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Zhao P, Higashijima Y, Sonoda H, Morinaga R, Uema K, Oguchi A, Matsuzaki T, Ikeda M. Glucocorticoid-induced acute diuresis in rats in relation to the reduced renal expression of sodium-dependent cotransporter genes. J Pharmacol Sci 2024; 156:115-124. [PMID: 39179330 DOI: 10.1016/j.jphs.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/17/2024] [Accepted: 07/19/2024] [Indexed: 08/26/2024] Open
Abstract
Although several studies have shown that glucocorticoids exert diuretic effects in animals and humans, the underlying mechanism responsible for the acute diuretic effect remains obscure. Here we examined the mechanism in terms of gene-expression. We observed that glucocorticoids, including dexamethasone (Dex) and prednisolone (PSL), acutely induced diuresis in rats in a dose-dependent manner. Free water clearance values were negative after Dex or PSL treatment, similar to those observed after treatment with osmotic diuretics (furosemide and acetazolamide). Dex significantly increased the urinary excretion of sodium, potassium, chloride, glucose, and inorganic phosphorus. Renal microarray analysis revealed that Dex significantly altered the renal expression of genes related to transmembrane transport activity. The mRNA levels of sodium/phosphate (NaPi-2a/Slc34a1, NaPi-2b/Slc34a2, and NaPi-2c/Slc34a3) and sodium/glucose cotransporters (Sglt2/Slc5a2) were significantly reduced in the Dex-treated kidney, being negatively correlated with the urinary excretion of their corresponding solutes. Dex did not affect renal expression of the natriuretic peptide receptor 1 (Npr1) gene, or the expression, localization, and phosphorylation of aquaporin-2 (AQP2), a water channel protein. These findings suggest that the acute diuretic effects of glucocorticoids might be mediated by reduced expression of sodium-dependent cotransporter genes.
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Affiliation(s)
- Peiyan Zhao
- Department of Veterinary Pharmacology, University of Miyazaki, Miyazaki, 889-2192, Japan
| | - Yoshiki Higashijima
- Institute for Promotion of Tenure Track, University of Miyazaki, Miyazaki, 889-2192, Japan
| | - Hiroko Sonoda
- Department of Veterinary Pharmacology, University of Miyazaki, Miyazaki, 889-2192, Japan
| | - Rio Morinaga
- Department of Veterinary Pharmacology, University of Miyazaki, Miyazaki, 889-2192, Japan
| | - Keito Uema
- Department of Veterinary Pharmacology, University of Miyazaki, Miyazaki, 889-2192, Japan
| | - Akane Oguchi
- Department of Veterinary Pharmacology, University of Miyazaki, Miyazaki, 889-2192, Japan
| | - Toshiyuki Matsuzaki
- Department of Anatomy and Cell Biology, Gunma University Graduate School of Medicine, Gunma, 371-8511, Japan
| | - Masahiro Ikeda
- Department of Veterinary Pharmacology, University of Miyazaki, Miyazaki, 889-2192, Japan.
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Ananda RA, Gwini SM, Long KM, Lai JH, Chen G, Russell GM, Stowasser M, Fuller PJ, Yang J. Diagnostic Delay and Disease Burden in Primary Aldosteronism: An International Patient Survey. Hypertension 2024; 81:348-360. [PMID: 38095087 DOI: 10.1161/hypertensionaha.123.21965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/14/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Primary aldosteronism (PA) is a common but underdiagnosed cause of hypertension. Many patients experience preventable end-organ injury due to delayed or missed diagnosis but data on the experience of patients are limited. METHODS We evaluated the lived experience of PA and determines factors associated with diagnostic delay through an international anonymous online cross-sectional survey, codesigned by researchers and PA consumers. We distributed the survey through academic medical centers, Amazon Mechanical Turk, Twitter, PA patient advocacy groups, and hypertension support groups on Facebook between March 21 and June 5, 2022. RESULTS Of 684 eligible respondents, 66.5% were women. Diagnostic delay (defined as ≥5 years between the diagnosis of hypertension and PA) was reported in 35.6%. Delay was more likely in women than in men (odds ratio, 1.55 [95% CI, 1.10-2.20]) and respondents with ≥3 comorbidities versus none (odds ratio, 1.77 [95% CI, 1.05-3.02]), ≥10 symptoms versus none (odds ratio, 2.73 [95% CI, 1.74-4.44]), and on ≥4 antihypertensive medications versus none (odds ratio, 18.23 [95% CI, 6.24-77.72]). Three-quarters of patients (74.4%) experienced reduced symptom burden following targeted PA treatment. Quality of life improved in 62.3% of patients, and greater improvement was associated with being a woman (odds ratio, 1.42, [95% CI, 1.02-1.97]), receiving adrenalectomy (odds ratio, 2.36 [95% CI, 1.67-3.35]), and taking fewer antihypertensive medications following diagnosis (odds ratio, 5.28 [95% CI, 3.55-7.90]). CONCLUSIONS One-third of patients with PA experienced prolonged diagnostic delays. Targeted treatment led to reduced symptom burden and improved quality of life. Gender differences in diagnostic delay and symptom burden are prominent. These findings suggest that routine screening for PA at the onset of hypertension may reduce diagnostic delay and facilitate timely diagnosis.
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Affiliation(s)
- Roshan A Ananda
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC, Australia (R.A.A., J.H.L., P.J.F., J.Y.)
- School of Public Health, Imperial College London, United Kingdom (R.A.A.)
| | - Stella May Gwini
- School of Public Health and Preventive Medicine Monash University, Melbourne, VIC, Australia (S.M.G.)
- Department of Biostatistics, University Hospital Geelong, Barwon Health, VIC, Australia (S.M.G.)
| | - Katrina M Long
- National Centre for Healthy Ageing, Frankston, VIC, Australia (K.M.L.)
| | - Jordan H Lai
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC, Australia (R.A.A., J.H.L., P.J.F., J.Y.)
| | - Gang Chen
- School of Primary and Allied Health Care (K.M.L.), Centre for Health Economics, Monash Business School (G.C.), Monash University, Frankston, VIC, Australia
| | - Grant M Russell
- Department of General Practice (G.M.R.), Monash University, Frankston, VIC, Australia
| | - Michael Stowasser
- Endocrine Hypertension Research Centre, University of Queensland, Brisbane, QLD, Australia (M.S.)
| | - Peter J Fuller
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC, Australia (R.A.A., J.H.L., P.J.F., J.Y.)
- Department of Endocrinology, Monash Health, Clayton, VIC, Australia (P.J.F., J.Y.)
| | - Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC, Australia (R.A.A., J.H.L., P.J.F., J.Y.)
- Department of Endocrinology, Monash Health, Clayton, VIC, Australia (P.J.F., J.Y.)
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