Glomerular Filtration Rate and Segmental Tubular Function in the Early Phase after Transplantation/Uninephrectomy in Recipients and Their Living-Related Kidney Donors

1. Glomerular filtration rate and sequential tubular function were investigated in 18 adult renal transplant recipients and in their matched, adult living-related kidney donors before and 5 days after transplantation/uninephrectomy. At day 54, 13 donors and 11 recipients were re-investigated. Sixteen of these constituted eight matched pairs. This reduction in the study population was caused by the application of two withdrawal criteria. 2. In the recipients glomerular filtration rate was unchanged at day 5 and had increased to 61 ml/min at day 54 (P < 0.05). In the donors glomerular filtration rate had increased to 59 ml/min by day 5 (P < 0.01) and was unchanged at day 54. 3. In the recipients lithium clearance was unchanged at day 5 and had increased to 23 ml/min at day 54 (P < 0.01). In the donors the lithium clearance had increased by day 5 (P < 0.01). 4. In the recipients the absolute proximal fluid reabsorption rate was about 36 ml/min throughout the study period. In the donors the absolute proximal fluid reabsorption rate had increased to 42 ml/min by day 5 (P < 0.05) and increased further to 44 ml/min by day 54 (P < 0.01). 5. In the recipients sodium clearance increased from 0.54 ml/min to 2.10 ml/min at day 54 (P < 0.01). In the donors it increased from 0.64 ml/min to 0.99 ml/min at day 54 (P < 0.05). 6. Donor-recipient comparison showed that at day 54 there was no significant difference with regard to glomerular filtration rate, lithium clearance, absolute and fractional proximal fluid reabsorption rate and absolute distal sodium reabsorption rate. The sodium clearance was higher and the fractional distal sodium reabsorption rate was lower in the recipients. 7. In conclusion, the difference in function between donors and recipients at day 5 can probably be explained by the damaging effect of many inevitable factors on the graft. Fifty-four days after transplantation the function of the graft could not be distinguished from that of the remaining kidney. This suggests that the ideal homograft possesses a normal potential for compensatory hypertrophy once the effects of the initial post-operative ischaemia and toxic factors have subsided.

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Lithium clearance and renal tubular sodium handling during acute and long-term nifedipine treatment in essential hypertension

Clinical Science ◽

10.1042/cs0750609 ◽

1988 ◽

Vol 75 (6) ◽

pp. 609-613 ◽

Cited By ~ 22

Author(s):

Niels Eske Bruun ◽

Hans Ibsen ◽

Peter Skøtt ◽

Dorthe Toftdahl ◽

Jørn Giese ◽

...

Keyword(s):

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Filtration Rate ◽

Sodium Reabsorption ◽

Lithium Clearance ◽

Tubular Sodium Reabsorption ◽

Potassium Clearance ◽

Renal Tubular ◽

Sodium Clearance

1. In two separate studies the lithium clearance method was used to evaluate the influence of acute and long-term nifedipine treatment on renal tubular sodium reabsorption. 2. In the acute study, after a 4 week placebo period two doses of 20 mg of nifedipine decreased supine blood pressure from 155/101 (20.6/13.5) ± 11/4 (1.5/0.5) to 139/88 (18.5/11.7) ± 16/9 (2.1/1.2) mmHg (kPa) (means ± sd; P < 0.01). Lithium clearance, glomerular filtration rate and sodium clearance did not change. Therefore the calculated values of absolute proximal and absolute distal sodium reabsorption rates were also unchanged, as were potassium clearance, urine flow and body weight. 3. In the long-term study, lithium clearance, glomerular filtration rate, sodium clearance, potassium clearance, urine flow and body fluid volumes were measured after a 4 weeks placebo period and after 6 and 12 weeks of nifedipine treatment. As compared with placebo, mean supine blood pressure decreased significantly. The glomerular filtration rate did not change but lithium clearance fell by 30%. Consequently, the absolute and the fractional proximal sodium reabsorption increased significantly. The fractional distal sodium reabsorption did not change. Sodium clearance, fractional sodium excretion, potassium clearance, plasma volume and extracellular fluid volume were also unchanged. 4. In conclusion, we found no changes of renal tubular sodium reabsorption during acute nifedipine treatment, whereas long-term nifedipine treatment caused a redistribution of tubular sodium reabsorption without a change in overall sodium excretion or body fluid compartments.

