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Kim JS, Shalaby-Rana E, Krill A, Pohl H, Majd M. Hydronephrotic lower moiety of duplex systems: Observations using diuresis renography. Clin Imaging 2024; 109:110138. [PMID: 38579501 DOI: 10.1016/j.clinimag.2024.110138] [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: 01/19/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/07/2024]
Abstract
PURPOSE The purpose of this study is to characterize the prevalence and behavior of hydronephrosis of non-refluxing lower moiety of duplex kidneys using MAG-3 diuresis renography. We compare our data to previous case series and ureteropelvic junction obstruction of single systems. MATERIALS AND METHODS An IRB-approved database of over 5000 diuresis renograms performed in 2025 patients was queried to identify cases of hydronephrosis of lower moiety of duplex kidneys suspicious for ureteropelvic obstruction, excluding those with hydroureter or reflux. Kidney function and post-furosemide drainage parameters on initial and follow-up diuresis renograms were recorded. Medical records and patient outcomes were reviewed. RESULTS In total, 19 renal units were identified in 18 patients (11 male, 7 female), age range 0.5 months to 17.8 years, including one patient with bilateral lower moiety hydronephrosis. Initial diuresis renograms in 12 asymptomatic patients (13 renal units) with antenatal hydronephrosis demonstrated varying drainage patterns from normal to obstructed. Follow-up studies showed worsening drainage in 3 patients, who all underwent surgery. Drainage improved in 4 patients and remained unchanged in 5 patients (6 renal units). Of the 6 patients presenting with Dietl's crisis, 5 showed obstructive drainage on initial diuresis renogram, 2/5 with decreased function. All 5 obstructed patients underwent surgery. CONCLUSION Hydronephrosis of the lower moiety of a duplex system is rare and behaves similarly to single systems. The majority are diagnosed antenatally, display a dynamic nature, and may present with acute obstruction. Diuresis renography is a valuable tool in its evaluation and management.
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Affiliation(s)
- Jane S Kim
- Division of Diagnostic Imaging and Radiology, Children's National Hospital, 111 Michigan Avenue NW, Washington, D.C. 20010, United States of America.
| | - Eglal Shalaby-Rana
- Division of Diagnostic Imaging and Radiology, Children's National Hospital, 111 Michigan Avenue NW, Washington, D.C. 20010, United States of America.
| | - Aaron Krill
- Division of Urology, Children's National Hospital, 111 Michigan Avenue NW, Washington, D.C. 20010, United States of America.
| | - Hans Pohl
- Division of Urology, Children's National Hospital, 111 Michigan Avenue NW, Washington, D.C. 20010, United States of America.
| | - Massoud Majd
- Division of Diagnostic Imaging and Radiology, Children's National Hospital, 111 Michigan Avenue NW, Washington, D.C. 20010, United States of America
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Marton A, Saffari SE, Rauh M, Sun RN, Nagel AM, Linz P, Lim TT, Takase-Minegishi K, Pajarillaga A, Saw S, Morisawa N, Yam WK, Minegishi S, Totman JJ, Teo S, Teo LLY, Ng CT, Kitada K, Wild J, Kovalik JP, Luft FC, Greasley PJ, Chin CWL, Sim DKL, Titze J. Water Conservation Overrides Osmotic Diuresis During SGLT2 Inhibition in Patients With Heart Failure. J Am Coll Cardiol 2024; 83:1386-1398. [PMID: 38599715 DOI: 10.1016/j.jacc.2024.02.020] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Sodium-glucose cotransporter 2 inhibitors are believed to improve cardiac outcomes due to their osmotic diuretic potential. OBJECTIVES The goal of this study was to test the hypothesis that vasopressin-driven urine concentration overrides the osmotic diuretic effect of glucosuria induced by dapagliflozin treatment. METHODS DAPA-Shuttle1 (Hepato-renal Regulation of Water Conservation in Heart Failure Patients With SGLT-2 Inhibitor Treatment) was a single-center, double-blind, randomized, placebo-controlled trial, in which patients with chronic heart failure NYHA functional classes I/II and reduced ejection fraction were randomly assigned to receive dapagliflozin 10 mg daily or placebo (1:1) for 4 weeks. The primary endpoint was change from baseline in urine osmolyte concentration. Secondary endpoints included changes in copeptin levels and solute free water clearance. RESULTS Thirty-three randomized, sodium-glucose cotransporter 2 inhibitor-naïve participants completed the study, 29 of whom (placebo: n = 14; dapagliflozin: n = 15) provided accurate 24-hour urine collections (mean age 59 ± 14 years; left ventricular ejection fraction 31% ± 9%). Dapagliflozin treatment led to an isolated increase in urine glucose excretion by 3.3 mmol/kg/d (95% CI: 2.51-4.04; P < 0.0001) within 48 hours (early) which persisted after 4 weeks (late; 2.7 mmol/kg/d [95% CI: 1.98-3.51]; P < 0.0001). Dapagliflozin treatment increased serum copeptin early (5.5 pmol/L [95% CI: 0.45-10.5]; P < 0.05) and late (7.8 pmol/L [95% CI: 2.77-12.81]; P < 0.01), leading to proportional reductions in free water clearance (early: -9.1 mL/kg/d [95% CI: -14 to -4.12; P < 0.001]; late: -11.0 mL/kg/d [95% CI: -15.94 to -6.07; P < 0.0001]) and elevated urine concentrations (late: 134 mmol/L [95% CI: 39.28-229.12]; P < 0.01). Therefore, urine volume did not significantly increase with dapagliflozin (mean difference early: 2.8 mL/kg/d [95% CI: -1.97 to 7.48; P = 0.25]; mean difference late: 0.9 mL/kg/d [95% CI: -3.83 to 5.62]; P = 0.70). CONCLUSIONS Physiological-adaptive water conservation eliminated the expected osmotic diuretic potential of dapagliflozin and thereby prevented a glucose-driven increase in urine volume of approximately 10 mL/kg/d · 75 kg = 750 mL/kg/d. (Hepato-renal Regulation of Water Conservation in Heart Failure Patients With SGLT-2 Inhibitor Treatment [DAPA-Shuttle1]; NCT04080518).
