Autoimmune Endolymphatic Hydrops: Five-Year Review

1988 ◽  
Vol 98 (3) ◽  
pp. 221-225 ◽  
Author(s):  
Gordon B. Hughes ◽  
Barbara P. Barna ◽  
Sam E. Kinney ◽  
Leonard H. Calabrese ◽  
Mohamed A. Hamid ◽  
...  
Keyword(s):  
Endolymphatic Hydrops ◽  
Neck Surgery ◽  
Cytotoxic Drugs ◽  
Treatment Results ◽  
Salt Diet ◽  
The Past ◽  
Low Salt ◽  
Inner Ear Disease ◽  
Autoimmune Inner Ear Disease ◽  
Bilateral Treatment

This article reviews the authors' experience with autoimmune endolymphatic hydrops over the past 5 years. Twenty-seven of 52 patients with diagnosed autoimmune inner ear disease (52%) manifested endolymphatic hydrops, usually bilateral. Treatment consisted of low salt diet, diuretic, vestibular suppressant, and usually prednisone. Cytotoxic drugs and lymphocytoplasmapheresis were reserved for refractory cases. Audiometric followup (average, 23 months) was available in 12 patients. Using American Academy of Otolaryngology-Head and Neck Surgery guidelines, hearing improved or stabilized in at least one ear in nine patients and deteriorated bilaterally in three patients. Vestibular treatment results paralleled auditory treatment results. Autoimmune endolymphatic hydrops should be considered in the differential diagnosis when symptoms are bilateral and do not respond to conventional therapy or when immune laboratory tests are positive. In suspect patients, medical therapy with prednisone, and rarely cytotoxic drugs and lymphocytoplasmapheresis, should be recommended. Further research is needed to determine whether surgery should be performed in medically unresponsive cases.

Drug Interactions and Reactions Update

1982 ◽  
Vol 16 (12) ◽  
pp. 925-929 ◽  
Keyword(s):  
Elderly Patient ◽  
Drug Interactions ◽  
The Elderly ◽  
Salt Diet ◽  
The Past ◽  
Inadequate Knowledge ◽  
Or Groups ◽  
Low Salt ◽  
Nonsteroidal Antiinflammatory Agents ◽  
Extreme Care

Elderly patients take a large number of drugs, especially psychoactive agents, and polypharmacy seems to be the rule in acute hospital settings and in institutions alike. Knowledge about alteration in drug response, with aging, is still at a preliminary and investigational stage, and the problem is compounded by the fact that there are relatively few drugs for which a special geriatric dosage is recommended. It appears to be common practice to keep the elderly in “chemical strait jackets” in some institutions, with emphasis on the use of antipsychotic and sedative/hypnotic combinations. Use of these agents has reached such proportions in Britain and America that it has become necessary to warn that antipsychotic drugs should be used only to treat acute behavior disorders in such patients. The potential for drug-drug interactions in the elderly patient is, therefore, large, and, in the community, the most common categories of prescribed drugs taken by the elderly are psychotropics, diuretics, and antipyretic/analgesics. In addition, analgesics and laxatives are often taken as nonprescribed medicines. Poor compliance with medication instructions, hoarding of drugs, and inadequate knowledge of the purpose of medication are very common. The eventual sequel to these factors is hospitalization; diuretics, hypotensives, antiparkinsonian agents, and psychotropics carry the greatest risk of evoking serious adverse drug reactions. Some specific drugs or groups of drugs present peculiar problems to the aged patient; these agents are relatively few in number and include digoxin, hypotensives, diuretics, nonsteroidal antiinflammatory agents, benzodiazepines, phenothiazines, lithium, and other psychoactive drugs. Currently, lithium and the antirheumatoid agent benoxaprofen are causing much concern in regard to the elderly. With lithium, there are adverse effects suggestive of neurotoxicity, and interactions with concurrent neuroleptic and/or antidepressant therapy, diuretics, and low salt diet are involved. As for benoxaprofen, reports in the past few months have causally linked this drug with fatal cholestatic jaundice and other serious reactions; this drug has now been withdrawn from clinical use. Health professionals must use extreme care when treating an elderly patient with drugs.

scholarly journals Urea and NaCl regulate UT-A1 urea transporter in opposing directions via TonEBP pathway during osmotic diuresis

2009 ◽  
Vol 296 (1) ◽  
pp. F67-F77 ◽  
Author(s):  
Yu-Mi Kim ◽  
Wan-Young Kim ◽  
Hyun-Wook Lee ◽  
Jin Kim ◽  
H. Moo Kwon ◽  
...  
Keyword(s):  
Transcription Factor ◽  
Plasma Osmolality ◽  
Urea Concentration ◽  
Urea Transporter ◽  
Osmotic Diuresis ◽  
High Salt Diet ◽  
Salt Diet ◽  
Low Protein ◽  
Low Salt ◽  
Urine Concentrating Ability

In our previous studies of varying osmotic diuresis, UT-A1 urea transporter increased when urine and inner medullary (IM) interstitial urea concentration decreased. The purposes of this study were to examine 1) whether IM interstitial tonicity changes with different urine urea concentrations during osmotic dieresis and 2) whether the same result occurs even if the total urinary solute is decreased. Rats were fed a 4% high-salt diet (HSD) or a 5% high-urea diet (HUD) for 2 wk and compared with the control rats fed a regular diet containing 1% NaCl. The urine urea concentration decreased in HSD but increased in HUD. In the IM, UT-A1 and UT-A3 urea transporters, CLC-K1 chloride channel, and tonicity-enhanced binding protein (TonEBP) transcription factor were all increased in HSD and decreased in HUD. Next, rats were fed an 8% low-protein diet (LPD) or a 0.4% low-salt diet (LSD) to decrease the total urinary solute. Urine urea concentration significantly decreased in LPD but significantly increased in LSD. Rats fed the LPD had increased UT-A1 and UT-A3 in the IM base but decreased in the IM tip, resulting in impaired urine concentrating ability. The LSD rats had decreased UT-A1 and UT-A3 in both portions of the IM. CLC-K1 and TonEBP were unchanged by LPD or LSD. We conclude that changes in CLC-K1, UT-A1, UT-A3, and TonEBP play important roles in the renal response to osmotic diuresis in an attempt to minimize changes in plasma osmolality and maintain water homeostasis.

