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Box JR, Oyama MA, Mosenco AS, Hess RS. Effect of sodium-glucose cotransporter 2 inhibitor canagliflozin on interstitial glucose concentration in insulin-treated diabetic dogs. J Vet Intern Med 2024. [PMID: 38528660 DOI: 10.1111/jvim.17053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/08/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND The utility of sodium-glucose cotransporter 2 inhibitors (SGLT2i) has not been reported in insulin-treated diabetic dogs. HYPOTHESIS Canagliflozin, a PO-administered SGLT2i, decreases interstitial glucose concentration (IG) in insulin-treated diabetic dogs. ANIMALS Five insulin-treated diabetic dogs. METHODS Uncontrolled open label longitudinal study. Canagliflozin (2-4 mg/kg/day PO) was added to an unchanged insulin dose for 7 days. Fractional excretion of glucose was calculated by dividing the product of urine glucose and serum creatinine concentrations by the product of serum glucose and urine creatinine concentrations. Hypoglycemia was defined as IG <60 mg/dL. RESULTS Median IG in 2869 measurements obtained while dogs were treated with insulin and canagliflozin was 87 mg/dL (range, 40-500 mg/dL) and was significantly lower than median IG in 1426 measurements obtained while dogs were treated with insulin alone (212 mg/dL; range, 41-500 mg/dL; P < .001). Median fractional excretion of glucose when dogs were treated with insulin and canagliflozin was 1.1% (range, 0.9%-2.0%), significantly higher than when dogs were treated with insulin alone (0.3%; range, 0.01%-1.0%; P = .04). The frequency of hypoglycemia was higher in dogs treated with insulin and canagliflozin (544 of 2869 IG measurements, 19%) compared with the frequency of hypoglycemia in dogs treated with insulin alone (52 of 1426 IG measurements, 4%; P < .001). CONCLUSIONS AND CLINICAL IMPORTANCE Canagliflozin may have a role in improving glycemic control in insulin-treated diabetic dogs, but the dose of insulin should be decreased when adding canagliflozin to insulin treatment.
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Affiliation(s)
- Jessica R Box
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark A Oyama
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ariel S Mosenco
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rebecka S Hess
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Sánchez-Briales P, Marques Vidas M, López-Sánchez P, López-Illázquez MV, Martín-Testillano L, Vedat-Ali A, Portolés J. The Uricosuric Effect of SGLT2 Inhibitors Is Maintained in the Long Term in Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus. J Clin Med 2024; 13:1360. [PMID: 38592682 PMCID: PMC10931679 DOI: 10.3390/jcm13051360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/16/2024] [Accepted: 02/24/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: Sodium-glucose co-transporter 2 inhibitors (SGLT2is) increase uric acid excretion. The intensity of uricosuria is linked to glycosuria. (2) Methods: We aim to analyze the effect of SGLT2 inhibitors on urinary fractional excretion (FE) of uric acid and glucose in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) in a single-center retrospective study with patients with T2DM and CKD who started on treatment with SGLT2is. Patients on renal replacement therapy or with glucagon-like peptide-1 (GLP1) analogs were excluded. Subgroup analysis was performed according to the estimated glomerular filtration rate (eGFR), the SGLT2i molecule, the main comorbidities, and concomitant treatment. As a secondary objective, the study analyzed the effect of SGLT2 inhibitors on uricemia levels. (3) Results: Seventy-three patients were analyzed, with a mean follow-up of 1.2 years. Uric acid and glucose FE significantly increased after the initiation of SGLT2is. This increase remained stable during the follow-up without differences among eGFR groups. No significant reduction in uricemia was observed. However, a trend towards a decrease was observed. (4) Conclusion: The use of SGLT2is in patients with CKD and T2DM is associated with an increase in uric acid FE, which maintains stability irrespective of glomerular filtration loss at least during 24 months of follow-up.
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Affiliation(s)
- Paula Sánchez-Briales
- Nephrology Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), 28222 Madrid, Spain; (P.S.-B.); (P.L.-S.); (M.V.L.-I.); (L.M.-T.); (A.V.-A.); (J.P.)
| | - María Marques Vidas
- Nephrology Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), 28222 Madrid, Spain; (P.S.-B.); (P.L.-S.); (M.V.L.-I.); (L.M.-T.); (A.V.-A.); (J.P.)