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Affiliation(s)
- Adriana Marton
- Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore; Department of Internal Medicine 4-Nephrology and Hypertension, Paracelsus Private Medical School Nuremberg, Nuremberg, Germany.
| | | | - Manfred Rauh
- Research Laboratory, Division of Paediatrics, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Ruo-Ning Sun
- Clinical Imaging Research Centre, Centre for Translational Medicine, Singapore
| | - Armin M Nagel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany; German Cancer Research Center (DKFZ), Division of Medical Physics in Radiology, Heidelberg, Germany
| | - Peter Linz
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Tzy Tiing Lim
- Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore
| | | | | | - Sharon Saw
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Norihiko Morisawa
- Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore
| | - Wan Keat Yam
- Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore
| | - Shintaro Minegishi
- Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore
| | - John J Totman
- Clinical Imaging Research Centre, Centre for Translational Medicine, Singapore; Radiography and Medical Imaging Department, Fatima College of Health Sciences, Abu Dhabi, United Arab Emirates
| | - Serena Teo
- Clinical Imaging Research Centre, Centre for Translational Medicine, Singapore
| | - Louis L Y Teo
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Choon Ta Ng
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Kento Kitada
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Johannes Wild
- Center for Cardiology, Cardiology I, Johannes Gutenberg-University, Mainz, Germany
| | - Jean-Paul Kovalik
- Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore
| | - Friedrich C Luft
- Experimental and Clinical Research Center, Max-Delbrück Center for Molecular Medicine, Medical Faculty of the Charité, Berlin, Germany
| | - Peter J Greasley
- Early Discovery and Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Calvin W L Chin
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - David K L Sim
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Jens Titze
- Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore; III. Department of Medicine and Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Nephrology, Duke University Medical Center, Durham, North Carolina, USA.
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Kawada T, Matsushita H, Yokota S, Yoshida Y, Fukumitsu M, Alexander J, Saku K. Short-term dynamic characteristics of diuresis during exogenous pressure perturbations with and without arterial baroreflex control. Am J Physiol Regul Integr Comp Physiol 2024; 326:R230-R241. [PMID: 38223938 DOI: 10.1152/ajpregu.00229.2023] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/16/2023] [Accepted: 01/08/2024] [Indexed: 01/16/2024]
Abstract
Although body fluid volume control by the kidneys may be classified as a long-term arterial pressure (AP) control system, it does not necessarily follow that the urine flow (UF) response to changes in AP is slow. We quantified the dynamic characteristics of the UF response to short-term AP changes by changing mean AP between 60 mmHg and 100 mmHg every 10 s according to a binary white noise sequence in anesthetized rats (n = 8 animals). In a baro-on trial (the carotid sinus baroreflex was enabled), the UF response represented the combined synergistic effects of pressure diuresis (PD) and neurally mediated antidiuresis (NMA). In a baro-fix trial (the carotid sinus pressure was fixed at 100 mmHg), the UF response mainly reflected the effect of PD. The UF step response was quantified using the sum of two exponential decay functions. The fast and slow components had time constants of 6.5 ± 3.6 s and 102 ± 85 s (means ± SD), respectively, in the baro-on trial. Although the gain of the fast component did not differ between the two trials (0.49 ± 0.21 vs. 0.66 ± 0.22 µL·min-1·kg-1·mmHg-1), the gain of the slow component was greater in the baro-on than in the baro-fix trial (0.51 ± 0.14 vs. 0.09 ± 0.39 µL·min-1·kg-1·mmHg-1, P = 0.023). The magnitude of NMA relative to PD was calculated to be 32.2 ± 29.8%. In conclusion, NMA contributed to the slow component, and its magnitude was approximately one-third of that of the effect of PD.NEW & NOTEWORTHY We quantified short-term dynamic characteristics of the urine flow (UF) response to arterial pressure (AP) changes using white noise analysis. The UF step response approximated the sum of two exponential decay functions with time constants of ∼6.5 s and 102 s. The neurally mediated antidiuretic (NMA) effect contributed to the slow component of the UF step response, with the magnitude of approximately one-third of that of the pressure diuresis (PD) effect.
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Affiliation(s)
- Toru Kawada
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroki Matsushita
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Shohei Yokota
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yuki Yoshida
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masafumi Fukumitsu
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Joe Alexander
- Medical and Health Informatics, NTT Research, Inc., Sunnyvale, California, United States
| | - Keita Saku
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
- Bio Digital Twin Center, National Cerebral and Cardiovascular Center, Osaka, Japan
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Nelson IE, Baker KA, Faraji A, White GS, Bibbs CS. Diuresis and α-glucosidase inhibition by erythritol in Aedes aegypti (Diptera: Culicidae) and viability for efficacy against mosquitoes. Parasit Vectors 2024; 17:76. [PMID: 38378683 PMCID: PMC10880232 DOI: 10.1186/s13071-024-06169-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/29/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Sugar alcohols, such as erythritol, are low-impact candidates for attractive toxic sugar baits (ATSB) to kill mosquitoes. To determine whether erythritol has a viable future in ATSB formulations, a suite of assays was conducted to diagnose toxicity mechanisms and starvation effects on mortality in Aedes aegypti (L.) as a model system. METHODS We measured general carbohydrate load, glucosidase levels, and free glucose in intoxicated adult mosquitoes to observe whether sugar digestion was impaired. We assayed the effects of sugar combinations with erythritol on larvae and adults. To measure erythritol effects when mosquitoes were not resource-deprived, additional assays manipulated the prior starvation status. RESULTS Up to 50,000 ppm of erythritol in water had no effect on larvae within 72 h, but an ammonia spike indicated diuresis in larvae as early as 4 h (F8,44 = 22.50, P < 0.0001) after sucrose/erythritol combinations were added. Adult consumption of erythritol was diuretic regardless of the sugar pairing, while sucrose and erythritol together generated above 80% mortality (F2,273 = 33.30, P < 0.0001) alongside triple the normal excretion (F5,78 = 26.80, P < 0.0004). Glucose and fructose paired individually with erythritol had less mortality, but still double the fecal excretion. When ingesting erythritol-laced meals, less sugar was detected in mosquitoes as compared to after sucrose meals (χ2 = 12.54, df = 1, P = 0.0004). CONCLUSIONS Data showed that erythritol is a linear competitive inhibitor of α-glucosidase, marking it as a novel class of insecticide in the current research climate. However, the efficacy on larvae was null and not persistent in adult mosquitoes when compared across various starvation levels. Despite significant diuresis, the combined effects from erythritol are not acute enough for vector control programs considering ATSB against mosquitoes.