scholarly journals Renal effects of the serine protease inhibitor aprotinin in healthy conscious mice

2021 ◽  
Author(s):  
Stefan Wörner ◽  
Bernhard N. Bohnert ◽  
Matthias Wörn ◽  
Mengyun Xiao ◽  
Andrea Janessa ◽  
...  
Keyword(s):  
Protease Inhibitor ◽  
Serine Protease ◽  
Kidney Injury ◽  
Serine Protease Inhibitor ◽  
Tubular Function ◽  
Proteolytic Activation ◽  
Salt Diet ◽  
Low Salt ◽  
Proximal Tubular ◽  
Proximal Tubular Function

AbstractTreatment with aprotinin, a broad-spectrum serine protease inhibitor with a molecular weight of 6512 Da, was associated with acute kidney injury, which was one of the reasons for withdrawal from the market in 2007. Inhibition of renal serine proteases regulating the epithelial sodium channel ENaC could be a possible mechanism. Herein, we studied the effect of aprotinin in wild-type 129S1/SvImJ mice on sodium handling, tubular function, and integrity under a control and low-salt diet. Mice were studied in metabolic cages, and aprotinin was delivered by subcutaneously implanted sustained release pellets (2 mg/day over 10 days). Mean urinary aprotinin concentration ranged between 642 ± 135 (day 2) and 127 ± 16 (day 8) µg/mL . Aprotinin caused impaired sodium preservation under a low-salt diet while stimulating excessive hyperaldosteronism and unexpectedly, proteolytic activation of ENaC. Aprotinin inhibited proximal tubular function leading to glucosuria and proteinuria. Plasma urea and cystatin C concentration increased significantly under aprotinin treatment. Kidney tissues from aprotinin-treated mice showed accumulation of intracellular aprotinin and expression of the kidney injury molecule 1 (KIM-1). In electron microscopy, electron-dense deposits were observed. There was no evidence for kidney injury in mice treated with a lower aprotinin dose (0.5 mg/day). In conclusion, high doses of aprotinin exert nephrotoxic effects by accumulation in the tubular system of healthy mice, leading to inhibition of proximal tubular function and counterregulatory stimulation of ENaC-mediated sodium transport.

The pathogenesis of the secondary forms of autoimmune inner ear disease (AIED): advancing beyond the audiogram data

2021 ◽  
Author(s):  
Virginia Corazzi ◽  
Stavros Hatzopoulos ◽  
Chiara Bianchini ◽  
Magdalena B Skarżyńska ◽  
Stefano Pelucchi ◽  
...  
Keyword(s):  
Inner Ear ◽  
Inner Ear Disease ◽  
Autoimmune Inner Ear Disease

A2714 The efficacy of low-salt diet education in hypertensive patients

2018 ◽  
Vol 36 ◽  
pp. e280
Author(s):  
Iryna Voloshyna ◽  
Vitaliy Krivenko ◽  
Vadym Vizir ◽  
Vladislav Ponomarenko
Keyword(s):  
Salt Diet ◽  
Hypertensive Patients ◽  
Low Salt

Azathioprine in Combination with Steroids in the Treatment of Autoimmune Inner-Ear Disease

1993 ◽  
Vol 21 (4) ◽  
pp. 192-196 ◽  
Author(s):  
Aytac Saraçaydin ◽  
Sedat Katircioğlu ◽  
Sami Katircioğlu ◽  
M Can Karatay
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Inner Ear ◽  
Sensorineural Deafness ◽  
Sensorineural Hearing ◽  
Once Daily ◽  
Uncommon Disease ◽  
Inner Ear Disease ◽  
Pure Tones ◽  
Autoimmune Inner Ear Disease

A total of twelve patients with a relatively uncommon form of progressive sensorineural deafness (autoimmune innerear disease) were treated orally with 1 mg/kg azathioprine, once daily, and with 30 mg prednisolone, every other day, for 4 weeks. Statistically significant increases in the ability to hear pure tones or in discrimination on audiometry took place in 10/12 patients. This condition was initially described as ‘sensorineural hearing loss', but it is now clear that the term ‘autoimmune inner-ear disease’ is more appropriate since the vestibular compartment as well as the cochlear compartment is involved. This relatively uncommon disease is one of the few forms of sensorineural deafness that can be successfully treated.

Does a low-salt diet exert a protective effect on endothelial function in normal rats?

2001 ◽  
Vol 138 (3) ◽  
pp. 200-205 ◽  
Author(s):  
A.H. Boonstra ◽  
S. Gschwend ◽  
M.J.A. Kocks ◽  
H. Buikema ◽  
D. de Zeeuw ◽  
...  
Keyword(s):  
Endothelial Function ◽  
Protective Effect ◽  
Salt Diet ◽  
Low Salt

Impact of Low-Salt Diet

2017 ◽  
pp. 1-16
Author(s):  
Flávia Ramos de Siqueira ◽  
Karin Carneiro de Oliveira ◽  
Joel Claudio Heimann ◽  
Luzia Naôko Shinohara Furukawa
Keyword(s):  
Salt Diet ◽  
Low Salt
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