- Medicine Department, Facultad de Medicina, Universidad Autónoma de Madrid, 28222 Madrid, Spain
| | - Paula López-Sánchez
- Nephrology Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), 28222 Madrid, Spain; (P.S.-B.); (P.L.-S.); (M.V.L.-I.); (L.M.-T.); (A.V.-A.); (J.P.)
| | - María Victoria López-Illázquez
- Nephrology Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), 28222 Madrid, Spain; (P.S.-B.); (P.L.-S.); (M.V.L.-I.); (L.M.-T.); (A.V.-A.); (J.P.)
| | - Lucía Martín-Testillano
- Nephrology Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), 28222 Madrid, Spain; (P.S.-B.); (P.L.-S.); (M.V.L.-I.); (L.M.-T.); (A.V.-A.); (J.P.)
| | - Aylin Vedat-Ali
- Nephrology Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), 28222 Madrid, Spain; (P.S.-B.); (P.L.-S.); (M.V.L.-I.); (L.M.-T.); (A.V.-A.); (J.P.)
| | - Jose Portolés
- Nephrology Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), 28222 Madrid, Spain; (P.S.-B.); (P.L.-S.); (M.V.L.-I.); (L.M.-T.); (A.V.-A.); (J.P.)
- Medicine Department, Facultad de Medicina, Universidad Autónoma de Madrid, 28222 Madrid, Spain
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3
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Guida SJ, Bazzle L. Rebound hyperkalemia in a dog with albuterol toxicosis after cessation of potassium supplementation. J Vet Emerg Crit Care (San Antonio) 2023; 33:715-721. [PMID: 37943086 DOI: 10.1111/vec.13352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/03/2022] [Accepted: 09/23/2022] [Indexed: 11/10/2023]
Abstract
OBJECTIVE To describe the presentation of rebound hyperkalemia as a delayed side effect of albuterol toxicity in a dog. CASE SUMMARY A 3-year-old female neutered mixed-breed dog was presented for albuterol toxicosis that led to a severe hypokalemia, hyperlactatemia, and hyperglycemia. The dog also experienced sinus tachycardia and generalized weakness. Treatment was instituted with intravenous fluid therapy and potassium supplementation, and the dog was monitored with a continuous electrocardiogram. Resolution of hypokalemia was documented 12 hours after initial presentation, at which time fluid therapy and potassium supplementation were discontinued. There were no further periods of sinus tachycardia, but instead the dog developed ventricular ectopy with rapid couplets (instantaneous rates of 300/min). An echocardiogram revealed normal cardiac size and function. Twenty-four hours after presentation, the patient developed severe hyperkalemia, despite discontinuation of fluids and potassium supplementation for 12 hours. Serial venous and urinary electrolytes were performed for determination of the fractional excretion of electrolytes. These data confirmed rebound hyperkalemia (7.0 mmol/L), consistent with a markedly increased fractional excretion of potassium, and secondary to the release of potassium from inside the cells. Fluid therapy with dextrose supplementation was provided until 36 hours postpresentation. The hyperkalemia resolved, and the dog was discharged after 44 hours of hospitalization. NEW OR UNIQUE INFORMATION PROVIDED This case documents rebound hyperkalemia following treatment of albuterol toxicosis in a dog. This case highlights the importance of understanding the distribution of total body potassium when treating serum hypokalemia. Transcellular shifts of potassium, as in the case of albuterol toxicosis, can lead to rebound hyperkalemia even after discontinuation of potassium supplementation. This case further explores the utility of fractional excretion of electrolytes in elucidating the etiology and management of electrolyte disturbances.
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Affiliation(s)
- Samantha J Guida
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, Georgia, USA
| | - Lisa Bazzle
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, Georgia, USA
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4
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Brown RS. Fractional Excretion of Sodium and Urea are Useful Tools in the Evaluation of AKI: COMMENTARY. Kidney360 2023; 4:e731-e733. [PMID: 37384889 PMCID: PMC10371367 DOI: 10.34067/kid.0002502022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/20/2022] [Indexed: 07/01/2023]
Affiliation(s)
- Robert S Brown
- Nephrology Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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5
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Bánfai G, Kanizsai P, Csontos C, Kun S, Lakatos Á, Lajtai A, Lelovics V, Szukits S, Bogner P, Miseta A, Wittmann I, Molnár GA. Plasma Levels and Renal Handling of Amino Acids Contribute to Determination of Risk of Mortality or Feed of Ventilation in Patients with COVID-19. Metabolites 2022; 12. [PMID: 35736419 DOI: 10.3390/metabo12060486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/02/2022] [Accepted: 05/23/2022] [Indexed: 12/13/2022] Open
Abstract
COVID-19 infection may lead to serious complications, e.g., need for mechanical ventilation or death in some cases. A retrospective analysis of patients referred to our COVID Emergency Department, indiscriminately, was performed. A routine lab analysis measured amino acids in plasma and urine of patients. Data of surviving and deceased patients and those requiring or not requiring mechanical ventilation were compared, and logistic regression analyses have been performed. Deceased patients were older, had higher blood glucose, potassium, AST, LDH, troponin, d-dimer, hsCRP, procalcitonin, interleukin-6 levels (p < 0.05 for all). They had lower plasma serine, glycine, threonine, tryptophan levels (p < 0.01), higher tyrosine and phenylalanine levels (p < 0.05), and higher fractional excretion of arginine, methionine, and proline (p < 0.05) than survivors. In a regression model, age, severity score of COVID-pneumonia, plasma levels of threonine and phenylalanine were predictors of in-hospital mortality. There was a difference in ventilated vs. non-ventilated patients in CT-scores, glucose, and renal function (p < 0.001). Using logistic regression, CT-score, troponin, plasma level, and fractional excretion of glycine were predictors of ventilation. Plasma levels and renal excretion of certain amino acids are associated with the outcome of COVID-19 infection beside other parameters such as the CT-score or age.