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Affiliation(s)
- Irvane E Nelson
- Salt Lake City Mosquito Abatement District, 2215 North 2200 West, Salt Lake City, UT, 84116, USA
- College of Science, Science Research Initiative (SRI), University of Utah, 1390 Presidents Circle, Crocker Science Center, rm 310, Salt Lake City, UT, 84112, USA
| | - Kobi A Baker
- Salt Lake City Mosquito Abatement District, 2215 North 2200 West, Salt Lake City, UT, 84116, USA
| | - Ary Faraji
- Salt Lake City Mosquito Abatement District, 2215 North 2200 West, Salt Lake City, UT, 84116, USA
| | - Gregory S White
- Salt Lake City Mosquito Abatement District, 2215 North 2200 West, Salt Lake City, UT, 84116, USA
| | - Christopher S Bibbs
- Salt Lake City Mosquito Abatement District, 2215 North 2200 West, Salt Lake City, UT, 84116, USA.
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Sartorius V, Giuseppi A, Iacobelli S, Leroy-Terquem E, Vinit N, Heidet L, Blanc T, Stirnemann J, Kermorvant-Duchemin E, Lapillonne A. Post-obstructive diuresis after posterior urethral valve treatment in neonates: a retrospective cohort study. Pediatr Nephrol 2024; 39:505-511. [PMID: 37656311 DOI: 10.1007/s00467-023-06100-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/04/2023] [Accepted: 07/04/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND The management of posterior urethral valve (PUV) in neonates requires close monitoring in the intensive care unit because of the risk of post-obstructive diuresis (POD). Our aim was to describe the incidence and factors associated with POD in newborns treated for PUV. METHODS Retrospective analysis of the medical records of all neonates who underwent surgical intervention for PUV in our neonatal intensive care unit between January 2014 and April 2021. RESULTS Of the 40 patients included, 15 (37.5%) had POD defined by urine output > 6 ml.kg-1.h-1 during the first 24 h following urinary tract obstruction relief. At prenatal ultrasound examinations, oligohydramnios was more common in the group with POD than in the group without (53.3% vs. 8%, p = 0.002). Preterm birth was more frequent in neonates with POD (66.7% vs. 8%; p < 0.001). Median serum creatinine (212 [137-246] vs. 95 [77-125] µmol.l-1; p < 0.001) and urea (8.5 [5.2-12.2] vs. 4.1 [3.5-4.7] mmol.l-1; p < 0.001) concentrations on the day of obstruction relief were significantly higher in the group with POD than in the group without. After adjustment for prematurity, logistic regression models confirmed correlation between the occurrence of POD and the severity of the consequences of urethral obstruction (i.e., oligohydramnios and serum creatinine levels; ß = 2.90 [0.88; 5.36], p = 0.013 and ß = 0.014 [0.003; 0.031], p = 0.034, respectively). CONCLUSIONS In neonates, POD is common after the relief of PUV-related obstruction. Our findings may help to identify patients at highest risk. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Victor Sartorius
- Department of Neonatal Intensive Care, AP-HP Hôpital Necker Enfants-Malades, 149 Rue de Sèvres, 75015, Paris, France.
- Université Paris Cité, Paris, France.
| | - Agnès Giuseppi
- Department of Neonatal Intensive Care, AP-HP Hôpital Necker Enfants-Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - Silvia Iacobelli
- Department of Neonatal and Pediatric Intensive Care, CHU La Réunion, Saint-Pierre, France
| | - Elise Leroy-Terquem
- Department of Neonatal Intensive Care, AP-HP Hôpital Necker Enfants-Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - Nicolas Vinit
- Université Paris Cité, Paris, France
- Department of Pediatric Surgery and Urology, AP-HP Hôpital Necker Enfants-Malades, Paris, France
| | - Laurence Heidet
- Université Paris Cité, Paris, France
- Department of Pediatric Nephrology, Reference Center for Inherited Renal Diseases (MARHEA), AP-HP Hôpital Necker Enfants-Malades, Paris, France
| | - Thomas Blanc
- Université Paris Cité, Paris, France
- Department of Pediatric Surgery and Urology, AP-HP Hôpital Necker Enfants-Malades, Paris, France
| | - Julien Stirnemann
- Université Paris Cité, Paris, France
- Department of Obstetrics and Fetal Medicine, AP-HP Hôpital Necker Enfants-Malades, Paris, France
| | - Elsa Kermorvant-Duchemin
- Department of Neonatal Intensive Care, AP-HP Hôpital Necker Enfants-Malades, 149 Rue de Sèvres, 75015, Paris, France
- Université Paris Cité, Paris, France
| | - Alexandre Lapillonne
- Department of Neonatal Intensive Care, AP-HP Hôpital Necker Enfants-Malades, 149 Rue de Sèvres, 75015, Paris, France
- Université Paris Cité, Paris, France
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de Berny Q, Saint-Jacques C, Santin A, Mattioni S, Steichen O, Chieze R, Frochot V, Letavernier E, Lionnet F, Haymann JP. Urine concentration impairment in sickle cell anemia: genuine nephrogenic diabetes insipidus or osmotic diuresis? Am J Physiol Renal Physiol 2024; 326:F278-F284. [PMID: 38059298 DOI: 10.1152/ajprenal.00313.2023] [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: 10/09/2023] [Revised: 11/16/2023] [Accepted: 12/03/2023] [Indexed: 12/08/2023] Open
Abstract
The urine concentration impairment responsible for hyposthenuria in sickle cell nephropathy is currently thought to be a consequence of renal medulla lesions, which lead to nephrogenic diabetes insipidus. The objective of the present study was to investigate the mechanism of hyposthenuria in patients with sickle cell anemia. We performed an observational study of patients with homozygous SS sickle cell anemia and data available on the fasting plasma antidiuretic hormone (ADH) concentration. A total of 55 patients were analyzed. The fasting plasma ADH values ranged from 1.2 to 15.4 pg/mL, and 82% of the patients had elevated ADH values and low fasting urine osmolality (<505 mosmol/kgH2O). Plasma ADH was positively associated with plasma tonicity and natremia (P < 0.001). None of the patients experienced polyuria and fasting free water clearance was negative in all cases, thus, ruling out nephrogenic diabetes insipidus. The tertile groups did not differ with regard to fasting urine osmolality, plasma renin level, mGFR, or several hemolysis biomarkers. The negative fasting free water clearance in all cases and the strong association between 24-h osmolal clearance and 24-h diuresis favors the diagnosis of osmotic diuresis due to an impaired medullary gradient, rather than lesions to collecting tubule.NEW & NOTEWORTHY The urine concentration impairment in sickle cell anemia is an osmotic diuresis related to an impaired renal medullary gradient leading to an ADH plateau effect. The fasting plasma ADH was high in the context of a basic state of close-to-maximal urine concentration probably driven by short nephrons maintaining a cortex-outer medullary gradient (about 400 milliosmoles). The patients had a low daily osmoles intake without evidence of thirst dysregulation so no one experienced polyuria.
