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Langenbeck's Archives of Surgery Mar 2022Intraoperative fluid restriction is reported to be associated with reduced postoperative tissue edema and decreased incidence of postoperative pancreatic fistula (POPF)...
PURPOSE
Intraoperative fluid restriction is reported to be associated with reduced postoperative tissue edema and decreased incidence of postoperative pancreatic fistula (POPF) in pancreatic surgery. However, there is limited information regarding the postoperative approach to prevent postoperative tissue edema and reduce POPF.
METHODS
Patients undergoing distal pancreatectomy from 2013 to 2018 in our institute were retrospectively enrolled (n = 128). The patients were classified into the two groups: an early diuresis group (ED group: patients administered diuretic agents on postoperative day 2 or earlier between 2016 and 2018, n = 69) and a conventional diuresis group (CD group: patients administered diuretic agents on postoperative day 3 or later between 2013 and 2015, n = 59). Postoperative tissue edema assessed by CT imaging and the incidence of clinically relevant POPF (CR-PF; grade B or C) were compared.
RESULTS
Postoperative tissue edema was significantly reduced in the ED group (p < 0.0001). The incidence of CR-PF was lower in the ED group (19% vs. 32%, p = 0.082), especially in patients with postoperative diuresis on POD 1 (12%, p = 0.044).
CONCLUSION
Early and aggressive postoperative diuresis potentially reduced postoperative visceral tissue edema. This postoperative approach to prevent tissue edema may reduce the incidence of CR-PF in pancreatic surgery.
Topics: Diuresis; Edema; Humans; Pancreatectomy; Pancreatic Fistula; Postoperative Complications; Retrospective Studies
PubMed: 34665325
DOI: 10.1007/s00423-021-02357-9 -
Physiological Reports Jan 2021In the aldosterone-sensitive distal nephron (ASDN), epithelial sodium channel (ENaC)-mediated Na absorption drives K excretion. K excretion depends on the delivery of Na...
BACKGROUND
In the aldosterone-sensitive distal nephron (ASDN), epithelial sodium channel (ENaC)-mediated Na absorption drives K excretion. K excretion depends on the delivery of Na to the ASDN and molecularly activated ENaC. Furosemide is known as a K wasting diuretic as it greatly enhances Na delivery to the ASDN. Here, we studied the magnitude of acute furosemide-induced kaliuresis under various states of basal molecular ENaC activity.
METHODS
C57/Bl6J mice were subjected to different dietary regimens that regulate molecular ENaC expression and activity levels. The animals were anesthetized and bladder-catheterized. Diuresis was continuously measured before and after administration of furosemide (2 µg/g BW) or benzamil (0.2 µg/g BW). Flame photometry was used to measure urinary [Na ] and [K ]. The kidneys were harvested and, subsequently, ENaC expression and cleavage activation were determined by semiquantitative western blotting.
RESULTS
A low K and a high Na diet markedly suppressed ENaC protein expression, cleavage activation, and furosemide-induced kaliuresis. In contrast, furosemide-induced kaliuresis was greatly enhanced in animals fed a high K or low Na diet, conditions with increased ENaC expression. The furosemide-induced diuresis was similar in all dietary groups.
CONCLUSION
Acute furosemide-induced kaliuresis differs greatly and depends on the a priori molecular expression level of ENaC. Remarkably, it can be even absent in animals fed a high Na diet, despite a marked increase of tubular flow and urinary Na excretion. This study provides auxiliary evidence that acute ENaC-dependent K excretion requires both Na as substrate and molecular activation of ENaC.
Topics: Amiloride; Animals; Epithelial Sodium Channels; Furosemide; Ion Transport; Kidney; Mice; Mice, Inbred C57BL; Natriuresis; Potassium; Sodium, Dietary
PubMed: 33410279
DOI: 10.14814/phy2.14668 -
Hellenic Journal of Nuclear Medicine 2017Prenatal ultrasound (US) screening detects the hydronephrosis (HN)-dilatation of fetal renal collecting system in 1%-5% of all pregnancies. In most children, HN is...