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Dropkin CA, Kruger JM, Langlois DK. Evaluation of urine electrolytes for the diagnosis of hypoadrenocorticism in dogs. Vet Clin Pathol 2021; 50:507-514. [PMID: 34699620 DOI: 10.1111/vcp.13018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/24/2021] [Accepted: 03/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Most dogs with primary hypoadrenocorticism (HA) have a mineralocorticoid deficiency, which decreases renal tubular sodium reabsorption and potassium excretion. Limited information is available concerning the clinical value of measuring urine electrolytes to aid in an HA diagnosis. OBJECTIVES We aimed to evaluate the diagnostic utility of urine electrolyte measurements in dogs with HA. METHODS Urine sodium and potassium concentrations were measured in 89 dogs, including 39 dogs with HA and 50 controls with nonadrenal illness. Fractional excretions of sodium (FENa ) and potassium (FEK ) were also calculated. Urine electrolytes and fractional excretion values were compared between the groups. Sensitivities and specificities were determined for various cut-points. RESULTS The median urine sodium to potassium (Na:K) ratio was twofold greater (P < .001), and median FENa was fourfold greater (P < .001) in HA dogs as compared with controls. However, no cut-point for any variable with >90% sensitivity or specificity provided a corresponding specificity or sensitivity of >50%. When only dogs with abnormal serum or plasma electrolytes were included in the analyses, absolute urine electrolyte concentrations and FENa were not different between study populations (P > .05 for all comparisons), but the FEK was increased (P = .005) and the urine potassium:creatinine ratio was decreased (P < .001) in the control dogs compared with the dogs with HA. CONCLUSIONS Urine electrolyte concentrations and fractional excretions are altered in dogs with HA. However, substantial overlap exists with control dogs with nonadrenal illness. Therefore, these values are unlikely to have diagnostic utility for dogs with HA.
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Affiliation(s)
- Casey A Dropkin
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - John M Kruger
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Daniel K Langlois
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
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7
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Parker VJ, Rudinsky AJ, Benedict JA, Beizaei A, Chew DJ. Effects of calcifediol supplementation on markers of chronic kidney disease-mineral and bone disorder in dogs with chronic kidney disease. J Vet Intern Med 2020; 34:2497-2506. [PMID: 33128421 PMCID: PMC7694821 DOI: 10.1111/jvim.15949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 10/11/2020] [Accepted: 10/19/2020] [Indexed: 12/18/2022] Open
Abstract
Background Chronic kidney disease‐mineral and bone disorder (CKD‐MBD) in dogs is associated with hypovitaminosis D, increased parathyroid hormone (PTH), and increased fibroblast growth factor‐23 (FGF‐23) concentrations. Best practice for vitamin D metabolite supplementation in CKD‐MBD remains unknown. Objective To provide an extended‐release calcifediol supplement to dogs with CKD and to measure its effects on variables indicative of CKD‐MBD. Animals Ten dogs with International Renal Interest Society stages 2 and 3 CKD. Methods In a prospective study, dogs received a calcifediol supplement for 84 days. Serum 25‐hydroxyvitamin D (25[OH]D), 1,25‐dihydroxyvitamin D (1,25[OH]2D), 24,25‐dihydroxyvitamin D (24,25[OH]2D), creatinine, calcium, phosphorus, PTH, plasma FGF‐23 concentrations, and urine profiles were measured monthly during supplementation. Urine calcium to creatinine (UCa/Cr) ratios and fractional excretion of calcium, phosphorus, and sodium were determined. Results All serum vitamin D metabolite concentrations increased significantly by day 84 (P < .001): [25(OH)D (median 249.9 ng/mL; range, 149.7‐469.9 ng/mL) compared to baseline (median 50.2 ng/mL; range, 31.3‐66.0 ng/mL); 1,25(OH)2D (median 66.1 pg/mL; range, 56.9‐88.1 pg/mL) compared to baseline (median 37.3 pg/mL; range, 29.3‐56.7 pg/mL); 24,25(OH)2D (median 81.4 ng/mL; range, 22.1‐151.7 ng/mL) compared to baseline (median 15.4 ng/mL; range, 6.9‐40.6 ng/mL)]. There were no significant differences in calcium, phosphorus, PTH concentrations, UCa/Cr or fractional excretion of calcium. No dog developed ionized hypercalcemia. Plasma FGF‐23 concentrations increased by day 84 (median 1219 pg/mL; range, 229‐8824 pg/mL) compared to baseline (median 798 pg/mL; range, 103‐4.145 pg/mL) (P < .01). Conclusions and Clinical Importance Calcifediol supplementation for 84 days was well‐tolerated in dogs with IRIS stages 2 and 3 CKD. It remains to be determined how long‐term supplementation would affect CKD progression and QOL.