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Affiliation(s)
- Quentin de Berny
- Service de Néphrologie, Dialyse et Transplantation Rénale, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - Camille Saint-Jacques
- Service d'Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, UMR-S 1155, Médecine Sorbonne Université, Paris, France
| | - Aline Santin
- Service de Médecine Interne, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Médecine Sorbonne Université, Paris, France
| | - Sarah Mattioni
- Service de Médecine Interne, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Médecine Sorbonne Université, Paris, France
| | - Olivier Steichen
- Service de Médecine Interne, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Médecine Sorbonne Université, Paris, France
| | - Rémi Chieze
- Service d'Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, UMR-S 1155, Médecine Sorbonne Université, Paris, France
| | - Vincent Frochot
- Service d'Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, UMR-S 1155, Médecine Sorbonne Université, Paris, France
| | - Emmanuel Letavernier
- Service d'Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, UMR-S 1155, Médecine Sorbonne Université, Paris, France
| | - François Lionnet
- Service de Médecine Interne, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Médecine Sorbonne Université, Paris, France
| | - Jean-Philippe Haymann
- Service d'Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, UMR-S 1155, Médecine Sorbonne Université, Paris, France
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Hsieh CY, Tsai PW, Tomioka Y, Matsumoto Y, Akiyama Y, Wang CC, Tayo LL, Lee CJ. Chronopharmacology of diuresis via metabolic profiling and key biomarker discovery of the traditional Chinese prescription Ji-Ming-San using tandem mass spectrometry in rat models. Phytomedicine 2024; 124:155260. [PMID: 38176264 DOI: 10.1016/j.phymed.2023.155260] [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] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/14/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Ji-Ming-Shan (JMS) is a traditional prescription used for patients with rheumatism, tendons swelling, relief of foot pain, athlete's foot, diuresis, gout. Although many studies have investigated the active compounds in each herb, the functional mechanism behind its therapeutic effect remains unclear. STUDY DESIGN Metabolic cages for sample collection. The serum components obtained from the experimental animals were analyzed using LC-MS/MS. Furthermore, cross-analysis using the software MetaboAnalyst and Venn diagrams were used to investigate chronopharmacology of JMS in the animal models. PURPOSE The aim of this study is to analyze the diuretic effects of JMS and to explore their chronopharmacology involved in organ regulation through four-quarter periods from serum samples of rat models. METHODS Metabolic cages were used for collecting the urine samples and PocketChem UA PU-4010, Fuji DRI-CHEM 800 were used to examine the urine biochemical parameters. The serum components were identified through ultra-performance liquid chromatography-quadrupole time-of-flight (UPLC-Q-TOF) with a new developed method. Cross analysis, Venn diagram, MetaboAnalyst were used to investigate the key biomarker and major metabolism route with the oral administration of the drug. RESULT JMS significantly changed the 6 h urine volume with no observed kidney toxicity. Urine pH value ranges from 7.0 to 7.5. The chronopharmacology of JMS diuresis activity were 0-6 and 6-12 groups. UPLC-Q-TOF analyses identified 243 metabolites which were determined in positive mode and negative mode respectively. With cross analysis in the Venn diagram, one key biomarker naringenin-7-O-glucoside has been identified. Major metabolic pathways such as 1: Glycerophospholipid metabolism, 2: Primary bile acid biosynthesis, 3: Sphingolipid metabolism, 4: Riboflavin metabolism, 5: Linoleic acid metabolism, 6: Butanoate metabolism. CONCLUSION JMS significantly changed the urine output of animals in the 0-6 and 6-12 groups. No change in urine pH was observed and also kidney toxicity. A new UPLC-Q-TOF method was developed for the detection of the metabolites of JMS after oral administration. The cross analysis with Venn diagram and identified the key biomarker of JMS namely naringenin-7-O-glucoside. The results showed that six major pathways are involved in the gastrointestinal system and the liver. This study demonstrated the capability of JMS prescription in the regulation of diuresis and identified a key biomarker that is responsible for its therapeutic effect.
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Affiliation(s)
- Cheng-Yang Hsieh
- Program in Clinical Drug Development of Herbal Medicine, College of Pharmacy, Taipei Medical University, Postal address: Teaching & research building, 250 Wu-Hsing Street, Taipei 110, Taiwan; Laboratory of Oncology, Pharmacy Practice and Sciences, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai Japan
| | - Po-Wei Tsai
- Department of Medical Science Industries, College of Health Sciences, Chang Jung Christian University, Tainan 711, Taiwan
| | - Yoshihisa Tomioka
- Laboratory of Oncology, Pharmacy Practice and Sciences, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai Japan
| | - Yotaro Matsumoto
- Laboratory of Oncology, Pharmacy Practice and Sciences, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai Japan
| | - Yasutoshi Akiyama
- Laboratory of Oncology, Pharmacy Practice and Sciences, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai Japan
| | - Ching-Chiung Wang
- Program in Clinical Drug Development of Herbal Medicine, College of Pharmacy, Taipei Medical University, Postal address: Teaching & research building, 250 Wu-Hsing Street, Taipei 110, Taiwan; Graduate Institute of Pharmacognosy, College of Pharmacy, Taipei Medical University, Taipei 110, Taiwan; Traditional Herbal Medicine Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan; School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei 110, Taiwan
| | - Lemmuel L Tayo
- School of Chemical, Biological, Materials Engineering and Sciences, Mapúa University, Intramuros, 1002 Metro Manila, Manila, Philippines; Department of Biology, School of Medicine and Health Sciences Mapua University, Makati, Philippines
| | - Chia-Jung Lee
- Program in Clinical Drug Development of Herbal Medicine, College of Pharmacy, Taipei Medical University, Postal address: Teaching & research building, 250 Wu-Hsing Street, Taipei 110, Taiwan; Graduate Institute of Pharmacognosy, College of Pharmacy, Taipei Medical University, Taipei 110, Taiwan; Traditional Herbal Medicine Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan.