OBJECTIVE
Prenatal ultrasound (US) screening detects the hydronephrosis (HN)-dilatation of fetal renal collecting system in 1%-5% of all pregnancies. In most children, HN is detected by prenatal US screening between 18-20 gestational week. Pelvi- ureteric junction (PUJ) stenosis is the most common etiological factor of prenatal HN and requires postnatal follow-up. Diuresis renography plays important role in the follow-up by complementing morphological information obtained by US with the data about differential renal function (DRF) and drainage. We studied the association between ultrasound parameters and results of diuresis renography in first diagnosed PUJ stenosis and the predictive factors of pyeloplasty in order to evaluate the usefulness of diuresis renography in these children postnatally.
PATIENTS AND METHODS
Children with antenatally detected HN attributed to presumed PUJ stenosis were investigated with mercapto-acetyltriglycine (MAG) diuresis renography. Parents gave informed consent for the procedure. The inclusion criteria were: age up to 4 years, diagnosis of prenatal HN determined by US during pregnancy based on the antero-posterior diameter (APD) of renal pyelon and at least one post-natal US which confirmed diagnosis. Exclusion criteria were: APD of pyelon <10mm, previous surgical treatment of HN, vesicoureteral reflux excluded by micturating cystourethrography, and patients having any anomaly of the contralateral kidney. Sixty two patients 43 boys, 19 girls, median age 16 months were selected. They were divided into three groups based on the size of pyelon, three groups based on the calyceal size and two groups according to thickness of parenchyma. Renography was performed for 24 minutes after the iv. application of Tc MAG, 144 ten-sec images were applied. Furosemide was administered after 2 min. (F+2). Post-void static images were acquired at 60min. The non-commercial software developed by International Atomic Energy Agency was applied to process the studies. The criteria for pathological findings (poor or no drainage) were the renographic curve maintaining a plateau, Normalized Residual Activity (NORA) at 20. min.>1.62, Output efficiency (OE) at 20. min.<71%, postmicturating NORA >0.11. The DRF was considered normal within the range of 45%-55%.
RESULTS
Good drainage had 74% of children, partial drainage 11%, and poor 15%. There was a clear association between the size of pyelon, calyces, parenchyma thickness and drainage. There was also a clear association between the calyceal size, parenchyma thickness and DRF. Differential renal function was <45% in 18% of children. A relation between the type of drainage and DRF was not determined. Thus, 66.7% of those with poor drainage had preserved DRF. Seven out of nine children with poor drainage underwent pyeloplasty. The threshold for pyeloplasty was the pyelon of 18mm and calyces of 10mm. The model of the multivariate logistic regression which included ultrasound parameters (APD of pyelon, calyces size and parenchymal thickness), drainage and DRF, which were significant predictors in univariate analysis, showed that only drainage was an independent predictor for the need of pyeloplasty.
CONCLUSION
Antero-posterior diameter of the pyelon <15mm indicates a favorable course of congenital HN in most children. Pattern of drainage obtained by diuresis renography was the only independent predictor for the need of pyeloplasty.
Topics: Child; Diuresis; Female; Humans; Hydronephrosis; Male; Pregnancy; Prenatal Diagnosis; Prognosis; Radioisotope Renography; Retrospective Studies; Ultrasonography
PubMed: 29324912
DOI: No ID Found -
American Journal of Physiology. Renal... Feb 2018The nephron segments in the inner medulla are part of the urine concentrating mechanism. Depending on the diuretic state, they are facing a large range of extracellular... (Comparative Study)
Comparative Study
The nephron segments in the inner medulla are part of the urine concentrating mechanism. Depending on the diuretic state, they are facing a large range of extracellular osmolality. We investigated whether water homeostasis affects tubular transport and permeability properties in inner medullary descending thin limb (IMdTL) and ascending thin limb (IMaTL). Three experimental groups of rats under different diuretic states were investigated on metabolic cages: waterload, furosemide-induced diuresis, and control (antidiuresis). Urine production and osmolalities reflected the 3-day treatment. To functionally investigate tubular epithelial properties, we performed experiments in freshly isolated inner medullary thin limbs from these animals. Tubular segments were acutely dissected and investigated for trans- and paracellular properties by in vitro perfusion and electrophysiological analysis. IMdTL and IMaTL were distinguished by morphological criteria. We confirmed absence of transepithelial electrogenic transport in thin limbs. Although diffusion potential measurements showed no differences between treatments in IMdTLs, we observed increased paracellular cation selectivity under waterload in IMaTLs. NaCl diffusion potential was -5.64 ± 1.93 mV under waterload, -1.99 ± 1.72 mV under furosemide-induced diuresis, and 0.27 ± 0.40 mV under control. The corresponding permeability ratio P was 1.53 ± 0.21 (waterload), 1.22 ± 0.18 (furosemide-induced diuresis), and 0.99 ± 0.02 (control), respectively. Claudins are main constituents of the tight junction responsible for paracellular selectivity; however, immunofluorescence did not show qualitative differences in claudin 4, 10, and 16 localization. Our results show that IMaTLs change tight junction properties in response to diuretic state to allow adaptation of NaCl reabsorption.