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Affiliation(s)
- Valerie J Parker
- Veterinary Clinical Sciences, The Ohio State University Veterinary Medical Center, Columbus, Ohio, USA
| | - Adam J Rudinsky
- Veterinary Clinical Sciences, The Ohio State University Veterinary Medical Center, Columbus, Ohio, USA
| | - Jason A Benedict
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Azadeh Beizaei
- EirGen Pharma LTD, R&D Center, IDA Business and Technology Park, Waterford, Ireland
| | - Dennis J Chew
- Veterinary Clinical Sciences, The Ohio State University Veterinary Medical Center, Columbus, Ohio, USA
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Schumacher SA, Toribio RE, Scansen B, Lakritz J, Bertone AL. Pharmacokinetics of magnesium and its effects on clinical variables following experimentally induced hypermagnesemia. J Vet Pharmacol Ther 2020; 43:577-590. [PMID: 32525571 DOI: 10.1111/jvp.12883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 03/22/2020] [Accepted: 05/07/2020] [Indexed: 12/16/2022]
Abstract
The objectives of this study were to describe pharmacokinetic and pharmacodynamic changes as a result of a single intravenous administration of magnesium sulfate (MgSO4 ) to healthy horses. MgSO4 is a magnesium salt that has been used to calm horses in equestrian competition and is difficult to regulate because magnesium is an essential constituent of all mammals. Six healthy adult female horses were administered a single intravenous dose of MgSO4 at 60 mg/kg of body weight over 5 min. Blood, urine, and cerebrospinal fluid (CSF) samples were collected, and cardiovascular parameters were monitored and echocardiograms performed at predetermined times. Noncompartmental pharmacokinetic analysis was applied to plasma concentrations of ionized magnesium (Mg2+ ). Objective data were analyzed using the Wilcoxon rank-sum test with p < .05 used as a determination for significance. Plasma concentrations of Mg2+ increased nearly fivefold, ionized calcium (Ca2+ ) decreased by nearly 10%, and the Ca2+ to Mg2+ ratio declined more than 3.5-fold and remained different than baseline until 24 hr (p < .05). Significant changes were seen with urinary fractional excretion of electrolytes, cardiovascular parameters, and echocardiographic measurements. No changes were detected in CSF electrolyte concentrations. The decrease in Ca2+ result of hypermagnesemia supports the interaction between these cations. Alterations detected in plasma electrolyte concentrations and urinary fractional excretion of electrolytes may serve as biomarkers for regulatory control for the nefarious administration of MgSO4 .
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Affiliation(s)
- Stephen A Schumacher
- College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA.,Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
| | - Ramiro E Toribio
- College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA.,Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
| | - Brian Scansen
- College of Veterinary Medicine & Biomedical Services, Colorado State University, Fort Collins, CO, USA
| | - Jeffrey Lakritz
- College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA.,Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
| | - Alicia L Bertone
- College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA.,Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
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Hsiao PJ, Liao CY, Kao YH, Chan JS, Lin YF, Chuu CP, Chen JS. Comparison of fractional excretion of electrolytes in patients at different stages of chronic kidney disease: A cross-sectional study. Medicine (Baltimore) 2020; 99:e18709. [PMID: 31914079 PMCID: PMC6959939 DOI: 10.1097/md.0000000000018709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Kidney handling of electrolytes varies in different stages of chronic kidney disease (CKD). Diabetes mellitus (DM) plays an important role in CKD. Fractional excretion (FE) is an important means in clinical practice. The relationship between FE of electrolytes in patients at different stages of CKD is worth further investigating.We designed a cross-sectional study in 1 teaching hospital, consecutive CKD patients were enrolled between February 2016 and January 2017. Including clinical demographic features, laboratory examination including spot urine electrolytes, blood biochemistries, and relevant medications were determined.A total of 762 CKD patients completed the study. Of these, 218 (28.6%) had DM. Participants were grouped according to estimated glomerular filtration rate into 7 categories: hyperfiltration (HF), CKD1, CKD2, CKD3a, CKD3b, CKD4, and CKD5. Groups HF, CKD1, 2, 3a, 3b, 4 and 5 contained 83, 143, 192, 94, 82, 82, and 86 patients, respectively. FE of electrolytes tended to increase along with the decline of renal function (CKD1-CKD5) (P < .001). The relationship was similar between the DM and non-DM groups. Diabetic patients demonstrated higher FE of magnesium compared with non-DM subjects at CKD2 and CKD5 (P < .05).CKD patients showed a progressive increase in the FE of electrolytes; FE of magnesium seemed to increase more among diabetic patients with CKD, and could be a potential predictor of CKD progression.