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8
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Sugiyama J, Ryuge A, Mitsubayashi K, Ito M, Matsumoto N, Takeuchi R, Azuma K, Hachiya A, Asano M, Nakamura T. Dapagliflozin induced hypernatremia via osmotic diuresis: a case report. CEN Case Rep 2024; 13:9-13. [PMID: 37074627 PMCID: PMC10834893 DOI: 10.1007/s13730-023-00790-x] [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: 01/27/2023] [Accepted: 04/09/2023] [Indexed: 04/20/2023] Open
Abstract
Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been widely used. They inhibit proximal tubular glucose reabsorption, resulting in glycosuria. Herein, we report the case of a 65-year-old woman who presented with hypernatremia during the perioperative period of a subarachnoid hemorrhage. The patient continued to take dapagliflozin postoperatively and subsequently developed severe hypernatremia. Based on the urinalysis findings, we diagnosed osmotic diuresis due to glycosuria as contributing to hypernatremia. Hypernatremia improved with the discontinuation of dapagliflozin and the administration of a hypotonic infusion. In the perioperative period, physicians should discontinue SGLT2 inhibitors owing to concerns about the development of hypernatremia.
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Affiliation(s)
- Juri Sugiyama
- Department of Nephrology, National Hospital Organization Nagoya Medical Center, 1-1 Sannomaru, Naka-Ku, Nagoya, Aichi, 460-0001, Japan
| | - Akihiro Ryuge
- Department of Nephrology, National Hospital Organization Nagoya Medical Center, 1-1 Sannomaru, Naka-Ku, Nagoya, Aichi, 460-0001, Japan.
| | - Kenta Mitsubayashi
- Department of Nephrology, National Hospital Organization Nagoya Medical Center, 1-1 Sannomaru, Naka-Ku, Nagoya, Aichi, 460-0001, Japan
| | - Masashi Ito
- Department of Neurosurgery, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Naoki Matsumoto
- Department of Nephrology, National Hospital Organization Nagoya Medical Center, 1-1 Sannomaru, Naka-Ku, Nagoya, Aichi, 460-0001, Japan
| | - Riku Takeuchi
- Department of Nephrology, National Hospital Organization Nagoya Medical Center, 1-1 Sannomaru, Naka-Ku, Nagoya, Aichi, 460-0001, Japan
| | - Kiho Azuma
- Department of Nephrology, National Hospital Organization Nagoya Medical Center, 1-1 Sannomaru, Naka-Ku, Nagoya, Aichi, 460-0001, Japan
| | - Asaka Hachiya
- Department of Nephrology, National Hospital Organization Nagoya Medical Center, 1-1 Sannomaru, Naka-Ku, Nagoya, Aichi, 460-0001, Japan
| | - Marina Asano
- Department of Nephrology, National Hospital Organization Nagoya Medical Center, 1-1 Sannomaru, Naka-Ku, Nagoya, Aichi, 460-0001, Japan
| | - Tomonobu Nakamura
- Department of Nephrology, National Hospital Organization Nagoya Medical Center, 1-1 Sannomaru, Naka-Ku, Nagoya, Aichi, 460-0001, Japan
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9
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Jiang GY, Lee C, Kearing SA, Wadhera RK, Gavin MC, Wasfy JH, Zeitler EP. IV Diuresis in Alternative Treatment Settings for the Management of Heart Failure: Implications for Mortality, Hospitalizations and Cost. J Card Fail 2024; 30:4-11. [PMID: 37714260 PMCID: PMC10840839 DOI: 10.1016/j.cardfail.2023.07.017] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 07/13/2023] [Accepted: 07/13/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Recent advances in heart failure (HF) care have sought to shift management from inpatient to outpatient and observation settings. We evaluated the association among HF treatment in the (1) inpatient; (2) observation; (3) emergency department (ED); and (4) outpatient settings with 30-day mortality, hospitalizations and cost. METHODS Using 100% Medicare inpatient, outpatient and Part B files from 2011-2018, 1,534,708 unique patient encounters in which intravenous (IV) diuretics were received for a primary diagnosis of HF were identified. Encounters were sorted into mutually exclusive settings: (1) inpatient; (2) observation; (3) ED; or (4) outpatient IV diuretic clinic. The primary outcome was 30-day all-cause mortality. Secondary outcomes included 30-day hospitalization and total 30-day costs. Multivariable logistic and linear regression were used to examine the association between treatment location and the primary and secondary outcomes. RESULTS Patients treated in observation and outpatient settings had lower 30-day mortality rates (observation OR 0.67, 95% CI 0.66-0.69; P < 0.001; outpatient OR 0.53, 95% CI 0.51-0.55; P < 0.001) compared to those treated in inpatient settings. Observation and outpatient treatment were also associated with decreased 30-day total cost compared to inpatient treatment. Observation relative cost -$5528.77, 95% CI -$5613.63 to -$5443.92; outpatient relative cost -$7005.95; 95% CI -$7103.94 to -$6907.96). Patients treated in the emergency department and discharged had increased mortality rates (OR 1.15, 95% CI 1.13-1.17; P < 0.001) and increased rates of hospitalization (OR 1.72, 95% CI 1.70-1.73; P < 0.001) compared to patients treated as inpatients. CONCLUSIONS Medicare beneficiaries who received IV diuresis for acute HF in the outpatient and observation settings had lower mortality rates and decreased costs of care compared to patients treated as inpatients. Outpatient and observation management of acute decompensated HF, when available, is a safe and cost-effective strategy in certain populations of patients with HF.
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Affiliation(s)
- Ginger Y Jiang
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Christopher Lee
- Section of Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Stephen A Kearing
- The Dartmouth Institute for Clinical Practice and Health Policy, Lebanon, NH
| | - Rishi K Wadhera
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Michael C Gavin
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jason H Wasfy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Emily P Zeitler
- Section of Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; The Dartmouth Institute for Clinical Practice and Health Policy, Lebanon, NH.
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10
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Vardeny O. SGLT2 Inhibitors and Diuresis: A Small Piece of the Puzzle. JACC Heart Fail 2024; 12:47-49. [PMID: 37943224 DOI: 10.1016/j.jchf.2023.09.013] [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: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Orly Vardeny
- Minneapolis VA Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis, Minnesota, USA.
