced chronic renal failure has been studied during the administration of diazoxide. 2. All nine patients showed a reduction in urinary sodium concentration to levels substantially lower than those which can normally be produced in such patients even with prolonged sodium depletion. Seven patients produced a nearly sodium-free urine. In all patients this effect could be reversed by the administration of high doses of frusemide. The fall in urinary sodium concentration was associated with a sustained fall in creatinine clearance in only two cases. 3. One patient with salt-losing renal disease showed a more modest fall in sodium concentration on treatment with diazoxide. 4. It is concluded that since the defect in sodium conservation shown by patients with chronic renal failure can be corrected without diminishing the osmotic load, it cannot be solely due to the effect of the osmotic diuresis upon residual functioning nephrons. It is suggested that the distal tubular transport mechanism for sodium is saturated by the increased delivery of sodium from the proximal tubule.

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High doses of mepivacaine for brachial plexus block in patients with end-stage chronic renal failure. A pilot study

European Journal of Anaesthesiology ◽

10.1097/00003643-200103000-00006 ◽

2001 ◽

Vol 18 (3) ◽

pp. 171-176 ◽

Cited By ~ 19

Author(s):

J. Rodríguez ◽

O. Quintela ◽

M. López-Rivadulla ◽

M. Bárcena ◽

C. Diz ◽

...

Keyword(s):

Renal Failure ◽

Chronic Renal Failure ◽

Pilot Study ◽

Brachial Plexus ◽

Brachial Plexus Block ◽

High Doses ◽

End Stage ◽

Plexus Block

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Role of High-Dose Intravenous Frusemide Therapy in the Management of Chronic Renal Failure

Journal of International Medical Research ◽

10.1177/030006057500300405 ◽

1975 ◽

Vol 3 (4) ◽

pp. 245-250

Author(s):

Mam Chandra ◽

M K Mitra ◽

N N Gupta

Keyword(s):

Renal Failure ◽

Chronic Renal Failure ◽

Side Effects ◽

Treated Group ◽

Fixed Dose ◽

High Dose ◽

Dose Regime ◽

Diuretic Response ◽

High Doses

The results of using high doses of intravenous frusemide in the management of 28 patients suffering from chronic renal failure are presented. The results are compared with those obtained from 14 patients also suffering from chronic renal failure, who received identical ‘conservative management’ but were not treated with diuretics. Large doses of intravenous frusemide produced a satisfactory diuretic response in a higher percentage of treated patients (71%) compared with controls (36%). It was also observed that in the treated group of patients a significant diuretic response could be obtained in patients with a creatinine clearance below 4 ml per minute. The study also demonstrated that in the group of patients receiving frusemide the response was better in those who were given a progressive-dose regime; 88% of patients improved with this regime compared with 68% of patients who were treated with a fixed dose of frusemide. Transient deafness with tinnitus and vertigo were the only side-effects observed. However these effects were only seen in patients who received 1000 mg or more frusemide in one day, administered over a period of one to two hours. It is concluded that all patients suffering from chronic renal failure should be given a trial of large doses of intravenous frusemide therapy, along with other conventional measures, particularly where facilities for dialysis are not immediately available.

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EFFECTS OF 9-ALPHA-FLUOROHYDROCORTISONE ON BLOOD PRESSURE, PLASMA VOLUME, AND SODIUM, POTASSIUM AND WATER BALANCE IN RATS

Acta Endocrinologica ◽

10.1530/acta.0.0760539 ◽

1974 ◽

Vol 76 (3) ◽

pp. 539-555 ◽

Cited By ~ 7

Author(s):

D. Haack ◽

E. Hackenthal ◽

E. Homsy ◽

B. Möhring ◽

J. Möhring

Keyword(s):

Blood Pressure ◽

Water Balance ◽

Plasma Volume ◽

Sodium Excretion ◽

Urinary Sodium Excretion ◽

Sodium Concentration ◽

Urinary Sodium ◽

Blood Pressure Elevation ◽

High Doses ◽

Water And Sodium Excretion

ABSTRACT In normal rats on a standard sodium diet, the administration of 9-alpha-fluorohydrocortisone (9aFF) induced a rapid increase of blood pressure in parallel to an increase of plasma volume. Water and potassium balances became negative. Urinary sodium excretion remained unchanged or increased after high doses, whereas urinary sodium concentration and faecal sodium excretion were reduced. The diurnal rhythm of water and sodium excretion changed: during the night-period, renal water and sodium excretion were diminished, whereas during the day-period both were enhanced. Thus, some effects of 9aFF on electrolyte and water balance are similar to those of DOC, while other effects are similar to those of cortisone. It is postulated that a shift of fluid from intracellular to extracellular compartments, which increases plasma volume, is of critical importance for the 9aFF-induced blood pressure elevation in rats.

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Early effects of contrast media on renal hemodynamics and tubular function in chronic renal failure.

Journal of the American Society of Nephrology ◽

10.1681/asn.v651451 ◽

1995 ◽

Vol 6 (5) ◽

pp. 1451-1458

Author(s):

D Russo ◽

R Minutolo ◽

B Cianciaruso ◽

B Memoli ◽

G Conte ◽

...

Keyword(s):

Renal Failure ◽

Single Dose ◽

Chronic Renal Failure ◽

Contrast Media ◽

Fractional Excretion ◽

Sodium Concentration ◽

Renal Hemodynamics ◽

Fractional Excretion Of Sodium ◽

Urinary Levels ◽

Renal Hypoperfusion

The pathophysiology and prevention of contrast media (CM)-induced nephropathy in chronic renal failure (CRF) are still ill defined. GFR, RPF, endothelin-1 (ET-1) levels, urinary sodium concentration, and fractional excretion of sodium were measured in CRF patients undergoing water diuresis in basal conditions and 20 to 120 min after an iv bolus of either the high-osmolar CM diatrizoate (D) or the low-osmolar CM iopamidol (I). The two CM induced an immediate and progressive decline of both GFR and RPF in the absence of hypovolemia, more pronounced in D (-36% at 120 min) than after I (-19% at 120 min; P < 0.05 versus D). Both CM determined a marked and steady increase of the fractional excretion of sodium. The natriuresis could not be totally ascribed to a CM-induced osmotic diuresis as because the urinary sodium concentration markedly increased. In two further groups of patients receiving D, we studied the effects of pretreatment with a single dose of either captopril or nifedipine. Both drugs, although not preventing the increase of natriuresis, partially antagonized D-induced renal hypoperfusion: GFR and RPF were equally reduced by 20% in D/captopril and D/nifedipine (P < 0.05 versus D). In unpretreated patients receiving either D or I, plasma ET-1 did not change but urinary levels increased; these changes were, however, dissociated from those observed in renal hemodynamics. Both plasma and urinary levels of ET-1 did not vary in pretreated groups. The 72-h follow-up evidenced a significant reduction of renal function only in the unpretreated D group. Therefore, the main findings after CM administration in CRF patients are: (1) an immediate GFR decline proportional to the osmolarity of CM and secondary to the renal hypoperfusion that is neither caused by hypovolemia nor mediated by ET-1, (2) an early tubular dysfunction at the level of the proximal nephron, and (3) a protective effect of single-dose pretreatment with either captopril or nifedipine on D-induced acute and short-term GFR changes.

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