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Affiliation(s)
- Po-Jen Hsiao
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
- Division of Nephrology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taiwan
- Division of Nephrology, Department of Medicine, Fu Jen Catholic University Hospital, School of Medicine, Fu Jen Catholic University
- Department of Life Sciences, National Central University, Taoyuan City
| | - Chen-Yi Liao
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
- Division of Nephrology, Department of Medicine, Kaohsiung Armed Forces General Hospital
| | - Yung-Hsi Kao
- Department of Life Sciences, National Central University, Taoyuan City
| | - Jenq-Shyong Chan
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
- Division of Nephrology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taiwan
| | - Yuh-Feng Lin
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital
- Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei
| | - Chih-Pin Chuu
- Institute of Cellular and System Medicine, National Health Research Institutes
- Graduate Program for Aging, China Medical University, Taichung City
| | - Jin-Shuen Chen
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
- Department of Medical Education and Research
- Division of Nephrology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan, Republic of China
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Wołyniec W, Kasprowicz K, Giebułtowicz J, Korytowska N, Zorena K, Bartoszewicz M, Rita-Tkachenko P, Renke M, Ratkowski W. Changes in Water Soluble Uremic Toxins and Urinary Acute Kidney Injury Biomarkers After 10- and 100-km Runs. Int J Environ Res Public Health 2019; 16:ijerph16214153. [PMID: 31661892 PMCID: PMC6862582 DOI: 10.3390/ijerph16214153] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 12/24/2022]
Abstract
Acute kidney injury (AKI) is described as a relatively common complication of exercise. In clinical practice the diagnosis of AKI is based on serum creatinine, the level of which is dependent not only on glomerular filtration rate but also on muscle mass and injury. Therefore, the diagnosis of AKI is overestimated after physical exercise. The aim of this study was to determine changes in uremic toxins: creatinine, urea, uric acid, asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), trimethylamine N-oxide (TMAO) and urinary makers of AKI: albumin, neutrophil gelatinase-associated lipocalin (uNGAL), kidney injury molecule-1 and cystatin-C (uCyst-C) after long runs. Sixteen runners, mean age 36.7 ± 8.2 years, (2 women, 14 men) participating in 10- and 100-km races were studied. Blood and urine were taken before and after the races to assess markers of AKI. A statistically significant increase in creatinine, urea, uric acid, SDMA and all studied urinary AKI markers was observed. TMAO and ADMA levels did not change. The changes in studied markers seem to be a physiological reaction, because they were observed almost in every runner. The diagnosis of kidney failure after exercise is challenging. The most valuable novel markers which can help in post-exercise AKI diagnosis are uCyst-C and uNGAL.
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Affiliation(s)
- Wojciech Wołyniec
- Department of Occupational, Metabolic and Internal Medicine, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 81-519 Gdynia, Poland.
| | - Katarzyna Kasprowicz
- Department of Biology, Ecology and Sports Medicine, Gdańsk University of Physical Education and Sport, 80-336 Gdańsk, Poland.
| | - Joanna Giebułtowicz
- Department of Bioanalysis and Drug Analysis, Faculty of Pharmacy, Medical University of Warsaw, 02-097 Warsaw, Poland.
| | - Natalia Korytowska
- Department of Bioanalysis and Drug Analysis, Faculty of Pharmacy, Medical University of Warsaw, 02-097 Warsaw, Poland.
| | - Katarzyna Zorena
- Department of Biology Ecology and Sport Medicine, Medical University of Gdańsk, 81-519 Gdynia, Poland.
| | - Maria Bartoszewicz
- Department of Biology Ecology and Sport Medicine, Medical University of Gdańsk, 81-519 Gdynia, Poland.
| | | | - Marcin Renke
- Department of Occupational, Metabolic and Internal Medicine, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 81-519 Gdynia, Poland.
| | - Wojciech Ratkowski
- Department of Athletics, Department of Athletics, Gdańsk University of Physical Education and Sport, 80-336 Gdańsk, Poland.