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11
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Dauw J, Charaya K, Lelonek M, Zegri-Reiriz I, Nasr S, Paredes-Paucar CP, Borbély A, Erdal F, Benkouar R, Cobo-Marcos M, Barge-Caballero G, George V, Zara C, Ross NT, Barker D, Lekhakul A, Frea S, Ghazi AM, Knappe D, Doghmi N, Klincheva M, Fialho I, Bovolo V, Findeisen H, Alhaddad IA, Galluzzo A, de la Espriella R, Tabbalat R, Miró Ò, Singh JS, Nijst P, Dupont M, Martens P, Mullens W. Protocolized Natriuresis-Guided Decongestion Improves Diuretic Response: The Multicenter ENACT-HF Study. Circ Heart Fail 2024; 17:e011105. [PMID: 38179728 DOI: 10.1161/circheartfailure.123.011105] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/25/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND The use of urinary sodium to guide diuretics in acute heart failure is recommended by experts and the most recent European Society of Cardiology guidelines. However, there are limited data to support this recommendation. The ENACT-HF study (Efficacy of a Standardized Diuretic Protocol in Acute Heart Failure) investigated the feasibility and efficacy of a standardized natriuresis-guided diuretic protocol in patients with acute heart failure and signs of volume overload. METHODS ENACT-HF was an international, multicenter, open-label, pragmatic, 2-phase study, comparing the current standard of care of each center with a standardized diuretic protocol, including urinary sodium to guide therapy. The primary end point was natriuresis after 1 day. Secondary end points included cumulative natriuresis and diuresis after 2 days of treatment, length of stay, and in-hospital mortality. All end points were adjusted for baseline differences between both treatment arms. RESULTS Four hundred one patients from 29 centers in 18 countries worldwide were included in the study. The natriuresis after 1 day was significantly higher in the protocol arm compared with the standard of care arm (282 versus 174 mmol; adjusted mean ratio, 1.64; P<0.001). After 2 days, the natriuresis remained higher in the protocol arm (538 versus 365 mmol; adjusted mean ratio, 1.52; P<0.001), with a significantly higher diuresis (5776 versus 4381 mL; adjusted mean ratio, 1.33; P<0.001). The protocol arm had a shorter length of stay (5.8 versus 7.0 days; adjusted mean ratio, 0.87; P=0.036). In-hospital mortality was low and did not significantly differ between the 2 arms (1.4% versus 2.0%; P=0.852). CONCLUSIONS A standardized natriuresis-guided diuretic protocol to guide decongestion in acute heart failure was feasible, safe, and resulted in higher natriuresis and diuresis, as well as a shorter length of stay.
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Affiliation(s)
- Jeroen Dauw
- Ziekenhuis Oost-Limburg, Department of Cardiology, Genk, Belgium (J.D., P.N., M.D., P.M.)
- UHasselt, Doctoral School for Medicine and Life Sciences, LCRC, Diepenbeek, Belgium (J.D., W.M.)
| | - Kristina Charaya
- Department of Cardiology, Sonography and Functional Diagnostics, First Moscow State Medical University, Russia (K.C.)
| | - Małgorzata Lelonek
- Department of Noninvasive Cardiology, Medical University of Lodz, Poland (M.L.)
| | - Isabel Zegri-Reiriz
- Department of Cardiology, Heart Failure and Heart Transplant Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (I.Z.-R.)
| | - Samer Nasr
- Department of Cardiology, Mount Lebanon Hospital-Balamand University Medical Center, Hazmiyeh (S.N.)
| | | | - Attila Borbély
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Hungary (A.B.)
| | - Fatih Erdal
- Department of Cardiology, Thorax Centrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands (F.E.)
| | - Riad Benkouar
- Benyoucef Benkhedda Faculty of Medicine, Mustapha Pacha Hospital, University of Algiers, Algeria (R.B.)
| | - Marta Cobo-Marcos
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda (IDIPHISA), Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (M.C.-M.)
| | - Gonzalo Barge-Caballero
- Advanced Heart Failure and Heart Transplant Unit, Department of Cardiology, Complexo Hospitalario Universitario A Coruña (CHUAC), Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain (G.B.-C.)
| | - Varghese George
- Pushpagiri Institute of Medical Sciences, Tiruvalla, India (V.G.)
| | | | - Noel T Ross
- Kuala Lumpur General Hospital, Malaysia (N.T.R.)
| | - Diane Barker
- University Hospitals of North Midlands, Stoke on Trent, United Kingdom (D.B.)
| | | | - Simone Frea
- Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Turin, Italy (S.F.)
| | - Azmee M Ghazi
- National Heart Institute, Kuala Lumpur, Malaysia (A.M.G.)
| | - Dorit Knappe
- Department of Cardiology, University Heart and Vascular Center Hamburg, Germany (D.K.)
| | - Nawal Doghmi
- Department of Cardiology, CHU Ibn Sina, Mohammed V University, Rabat, Morocco (N.D.)
| | | | - Inês Fialho
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal (I.F.)
| | - Virginia Bovolo
- Department of Cardiology, Michele e Pietro Ferrero Hospital, Verduno, Italy (V.B.)
| | - Hajo Findeisen
- Department of Internal Medicine, Red Cross Hospital, Bremen, Germany (H.F.)
| | | | | | | | - Ramzi Tabbalat
- Department of Cardiology, Abdali Hospital, Amman, Jordan (R.T.)
| | - Òscar Miró
- Emergency Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Catalonia, Spain (Ò.M.)
| | - Jagdeep S Singh
- The Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (J.S.S.)
| | - Petra Nijst
- Ziekenhuis Oost-Limburg, Department of Cardiology, Genk, Belgium (J.D., P.N., M.D., P.M.)
| | - Matthias Dupont
- Ziekenhuis Oost-Limburg, Department of Cardiology, Genk, Belgium (J.D., P.N., M.D., P.M.)
| | - Pieter Martens
- Ziekenhuis Oost-Limburg, Department of Cardiology, Genk, Belgium (J.D., P.N., M.D., P.M.)
| | - Wilfried Mullens
- UHasselt, Doctoral School for Medicine and Life Sciences, LCRC, Diepenbeek, Belgium (J.D., W.M.)
- UHasselt, Biomedical Research Institute, Faculty of Medicine and Life Sciences, LCRC, Diepenbeek, Belgium (W.M.)