Topics: Animals; Claudins; Diffusion; Diuresis; Diuretics; Drinking; Epithelial Cells; Female; Furosemide; Loop of Henle; Male; Osmolar Concentration; Permeability; Rats, Sprague-Dawley; Renal Reabsorption; Sodium Chloride; Tight Junctions; Water
PubMed: 28971992
DOI: 10.1152/ajprenal.00419.2017 -
European Journal of Heart Failure Jul 2021
Topics: Diuresis; Heart Failure; Humans; Kidney
PubMed: 34117684
DOI: 10.1002/ejhf.2267 -
American Journal of Physiology. Renal... Jun 2015Caffeine is one of the most widely consumed behavioral substances. We have previously shown that caffeine- and theophylline-induced inhibition of renal reabsorption...
Caffeine is one of the most widely consumed behavioral substances. We have previously shown that caffeine- and theophylline-induced inhibition of renal reabsorption causes diuresis and natriuresis, an effect that requires functional adenosine A1 receptors. In this study, we tested the hypothesis that blocking the Gi protein-coupled adenosine A1 receptor via the nonselective adenosine receptor antagonist caffeine changes Na(+)/H(+) exchanger isoform 3 (NHE3) localization and phosphorylation, resulting in diuresis and natriuresis. We generated tubulus-specific NHE3 knockout mice (Pax8-Cre), where NHE3 abundance in the S1, S2, and S3 segments of the proximal tubule was completely absent or severely reduced (>85%) in the thick ascending limb. Consumption of fluid and food, as well as glomerular filtration rate, were comparable in control or tubulus-specific NHE3 knockout mice under basal conditions, while urinary pH was significantly more alkaline without evidence for metabolic acidosis. Caffeine self-administration increased total fluid and food intake comparably between genotypes, without significant differences in consumption of caffeinated solution. Acute caffeine application via oral gavage elicited a diuresis and natriuresis that was comparable between control and tubulus-specific NHE3 knockout mice. The diuretic and natriuretic response was independent of changes in total NHE3 expression, phosphorylation of serine-552 and serine-605, or apical plasma membrane NHE3 localization. Although caffeine had no clear effect on localization of the basolateral Na(+)/bicarbonate cotransporter NBCe1, pretreatment with DIDS inhibited caffeine-induced diuresis and natriuresis. In summary, NHE3 is not required for caffeine-induced diuresis and natriuresis.
Topics: Animals; Caffeine; Diuresis; Diuretics; Female; Glomerular Filtration Rate; Kidney Tubules; Male; Mice; Natriuresis; Sodium; Sodium-Hydrogen Exchanger 3; Sodium-Hydrogen Exchangers
PubMed: 25925253
DOI: 10.1152/ajprenal.00129.2015 -
Nature Reviews. Nephrology Jan 2021Therapeutic inhibition of the sodium-glucose co-transporter 2 (SGLT2) leads to substantial loss of energy (in the form of glucose) and additional solutes (in the form of... (Review)
Review
Therapeutic inhibition of the sodium-glucose co-transporter 2 (SGLT2) leads to substantial loss of energy (in the form of glucose) and additional solutes (in the form of Na and its accompanying anions) in urine. However, despite the continuously elevated solute excretion, long-term osmotic diuresis does not occur in humans with SGLT2 inhibition. Rather, patients on SGLT2 inhibitor therapy adjust to the reduction in energy availability and conserve water. The metabolic adaptations that are induced by SGLT2 inhibition are similar to those observed in aestivation - an evolutionarily conserved survival strategy that enables physiological adaptation to energy and water shortage. Aestivators exploit amino acids from muscle to produce glucose and fatty acid fuels. This endogenous energy supply chain is coupled with nitrogen transfer for organic osmolyte production, which allows parallel water conservation. Moreover, this process is often accompanied by a reduction in metabolic rate. By comparing aestivation metabolism with the fuel switches that occur during therapeutic SGLT2 inhibition, we suggest that SGLT2 inhibitors induce aestivation-like metabolic patterns, which may contribute to the improvements in cardiac and renal function observed with this class of therapeutics.