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Uwai Y, Suzuki T, Kondo R, Kawasaki T, Nabekura T. Effect of renal ischemia on urinary excretion of lithium in rats. Biopharm Drug Dispos 2018; 39:448-451. [PMID: 30393876 DOI: 10.1002/bdd.2163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/12/2018] [Accepted: 10/20/2018] [Indexed: 11/11/2022]
Abstract
Lithium, administered to patients with bipolar disorders, is mainly excreted in the urine, and tubular reabsorption is involved. This study characterized the renal excretion of lithium in rats subjected to renal ischemia for 60 min or 90 min. After intravenous injection of lithium chloride at 25 mg/kg, the pharmacokinetic parameters of lithium were determined. In sham-operated rats, the renal clearance of lithium was calculated to be 1.49 ml/min/kg, and its ratio to creatinine clearance (fractional excretion) was 43.4%. Renal ischemia inhibited the renal excretion of lithium, and did not affect its fractional excretion. The urinary pH of rats with renal ischemia for 90 min was significantly higher than those of the other groups, and the linear regression with the fractional excretion of lithium in rats with renal ischemia showed a moderate correlation (r = 0.650, p = 0.00193). This study demonstrated the effect of renal ischemia on the renal excretion of lithium in rats. It was suggested that not only glomerular filtration but also the reabsorption of lithium was impaired by renal ischemia.
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Affiliation(s)
- Yuichi Uwai
- Department of Pharmaceutics, School of Pharmacy, Aichi Gakuin University, Nagoya, Japan
| | - Takato Suzuki
- Department of Pharmaceutics, School of Pharmacy, Aichi Gakuin University, Nagoya, Japan
| | - Ryota Kondo
- Department of Pharmaceutics, School of Pharmacy, Aichi Gakuin University, Nagoya, Japan
| | - Tatsuya Kawasaki
- Department of Pharmaceutics, School of Pharmacy, Aichi Gakuin University, Nagoya, Japan
| | - Tomohiro Nabekura
- Department of Pharmaceutics, School of Pharmacy, Aichi Gakuin University, Nagoya, Japan
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Ledeganck KJ, Anné C, De Monie A, Meybosch S, Verpooten GA, Vinckx M, Van Hoeck K, Van Eyck A, De Winter BY, Trouet D. Longitudinal Study of the Role of Epidermal Growth Factor on the Fractional Excretion of Magnesium in Children: Effect of Calcineurin Inhibitors. Nutrients 2018; 10:E677. [PMID: 29861470 DOI: 10.3390/nu10060677] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 05/17/2018] [Accepted: 05/21/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND It was shown in animal models and adults that the epidermal growth factor (EGF) is involved in the pathophysiology of calcineurin inhibitor (CNI) induced renal magnesium loss. In children, however, the exact mechanism remains unclear, which was set as the purpose of the present study. METHODS Children with nephrotic syndrome and renal transplant children treated with CNI (n = 50) and non-CNI treated children (n = 46) were included in this study. Urine and serum samples were collected at three time points to determine magnesium, creatinine, and EGF. The magnesium intake was calculated from a food frequency questionnaire. RESULTS Serum Mg2+ and urinary EGF/creatinine were significantly lower in the CNI treated children, with significantly more CNI-treated children developing hypomagnesaemia. In the latter patients, the fractional excretion of magnesium (FE Mg2+) was significantly higher. Urinary EGF, age, renal function, and serum magnesium were independent predictors of the FE Mg2+. Only 29% of the children reached the recommended daily intake of magnesium. The magnesium intake did not differ between hypomagnesemic and normomagnesemic patients and was not a predictor of the FE Mg2+. CONCLUSIONS In CNI-treated children who developed hypomagnesemia, the FE Mg2+ was increased. The urinary EGF concentration, age, and renal function are independent predictors of the FE Mg2+.