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12
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Kodama T, Otani K, Okada M, Yamawaki H. Eukaryotic elongation factor 2 kinase inhibitor, A484954 induced diuresis via nitric oxide production in spontaneously hypertensive rats. J Vet Med Sci 2023; 85:1314-1318. [PMID: 37853639 PMCID: PMC10788169 DOI: 10.1292/jvms.23-0306] [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: 07/13/2023] [Accepted: 10/03/2023] [Indexed: 10/20/2023] Open
Abstract
Eukaryotic elongation factor 2 (eEF2) kinase (eEF2K) is a protein kinase that inactivates eEF2, a protein that mediates a peptidyl-tRNA translocation during an elongation step of protein synthesis. We have previously shown that eEF2K was involved in pathogenesis of essential and pulmonary hypertension. A484954 (7-amino-1-cyclopropyl-3-ethyl-2,4-dioxo-1,2,3,4-tetrahydropyrido[2,3-d] pyrimidine-6-carboxamide), a selective eEF2K inhibitor, is a membrane permeable small molecule. We have previously shown that A484954 lowered blood pressure and induced diuretic effects in spontaneously hypertensive rats (SHR) due to an increase in renal blood flow. Here we aimed to reveal mechanisms underlying the diuretic effects of A484954 in SHR. A484954-induced diuresis and increase in urinary Na+ excretion were inhibited by N (G)-nitro-L-arginine methyl ester (L-NAME), a nitric oxide (NO) synthase inhibitor. A484954 increased mRNA expression of angiotensin type 2 receptor (AT2R) and nuclear factor-erythroid 2-related factor 2 (Nrf2). In summary, we for the first time revealed that A484954 induces diuresis in SHR at least partly via the activation of NO/Nrf2/AT2R pathway.
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Affiliation(s)
- Tomoko Kodama
- Laboratory of Veterinary Pharmacology, School of Veterinary Medicine, Kitasato University, Aomori, Japan
| | - Kosuke Otani
- Laboratory of Veterinary Pharmacology, School of Veterinary Medicine, Kitasato University, Aomori, Japan
| | - Muneyoshi Okada
- Laboratory of Veterinary Pharmacology, School of Veterinary Medicine, Kitasato University, Aomori, Japan
| | - Hideyuki Yamawaki
- Laboratory of Veterinary Pharmacology, School of Veterinary Medicine, Kitasato University, Aomori, Japan
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13
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Raju S, Sharma A, Kumar S, Seth A, Sharma A, Pandey AK, Kumar R. Impact of forced diuresis at two different time points on pelvic imaging in prostatic carcinoma with 68 Ga-PSMA PET/CT. Nucl Med Commun 2023; 44:1135-1143. [PMID: 37799105 DOI: 10.1097/mnm.0000000000001771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
OBJECTIVE We compared diagnostic quality of 68 Ga-PSMA PET/CT imaging focused on the pelvic structures using two furosemide protocols in two different groups of patients. MATERIAL AND METHODS A total of 55 patients with prostate cancer were retrospectively enrolled in the study. Out of 55, 31 patients were in group 1 (median age: 66 years, Range 44-78 years) in which furosemide injection was given after completion of whole-body 68 Ga-PSMA PET/CT scan and 24 patients were in group 2 (median age: 63.5 years, range: 50-82 years) in which it was given along with the 68 Ga-PSMA injection. In both groups, an initial time point scan (T0 scan) and a delayed time point scan (T1scan) were done. The images were analyzed qualitatively as well as quantitatively. RESULTS Quantitatively there was no statistically significant difference between the SUVmax and T:B of prostatic lesion and seminal vesicle invasion (SVI) in both the groups at two time points ( P > 0.05). Early furosemide injection caused a washout of the urinary bladder radiotracer concentration in significantly higher number of patients in group 2 (62.5% vs. 6.45% patients, P < 0.001). There was significant clearance of radiotracer activity from the ureters in group 2 (SUVmax: 9.28 vs. 3.09, P = 0.002). CONCLUSION The simultaneous furosemide and 68 Ga-PSMA injection can reduce the urinary excretion of the tracer and improve the diagnostic confidence of prostatic lesion, SVI and lymph nodal metastasis, along with reducing the scanning time and radiation burden, making this protocol an effective alternative to the present protocol of delayed furosemide injection.
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Affiliation(s)
| | | | | | | | | | | | - Rakesh Kumar
- Diagnostic Nuclear Medicine Division, Department of Nuclear Medicine, AIIMS, New Delhi, India
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14
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Cuthbert JJ, Cleland JGF. Should we resurrect acetazolamide as a diuretic for congestion due to heart failure? Cardiovasc Res 2023; 119:e149-e151. [PMID: 37850512 DOI: 10.1093/cvr/cvad148] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Affiliation(s)
- Joe J Cuthbert
- Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire HU6 7RX, UK
- Department of Cardiology, Hull University Teaching Hospitals NHS Trust, Daisy Building, Castle Hill Hospital, Castle Road, Cottingham, Kingston-Upon-Hull, East Riding of Yorkshire HU16 5JQ, UK
| | - John G F Cleland
- School of Cardiovascular and Metabolic Health, British Heart Foundation Centre of Research Excellence, 126 University Place, University of Glasgow, Glasgow, Lanarkshire G12 8TA, UK
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15
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Cox ZL, Siddiqi HK, Stevenson LW, Bales B, Han JH, Hart K, Imhoff B, Ivey-Miranda JB, Jenkins CA, Lindenfeld J, Shotwell MS, Miller KF, Ooi H, Rao VS, Schlendorf K, Self WH, Siew ED, Storrow A, Walsh R, Wrenn JO, Testani JM, Collins SP. Randomized controlled trial of urinE chemiStry guided aCute heArt faiLure treATmEnt (ESCALATE): Rationale and design. Am Heart J 2023; 265:121-131. [PMID: 37544492 PMCID: PMC10592235 DOI: 10.1016/j.ahj.2023.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
Diuresis to achieve decongestion is a central aim of therapy in patients hospitalized for acute decompensated heart failure (ADHF). While multiple clinical trials have investigated initial diuretic strategies for a designated period of time, there is a paucity of evidence to guide diuretic titration strategies continued until decongestion is achieved. The use of urine chemistries (urine sodium and creatinine) in a natriuretic response prediction equation accurately estimates natriuresis in response to diuretic dosing, but a randomized clinical trial is needed to compare a urine chemistry-guided diuresis strategy with a strategy of usual care. The urinE chemiStry guided aCute heArt faiLure treATmEnt (ESCALATE) trial is designed to test the hypothesis that protocolized diuretic therapy guided by spot urine chemistry through completion of intravenous diuresis will be superior to usual care and improve outcomes over the 14 days following randomization. ESCALATE will randomize and obtain complete data on 450 patients with acute heart failure to a diuretic strategy guided by urine chemistry or a usual care strategy. Key inclusion criteria include an objective measure of hypervolemia with at least 10 pounds of estimated excess volume, and key exclusion criteria include significant valvular stenosis, hypotension, and a chronic need for dialysis. Our primary outcome is days of benefit over the 14 days after randomization. Days of benefit combines patient symptoms captured by global clinical status with clinical state quantifying the need for hospitalization and intravenous diuresis. CLINICAL TRIAL REGISTRATION: NCT04481919.