Topics: Adaptation, Physiological; Amphibians; Animals; Dehydration; Diabetes Mellitus, Type 2; Diuresis; Estivation; Heart; Heart Failure; Humans; Kidney; Liver; Mammals; Myocardium; Renal Insufficiency, Chronic; Sodium-Glucose Transporter 2 Inhibitors; Water-Electrolyte Balance
PubMed: 33005037
DOI: 10.1038/s41581-020-00350-x -
Chemico-biological Interactions Sep 2019The aim of the present study was to evaluate the diuretic effect of 1,3,5,6-tetrahydroxyxanthone (THX), isolated from preparations of Garcinia achachairu Rusby...
The aim of the present study was to evaluate the diuretic effect of 1,3,5,6-tetrahydroxyxanthone (THX), isolated from preparations of Garcinia achachairu Rusby (Clusiaceae) branches, in rats. Wistar normotensive (NTR) and spontaneously hypertensive rats (SHR) received a single oral treatment with THX, hydrochlorothiazide (HCTZ) or just vehicle (VEH). The effects of THX in combination with diuretics of clinical use, as well as with l-NAME, atropine, and indomethacin were also explored. Cumulative urine volume and urinary parameters were measured at the end of the 8-h or 24-h experiment. THX was able to stimulate 8-h and 24-h diuresis in both NTR and SHR, as well as urinary Na and K excretion, at a dose of 0.1 mg/kg; while 8-h urinary Cl levels were only significantly increased in the group of animals treated with THX at the dose of 0.3 mg/kg. In addition, Ca content was reduced in the 24-h urine of THX-treated NTR and SHR, like that obtained in the HCTZ (10 mg/kg) group. The combination with HCTZ or furosemide, but not with amiloride, significantly enhanced THX-induced diuresis. The diuretic effect with HCTZ plus THX treatment was accompanied by an increase of the urinary Na, K, and Cl excretion. On the other hand, when given THX in combination with amiloride, there was a significant increase in Na and a decrease in K excretion, an effect characteristic of this class of diuretics. Moreover, the diuretic effect of THX was heightened after pretreatment with l-NAME, and its ability to induce diuresis was prevented neither in the presence of indomethacin nor in the presence of atropine. However, the pretreatment with atropine completely avoided the saluretic effect stimulated by THX, suggesting, at least in part, the role of muscarinic receptors in the renal effects of THX disclosed in this study.
Topics: Animals; Atropine; Clusiaceae; Diuresis; Female; Hydrochlorothiazide; Hypertension; NG-Nitroarginine Methyl Ester; Potassium; Rats; Rats, Inbred SHR; Rats, Wistar; Sodium; Xanthones
PubMed: 31377058
DOI: 10.1016/j.cbi.2019.108778 -
European Radiology May 2023Increased detection of prostate cancer (PCa) recurrences using [Ga]Ga-PSMA-11 PET/CT has been reported by adding forced diuresis or late-phase imaging to the standard...
OBJECTIVES
Increased detection of prostate cancer (PCa) recurrences using [Ga]Ga-PSMA-11 PET/CT has been reported by adding forced diuresis or late-phase imaging to the standard protocol. However, the combination of these procedures in the clinical setting is still not standardized.
METHODS
One hundred prospectively recruited biochemical recurrent PCa patients were restaged with dual-phase [Ga]Ga-PSMA-11 PET/CT from September 2020 to October 2021. All patients received a standard scan (60 min), followed by diuretics (140 min) and a late-phase abdominopelvic scan (180 min). PET readers with low (n = 2), intermediate (n = 2), or high (n = 2) experience rated (i) standard and (ii) standard + forced diuresis late-phase images in a stepwise fashion according to E-PSMA guidelines, scoring their level of confidence. Study endpoints were (i) accuracy against a composite reference standard, (ii) reader's confidence level, and (iii) interobserver agreement.