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Aksenov S, Peck CC, Eriksson UG, Stanski DR. Individualized treatment strategies for hyperuricemia informed by a semi-mechanistic exposure-response model of uric acid dynamics. Physiol Rep 2018; 6:e13614. [PMID: 29488355 PMCID: PMC5828935 DOI: 10.14814/phy2.13614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 01/08/2023] Open
Abstract
To provide insight into pharmacological treatment of hyperuricemia we developed a semi-mechanistic, dynamical model of uric acid (UA) disposition in human. Our model represents the hyperuricemic state in terms of production of UA (rate, PUA), its renal filtration (glomerular filtration rate, GFR) and proximal tubular reabsorption (fractional excretion coefficient, FE). Model parameters were estimated using data from 9 Phase I studies of xanthine oxidase inhibitors (XOI) allopurinol and febuxostat and a novel uricosuric, the selective UA reabsorption inhibitor lesinurad, approved for use in combination with a XOI. The model was qualified for prediction of the effect of patients' GFR and FE on concentration of UA in serum (sUA) and UA excretion in urine and their response to drug treatment, using data from 2 Phase I and 4 Phase III studies of lesinurad. Percent reduction in sUA from baseline by a XOI is predicted to be independent of GFR, FE or PUA. Uricosurics are more effective in underexcreters of UA or patients with normal GFR. Co-administration of a XOI and an uricosuric agent should be considered for patients with high sUA first in the treatment algorithm of gout before uptitration of XOI. The XOI dose in combination with a uricosuric can be reduced compared to XOI alone for the same target sUA to the degree dependent on patient's GFR and FE. This exposure-response model of UA can be used to rationally select the best drug treatment option to lower elevated sUA in gout patients under differing pathophysiological situations.
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Affiliation(s)
- Sergey Aksenov
- Quantitative Clinical PharmacologyEarly Clinical DevelopmentIMED Biotech UnitAstraZenecaWalthamMA
| | - Carl C. Peck
- University of California at San Francisco and NDA Partners LLCSan Luis ObispoCA
| | - Ulf G. Eriksson
- Quantitative Clinical PharmacologyEarly Clinical DevelopmentIMED Biotech UnitAstraZenecaGothenburgSweden
| | - Donald R. Stanski
- Quantitative Clinical PharmacologyEarly Clinical DevelopmentIMED Biotech UnitAstraZenecaGaithersburgMD
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Ledeganck KJ, De Winter BY, Van den Driessche A, Jürgens A, Bosmans JL, Couttenye MM, Verpooten GA. Magnesium loss in cyclosporine-treated patients is related to renal epidermal growth factor downregulation. Nephrol Dial Transplant 2013; 29:1097-102. [PMID: 24353324 DOI: 10.1093/ndt/gft498] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cyclosporine (CsA) treatment is associated with hypomagnesaemia due to a renal Mg(2+) leak. In animal studies a role for the Mg(2+) channel TRPM6 localized in the distal convoluted tubule and stimulated by epidermal growth factor (EGF) is suggested. We hypothesize that CsA-induced hypomagnesaemia is due to a renal magnesium leak, also in patients, resulting from a downregulation of the renal EGF production, thereby inhibiting the activation of TRPM6. METHODS Renal transplant patients treated with CsA (n = 55) and 35 chronic kidney disease (CKD) patients were included. At three time points, with an interval of at least 1 month, blood and urine samples were taken to determine creatinine, Mg(2+), sodium and EGF. RESULTS Serum Mg(2+) was significantly lower in the CsA group versus the CKD group with significantly more CsA-treated patients developing hypomagnesaemia. Although the fractional excretion (FE) Mg(2+) did not differ significantly between the two groups, subanalysis of the patients with hypomagnesaemia showed a significantly higher FE Mg(2+) in CsA-treated patients compared with CKD patients (P = 0.05). The urinary EGF excretion was significantly decreased in the CsA group and was a predictor of the FE Mg(2+) in the two groups. Serum sodium was significantly decreased in the CsA group simultaneously with an increased FE Na(+). CONCLUSIONS In CsA-treated patients, the association of a low urinary EGF excretion and a decreased renal Mg(2+) reabsorption is in accordance with in vitro and animal studies. In the whole study population, log urinary EGF excretion is an independent predictor of the FE Mg(2+), supporting the role of EGF in magnesium reabsorption.
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Affiliation(s)
- Kristien J Ledeganck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
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Henniger T, Schwert B, Henniger P, Distl O, Ganter M. [Renal function tests in milk fed calves--reference values and influence of bovine neonatal pancytopenia (BNP)]. Tierarztl Prax Ausg G Grosstiere Nutztiere 2013; 41:345-352. [PMID: 24326789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 05/28/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Renal function tests were performed on 38 clinically healthy Holstein calves aged 1435 days, of which seven had survived bovine neonatal pancytopenia (BNP). The main objective was the establishment of reference values for renal fractional excretions (FE) of sodium (Na), potassium (K), calcium (Ca) and phosphate (P) in calves fed milk replacer. Additionally, it should be clarified whether calves suffer from permanent renal disorders as a result of BNP. MATERIAL AND METHODS The fractional excretions were determined using wet chemical analyses of simultaneously taken urine and blood samples. Their calculation was based on the endogenous excretion of creatinine. RESULTS There were no significant differences in the FE between calves with and without a history of BNP. Based on the values of all 38 calves, reference values were calculated for the FE indicated above, and also for the urinary γ-glutamyltransferase-creatinine ratio as a parameter for the damage of tubular cells. CONCLUSION It has been demonstrated that age- and feeding-specific reference values for renal function parameters in cattle are necessary. For renal function analyses in calves, the nutritional supply with electrolytes has to be considered to differentiate the variability of electrolyte excretions due to different feeding regimes from renal disorders. Based on the calculated reference values for calves fed milk replacer, renal function disorders can be determined sensitively and further differentiation is possible.
