Urinary sodium and chloride during renal salt retention

Effects of isoenergetic supplementation as water use mitigation strategy on water footprint and health of nursing bull calves

Sustainable livestock systems focus on mitigating natural resource use such as water. Dietary management strategies can significantly reduce the water footprint of livestock animals; however, animal health is of concern when animals reduce water intake due to subacute dehydration. To evaluate potential consequences of this nutritional management intervention, a total of 23, 60 ± 3 days old nursing Holstein bull calves, weighing 94.7 ± 12.07 kg, were distributed in a completely randomized design and received one of three diets. Control was a basal diet composed of a non-medicated milk replacer (milk replacer; n = 7), and the additional two diets, were composed of the same non-medicated milk replacer in addition to either lipid [n = 8; milk replacer + menhaden fish oil (3 %)] or soluble carbohydrate [n = 8; milk replacer + corn starch (7%) isoenergetic to fat group] supplements. Animals were offered ad libitum mineral mix and water, as well as 120 g/day of a composite mix of dried microbrewery's spent grains. Data were analyzed as linear and generalized linear mixed models with diet as a fixed effect and animal as random utilizing R studio (R Core Team, 2021, Vienna, Austria; SAS Inst., Cary, NC). Within supplementation groups, lipid supplemented calves had the highest lymphocyte (63.24 vs 57.69 counts/100 lymphocytes; P < 0.033), and lowest neutrophil counts (29.3 vs 35.3 counts/100 lymphocytes; P < 0.047). Supplementation significantly increased total serum protein (P = 0.001) and skin moisture (P < 0.011), with carbohydrate group having the highest skin moisture (5.30 vs 3.99; P < 0.047). Supplementation also decreased fecal fluidity scores (P < 0.001) with no significant change in serum electrolytes (P > 0.256). No significant differences were found amongst treatments for the ingestive behavior (P > 0.338). The carbohydrate-supplemented calves significantly decreased all daily water footprints compared to the control and fat-supplemented groups: blue a 47.55 L decrease, (P < 0.001), green a 265.62 L decrease (P = 0.005), and gray a 55.87 L decrease (P = 0.009) water footprint, as well as total water footprint (369.04 L, P = 0.004). Our results indicate the potential to maintain animal performance while increasing water use efficiency through diet supplementation tailored to mitigate water use, without adverse effects on animal health.

"I don't get no respect": the role of chloride in acute kidney injury

Acute kidney injury (AKI) is a major public health problem that complicates 10-40% of hospital admissions. Importantly, AKI is independently associated with increased risk of progression to chronic kidney disease, end-stage renal disease, cardiovascular events, and increased risk of in-hospital and long-term mortality. The chloride content of intravenous fluid has garnered much attention over the last decade, as well as its association with excess use and adverse outcomes, including AKI. Numerous studies show that changes in serum chloride concentration, independent of serum sodium and bicarbonate, are associated with increased risk of AKI, morbidity, and mortality. This comprehensive review details the complex renal physiology regarding the role of chloride in regulating renal blood flow, glomerular filtration rate, tubuloglomerular feedback, and tubular injury, as well as the findings of clinical research related to the chloride content of intravenous fluids, changes in serum chloride concentration, and AKI. Chloride is underappreciated in both physiology and pathophysiology. Although the exact mechanism is debated, avoidance of excessive chloride administration is a reasonable treatment option for all patients and especially in those at risk for AKI. Therefore, high-risk patients and those with "incipient" AKI should receive balanced solutions rather than normal saline to minimize the risk of AKI.

Hepatorenal syndrome. Definition, pathophysiology, and intervention

Hepatorenal syndrome is a well characterized entity in which vasodilation of splanchnic vessels and intense constriction of the renal cortical vasculature occur in concert. The condition is often fatal unless orthotopic liver transplantation (OLT) is performed. Many extracorporeal blood purification techniques exist which can be offered to patients awaiting OLT. Continuous hemofiltration, with or without other modalities such as therapeutic plasma exchange and hemoperfusion, may be helpful in improving the level of consciousness of these patients. Unfortunately, mortality and hepatic regeneration do not appear to be affected by such interventions. The development of a hybrid bioartifical liver support system and pharmacologic manipulation of the hemodynamic perturbations that occur in HRS provide particularly appealing prospects as a means of providing a bridge to liver transplantation in the future.

Bedside urinary chloride measurement: assessment in the acute setting

In 100 random urine samples from hospitalized patients, the results of a rapid bedside test for urinary chloride (Quantab chloride titrators) were compared with those of the hospital laboratory. Renal chloride retention (less than or equal to 20 mEq/L) was recognized using the titrator in 25 of 27 samples. There were no falsely low results in samples containing greater than 20 mEq/L by laboratory analysis. The titrator strips should aid in rapid diagnosis of conditions in which the recognition of renal salt retention is important.