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Effect of Urodilatin Infusion on Renal Haemodynamics, Tubular Function and Vasoactive Hormones

Clinical Science ◽

10.1042/cs0920397 ◽

1997 ◽

Vol 92 (4) ◽

pp. 397-407 ◽

Cited By ~ 19

Author(s):

JAN Carstens ◽

Kaare T. Jensen ◽

Erling B. Pedersen

Keyword(s):

Blood Pressure ◽

Body Weight ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Filtration Rate ◽

Distal Part ◽

Renal Haemodynamics ◽

Sodium Reabsorption ◽

Lithium Clearance ◽

Short Term

1. The renal efficacy of urodilatin in humans has only been partly investigated. It is unknown whether intravenously infused urodilatin has an effect on sodium reabsorption in both the proximal and distal part of the nephron. 2. Twelve healthy subjects participated in this double-blind, placebo-controlled study in a crossover design. They received, in a randomized order, a short term (60 min) infusion of urodilatin in three different doses (10, 20 and 40 ng min−1 kg−1 of body weight) and placebo. Renal haemodynamics were estimated by clearance technique with radioactive tracers, and proximal tubular handling of sodium was evaluated by lithium clearance. 3. The 20 ng min−1 kg−1 dose increased the urinary sodium excretion and urinary flow rate compared with the effects of placebo. It increased the glomerular filtration rate and decreased the effective renal plasma flow. In addition, the dose increased the lithium clearance compared with placebo, but did not significantly change the fractional excretion of lithium. On the other hand, it markedly decreased the distal fractional reabsorption of sodium. It also had a suppressive effect on renin secretion. The systemic arterial blood pressure was unchanged, but the dose increased the pulse rate and the haematocrit. The highest dose (40 ng min−1 kg−1) induced a wide variation in the natriuretic and diuretic responses, probably due to a blood-pressure-lowering effect. 4. We conclude, that the urodilatin dose of 20 ng min−1 kg−1 of body weight was most efficacious in this short-term infusion study, and that it had potent natriuretic and diuretic qualities, probably due to stimulation of the glomerular filtration rate and inhibition of sodium reabsorption in the distal part of the nephron.

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Lithium clearance method and the renal response to low-dose dopamine in man: a randomized, controlled study

Clinical Science ◽

10.1042/cs0840237 ◽

1993 ◽

Vol 84 (2) ◽

pp. 237-242 ◽

Cited By ~ 10

Author(s):

Niels Vidiendal Olsen ◽

Michael Hecht Olsen ◽

Niels Fogh-Andersen ◽

Bo Feldt-Rasmussen ◽

Annelise Kamper ◽

...

Keyword(s):

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Plasma Flow ◽

Filtration Rate ◽

Low Dose ◽

Renal Plasma Flow ◽

Effective Renal Plasma Flow ◽

Lithium Clearance ◽

Clearance Studies ◽

Sodium Clearance

1. The effect of a single dose of lithium on renal function before and during intravenous infusion of dopamine (3 μg min−1 kg−1) was investigated in 12 healthy males. In a double-blind and randomized design, 450 mg or 600 mg of lithium carbonate or placebo was administered orally at 22.00 hours on three different occasions. After an overnight fast, the subjects were water-loaded and clearance studies were started at 09.00 hours with a 1 h baseline period and three 1 h periods during dopamine infusion. 2. Baseline sodium clearance with placebo was 0.65 ± 0.35 ml/min, but with lithium it increased to 1.25 ± 0.44 (P < 0.001) and 1.17 ± 0.46 ml/min (P < 0.01) after 450 and 600 mg, respectively. Urine flow rates were unchanged compared with placebo. Lithium did not significantly affect glomerular filtration rate, but both doses slightly increased effective renal plasma flow by 7% (P < 0.05) and 10% (P < 0.01), respectively. 3. The maximal natriuretic and diuretic effects of dopamine were not reduced by lithium, but the percentage increases in sodium clearance were significantly diminished after 450 mg (P < 0.01) and 600 mg (P < 0.001) of lithium. Lithium had no effect on dopamine-induced changes in effective renal plasma flow, glomerular filtration rate or osmolal clearance. Neither lithium nor dopamine influenced plasma concentrations of renin, aldosterone or atrial natriuretic peptide. 4. In conclusion, single test doses of lithium, as normally used in lithium clearance studies, increase baseline values of sodium clearance and effective renal plasma flow. Although these effects of lithium do not reduce the maximal renal responses to low-dose dopamine, they result in an underestimation of the percentage increase in sodium excretion.