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Affiliation(s)
- T Henniger
- Thomas Henniger, Institut für Tierzucht und Vererbungsforschung, Stiftung Tierärztliche Hochschule Hannover, Bünteweg 17p, 30559 Hannover, E-Mail:
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Abstract
Mechanistic understanding of secondary hyperparathyroidism, vascular calcification, and regulation of phosphate metabolism in chronic kidney disease (CKD) has advanced significantly in the past five decades. In 1960, Bricker developed the 'intact nephron hypothesis', opening the door for hundreds of investigations. He emphasized that 'as the number of functioning nephrons decreases, each remaining nephron must perform a greater fraction of total renal excretion'. Phosphate per se, independent of Ca²+ and calcitriol, directly affects the development of parathyroid gland hyperplasia and secondary hyperparathyroidism. Vitamin D receptor, Ca²+ sensing receptor, and Klotho-fibroblast growth factor (FGF) receptor-1 complex are all significantly decreased in the parathyroid glands of patients with CKD. Duodenal instillation of phosphate rapidly decreases parathyroid hormone release without changes in calcium or calcitriol. The same procedure also rapidly increases renal phosphate excretion independently of FGF-23, suggesting the possibility of an 'intestinal phosphatonin'. These observations suggest a possible 'phosphate sensor' in the parathyroid glands and gastrointestinal tract, although as yet there is no proof for the existence of such a sensor. Evidence shows that phosphate has a key role in parathyroid hyperplasia by activating the transforming growth factor-α-epidermal growth factor receptor complex. Thus, control of serum phosphorus early in the course of CKD will significantly ameliorate the pathological manifestations observed during progressive deterioration of renal function.
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Affiliation(s)
- Eduardo Slatopolsky
- Renal Division, Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri 63110, USA.
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Abstract
The urea transporters UT-A1 and UT-A3 mediate rapid transepithelial urea transport across the inner medullary collecting duct (IMCD). In a previous study, using a new mouse model in which both UT-A1 and UT-A3 were genetically deleted from the IMCD (UT-A1/3(-/-) mice), we investigated the role of these transporters in the function of the renal inner medulla. Here the authors report a new series of studies investigating more generally the renal phenotype of UT-A1/3(-/-) mice. Pathologic screening of 33 tissues revealed abnormalities in both the testis (increased size) and kidney (decreased size and vascular congestion) of UT-A1/3(-/-) mice. Total urinary nitrate and nitrite (NOx) excretion rates in UT-A1/3(-/-) mice were more than double those in wild-type mice. Total renal blood flow was not different between UT-A1/3(-/-) and wild-type mice but underwent a greater percentage decrease in response to NG-Nitro-L-arginine methyl ester hydrochloride (L-NAME) infusion. Whole kidney GFR (FITC-inulin clearance) was not different in UT-A1/3(-/-) mice compared with controls and underwent a similar increase in response to a greater dietary protein intake. Fractional urea excretion was markedly elevated in UT-A1/3(-/-) mice on a 40% protein diet, reaching 102.4 +/- 8.8% of the filtered load, suggesting that there may be active urea secretion somewhere along the renal tubule. Although there was a marked urinary concentrating defect in UT-A1/3(-/-) mice, there was no decrease in aquaporin 2 or aquaporin 3 expression. Furthermore, although urea accumulation in the inner medulla was markedly attenuated, there was no decrease in sodium ion concentration in tissue from outer medulla or two levels of the inner medulla. These results support our conclusion that the urinary concentrating defect in UT-A1/3(-/-) mice is caused by a failure of urea transport from the IMCD lumen to the inner medullary interstitium, resulting in osmotic diuresis.
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Affiliation(s)
- Robert A Fenton
- Laboratory of Kidney Electrolyte Metabolism, National Heart, Lung and Blood Institutes, National Institutes of Health, 10 Center Drive, Building 10, Room 6N260, Bethesda, MD 20892-1603, USA.
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