RESULTS
Forced diuresis late-phase imaging increased the reader's confidence category for local and nodal restaging (both p < 0.0001), and the interobserver agreement in identifying nodal recurrences (from moderate to substantial, p < 0.01). However, it significantly increased diagnostic accuracy exclusively for local uptakes rated by low-experienced readers (from 76.5 to 84%, p = 0.05) and for nodal uptakes rated as uncertain at standard imaging (from 68.1 to 78.5%, p < 0.05). In this framework, SUVmax kinetics resulted in an independent predictor of PCa recurrence compared to standard metrics, potentially guiding the dual-phase PET/CT interpretation.
CONCLUSIONS
The present results do not support the systematic combination of forced diuresis and late-phase imaging in the clinical setting, but allow the identification of patients-, lesions-, and reader-based scenarios that might benefit from it.
KEY POINTS
• Increased detection of prostate cancer recurrences has been reported by adding diuretics administration or an additional late abdominopelvic scan to the standard [Ga]Ga-PSMA-11 PET/CT procedure. • We verified the added value of combined forced diuresis and delayed imaging, showing that this protocol only slightly increases the diagnostic accuracy of [Ga]Ga-PSMA-11 PET/CT, thus not justifying its systematic use in clinics. • However, it can be helpful in specific clinical scenarios, e.g., when PET/CT is reported by low-experienced readers. Moreover, it increased the reader's confidence and the agreement among observers.
Topics: Male; Humans; Gallium Radioisotopes; Positron Emission Tomography Computed Tomography; Neoplasm Recurrence, Local; Prostatic Neoplasms; Diuresis; Diuretics; Edetic Acid
PubMed: 36892650
DOI: 10.1007/s00330-023-09516-0 -
Diabetes & Metabolism Jun 2020Copeptin, a surrogate of vasopressin, is elevated in type 1 diabetes (T1D) and predicts kidney disease and cardiovascular mortality. Given the cardiorenal protective...
AIMS
Copeptin, a surrogate of vasopressin, is elevated in type 1 diabetes (T1D) and predicts kidney disease and cardiovascular mortality. Given the cardiorenal protective effects of SGLT2 inhibition (SGLT2i), our aim was to examine: 1) the relationship between serum copeptin, metabolic, renal and systemic hemodynamic parameters in adults with T1D; and 2) serum copeptin after SGLT2i with empagliflozin.
MATERIALS AND METHODS
In this post-hoc, exploratory analysis, serum copeptin, glomerular filtration rate (GFR), effective renal plasma flow (ERPF), plasma renin angiotensin aldosterone system markers, HbA, 24-hour urine volume and sodium excretion were measured in 40 participants with T1D (24.3±5.1 years) during eu- and hyperglycaemia before and after 8 weeks of 25mg of daily empagliflozin.
RESULTS
Higher baseline copeptin correlated with higher HbA, lower 24-hour urine volume and sodium excretion, after correcting for age, sex, systolic blood pressure, and HbA. Copeptin concentrations increased in response to empagliflozin under euglycaemia (4.1±2.1 to 5.1±2.8pmol/L, P=0.0053) and hyperglycaemia (3.3±1.4 to 5.6±2.8pmol/L, P<0.0001). The rise in copeptin in response to empagliflozin correlated with change in 24-hour urine volume, but was independent of changes in fractional excretion of sodium and haematocrit.
CONCLUSIONS
Elevated serum copeptin was associated with worse glycaemic control and lower diuresis and natriuresis. SGLT2i increased serum copeptin in adults with T1D, and the rise correlated with change in diuresis, but not natriuresis and hemo-concentration. Further work is required to evaluate the clinical implications of elevated copeptin with SGLT2i, including whether it is simply a marker of diuresis or may contribute to cardiorenal disease long-term.
Topics: Adult; Blood Pressure; Diabetes Mellitus, Type 1; Female; Glomerular Filtration Rate; Glycated Hemoglobin; Glycemic Control; Glycopeptides; Hemodynamics; Humans; Male; Natriuresis; Renin-Angiotensin System; Sodium-Glucose Transporter 2 Inhibitors; Young Adult
PubMed: 31816431
DOI: 10.1016/j.diabet.2019.11.006