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Assessing glomerular filtration rate in healthy adult potential kidney donors in Bangladesh: A comparison of various prediction equations with measured glomerular filtration rate by diethylentriamine pentaacetic acid renogram

Bangladesh Medical Research Council Bulletin ◽

10.3329/bmrcb.v39i2.19646 ◽

2014 ◽

Vol 39 (2) ◽

pp. 74-79

Author(s):

F Jahan ◽

MNU Chowdhury ◽

T Mahbub ◽

SM Arafat ◽

S Jahan ◽

...

Keyword(s):

Renal Function ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Filtration Rate ◽

Healthy Adult ◽

Healthy Population ◽

Prediction Equations ◽

Estimated Gfr ◽

Kidney Donors ◽

Measured Gfr

To ensure that potential kidney donors in Bangladesh have no renal impairment, it is extremely important to have accurate methods for evaluating the glomerular filtration rate (GFR). We evaluated the performance of serum creatinine based GFR in healthy adult potential kidney donors in Bangladesh to compare GFR determined by DTPA with that determined by various prediction equations. In this study GFR in 61 healthy adult potential kidney donors were measured with 99mTc-diethylenetriamine penta-acetic acid (DTPA) renogram. We also estimated GFR using a four variable equation modification of diet in renal disease (MDRD), Cockcroft-Gault creatinine clearance (CG CrCl), Cockcroft-Gault glomerular filtration rate (CG-GFR). The mean age of study population was 34.31±9.46 years and out of them 65.6% was male. In this study mean mGFR was 85.4±14.8. Correlation of estimated GFR calculated by CG-CrCl, CG-GFR and MDRD were done with measured GFR DTPA using quartile. Kappa values were also estimated which was found to be 0.104 for (p=0.151), 0.336 for (p=0.001) and 0.125 for (p=0.091) respectively. This indicates there is no association between estimated GFR calculated by CG-CrCl, CG-GFR, MDRD with measured GFR DTPA. These results show poor performance of these equations in evaluation of renal function among healthy population and also raise question regarding validity of these equations for assessment of renal function in chronic kidney disease in our population. DOI: http://dx.doi.org/10.3329/bmrcb.v39i2.19646 Bangladesh Med Res Counc Bull 2013; 39: 74-79

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Changes in glomerular filtration rate, lithium clearance and plasma protein clearances in the early phase after unilateral nephrectomy in living healthy renal transplant donors

Clinical Science ◽

10.1042/cs0750655 ◽

1988 ◽

Vol 75 (6) ◽

pp. 655-659 ◽

Cited By ~ 16

Author(s):

S. Strandgaard ◽

A. Kamper ◽

P. Skaarup ◽

N. H. Holstein-Rathlou ◽

P. P. Leyssac ◽

...

Keyword(s):

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Plasma Protein ◽

Immunoglobulin G ◽

Filtration Rate ◽

Early Response ◽

Unilateral Nephrectomy ◽

Lithium Clearance ◽

Β2 Microglobulin ◽

Observation Period

1. Glomerular and tubular function was studied before and 2 months after unilateral nephrectomy in 14 healthy kidney donors by measurement of the clearances of 51Cr-labelled ethylenediaminetetra-acetate, lithium, β2-microglobulin, albumin and immunoglobulin G. 2. The glomerular filtration rate (GFR) of the kidney that remained in the donor rose from 45 ± 10 (mean ± sd) to 59 ± 10 ml/min (P < 0.01) 5 days after contralateral nephrectomy and remained at this level through the observation period. 3. The lithium clearance (CLi) of the remaining kidney rose from 11.6 ± 3.7 to 20.5 ± 8.2 ml/min (P < 0.01) and remained significantly elevated throughout the observation period. 4. Absolute proximal fluid reabsorption rate (APR), which was estimated as GFR minus CLi, was unchanged 5 days after contralateral nephrectomy, but then rose gradually to reach significantly elevated levels after 4 weeks. 5. Fractional proximal reabsorption (FPR; APR/GFR) fell from 0.75 ± 0.06 to 0.66 ± 0.11 (P < 0.01) but subsequently rose to levels not significantly decreased from normal. 6. Twenty-four hour fractional clearances of β2-microglobulin, albumin and immunoglobulin G rose markedly on the day of nephrectomy, peaked at 2–3 days and subsequently fell to moderately elevated levels. 7. Both the CLj and the plasma protein clearance studies demonstrate that the early response of the remaining kidney to contralateral nephrectomy in man is an increase in GFR, an unchanged APR and a fall in FPR. The proximal tubules thus initially handle the increased filtrate load by passing it on to more distal nephron segments. Within 2–4 weeks, an adaptive increase is seen in proximal reabsorption of both protein and fluid, resulting in an almost complete normalization of glomerulotubular balance.

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Unilateral nephrectomy causes an early abrupt decrease in plasma arginine and simultaneous reduction in glomerular filtration rate in living kidney donors

Clinical Biochemistry ◽

10.1016/j.clinbiochem.2013.04.031 ◽

2013 ◽

Vol 46 (15) ◽

pp. 1394-1398 ◽

Cited By ~ 5

Author(s):

Gordana Žunić ◽

Aleksandar Tomić ◽

Slavica Spasić

Keyword(s):

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Filtration Rate ◽

Unilateral Nephrectomy ◽

Kidney Donors ◽

Abrupt Decrease ◽

Simultaneous Reduction ◽

Living Kidney Donors ◽

Plasma Arginine

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Sodium and Water Excretion in Nephrotic Patients: Effects of Changes in Renal Haemodynamics

Clinical Science ◽

10.1042/cs0790123 ◽

1990 ◽

Vol 79 (2) ◽

pp. 123-129 ◽

Cited By ~ 3

Author(s):

Michael Allon ◽

Charles B. Pasque ◽

Mariano Rodriguez

Keyword(s):

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Plasma Flow ◽

Filtration Rate ◽

Renal Plasma Flow ◽

Urine Volume ◽

Sodium Reabsorption ◽

Plasma Volume Expansion ◽

Water Excretion ◽

Significant Change

1. Eight nephrotic patients were studied in order to evaluate the effects of acute changes in renal plasma flow and glomerular filtration rate on renal solute and water handling, in the absence of plasma volume expansion. 2. The subjects were studied first after the administration of captopril, a manoeuvre that increased renal plasma flow without a significant change in glomerular filtration rate, and a second time after receiving combined therapy with captopril and ibuprofen, a manoeuvre that decreased glomerular filtration rate without a significant change in renal plasma flow. 3. After captopril therapy, despite the increase in renal plasma flow, there was no significant change in proximal sodium reabsorption (as estimated from fractional lithium reabsorption), urine volume or urine osmolality. 4. The decrease in glomerular filtration rate observed after the administration of captopril plus ibuprofen was associated with decreases in fractional excretion of sodium and urine volume, and an increase in urine osmolality. The changes in these parameters of tubular function were proportionate to the changes in glomerular filtration rate. Fractional proximal sodium reabsorption increased substantially. 5. These observations suggest that, in the absence of plasma volume expansion, an increase in renal plasma flow does not increase sodium or water excretion by the nephrotic kidney. Moreover, during acute decreases in glomerular filtration rate, glomerulotubular balance appears to be disrupted, resulting in disproportionately high rates of proximal tubule sodium reabsorption.

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