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Affiliation(s)
- Zachary L Cox
- Department of Pharmacy, Lipscomb University College of Pharmacy, Nashville, TN; Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN.
| | - Hasan K Siddiqi
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Lynne W Stevenson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Brian Bales
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Jin H Han
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Geriatric Research, Education and Clinical Center, Tennessee Valley Healthcare System, TN
| | - Kimberly Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Brant Imhoff
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Juan B Ivey-Miranda
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Hospital de Cardiologia, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Cathy A Jenkins
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - JoAnn Lindenfeld
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Matthew S Shotwell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Karen F Miller
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Henry Ooi
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Department of Medicine, Veterans Affairs Tennessee Valley Healthcare System, TN
| | - Veena S Rao
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Kelly Schlendorf
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Edward D Siew
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Alan Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Ryan Walsh
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Jesse O Wrenn
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Jeffrey M Testani
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Sean P Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Geriatric Research, Education and Clinical Center, Tennessee Valley Healthcare System, TN
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16
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Yoon HJ, Price BE, Parks RK, Ahn SJ, Choi MY. Diuretic hormone 31 activates two G protein-coupled receptors with differential second messengers for diuresis in Drosophila suzukii. Insect Biochem Mol Biol 2023; 162:104025. [PMID: 37813200 DOI: 10.1016/j.ibmb.2023.104025] [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] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 10/11/2023]
Abstract
Diuretic hormones (DHs) bind to G protein-coupled receptors (GPCRs), regulating water and ion balance to maintain homeostasis in animals. Two distinct DHs are known in insects: calcitonin (CT)-like DH31 and corticotropin-releasing factor (CRF)-like DH44. In this study, we identified and characterized DH31 and two DH31 GPCR variants, DH31-Ra and DH31-Rb, from spotted-wing drosophila, Drosophila suzukii, a globally prevalent vinegar fly causing severe damage to small fruits. Both GPCRs are active, but DH31-Ra is the dominant receptor based on gene expression analyses and DH31 peptide binding affinities. A notable difference between the two variants lies in 1) the GPCR structures of their C-termini and 2) the utilization of second messengers, and the amino acid sequences of the two variants are identical. DH31-Ra contains 12 additional amino acids, providing different intracellular C-terminal configurations. DH31-Ra utilizes both cAMP and Ca2+ as second messengers, whereas DH31-Rb utilizes only cAMP; this is the first time reported for an insect CT-like DH31 peptide. DH31 stimulated fluid secretion in D. suzukii adults, and secretion increased in a dose-dependent manner. However, when the fly was injected with a mixture of DH31 and CAPA, an anti-diuretic hormone, fluid secretion was suppressed. Here, we discuss the structures of the DH31 receptors and the differential signaling pathways, including second messengers, involved in fly diuresis. These findings provide fundamental insights into the characterization of D. suzukii DH31 and DH31-Rs, and facilitate the identification of potential biological targets for D. suzukii management.
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Affiliation(s)
- Ho Jung Yoon
- USDA-ARS, Horticultural Crops Research Unit, 3420 NW Orchard Ave, Corvallis, OR, 97330, USA; Department of Horticulture, Oregon State University, 3420 NW Orchard Ave, Corvallis, OR, 97330, USA
| | - Briana E Price
- USDA-ARS, Horticultural Crops Research Unit, 3420 NW Orchard Ave, Corvallis, OR, 97330, USA
| | - Ryssa K Parks
- USDA-ARS, Horticultural Crops Research Unit, 3420 NW Orchard Ave, Corvallis, OR, 97330, USA; Department of Horticulture, Oregon State University, 3420 NW Orchard Ave, Corvallis, OR, 97330, USA
| | - Seung-Joon Ahn
- Department of Biochemistry, Molecular Biology, Entomology, and Plant Pathology, Mississippi State University, Mississippi State, MS, 39762, USA
| | - Man-Yeon Choi
- USDA-ARS, Horticultural Crops Research Unit, 3420 NW Orchard Ave, Corvallis, OR, 97330, USA.
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17
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Briguori C, Romagnoli E, Biondi-Zoccai G. Diuresis-matched hydration to prevent contrast-associated acute kidney injury in percutaneous cardiovascular procedures: the more the merrier? Rev Esp Cardiol (Engl Ed) 2023; 76:752-754. [PMID: 37001809 DOI: 10.1016/j.rec.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Carlo Briguori
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli (IRCCS), Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Naples, Italy.
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18
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Meekers E, Dauw J, Martens P, Dhont S, Verbrugge FH, Nijst P, Ter Maaten JM, Damman K, Mebazaa A, Filippatos G, Ruschitzka F, Tang WHW, Dupont M, Mullens W. Renal function and decongestion with acetazolamide in acute decompensated heart failure: the ADVOR trial. Eur Heart J 2023; 44:3672-3682. [PMID: 37623428 DOI: 10.1093/eurheartj/ehad557] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/09/2023] [Accepted: 08/20/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND AND AIMS In the ADVOR trial, acetazolamide improved decongestion in acute decompensated heart failure (ADHF). Whether the beneficial effects of acetazolamide are consistent across the entire range of renal function remains unclear. METHODS This is a pre-specified analysis of the ADVOR trial that randomized 519 patients with ADHF to intravenous acetazolamide or matching placebo on top of intravenous loop diuretics. The main endpoints of decongestion, diuresis, natriuresis, and clinical outcomes are assessed according to baseline renal function. Changes in renal function are evaluated between treatment arms. RESULTS On admission, median estimated glomerular filtration rate (eGFR) was 40 (30-52) mL/min/1.73 m². Acetazolamide consistently increased the likelihood of decongestion across the entire spectrum of eGFR (P-interaction = .977). Overall, natriuresis and diuresis were higher with acetazolamide, with a higher treatment effect for patients with low eGFR (both P-interaction < .007). Acetazolamide was associated with a higher incidence of worsening renal function (WRF; rise in creatinine ≥ 0.3 mg/dL) during the treatment period (40.5% vs. 18.9%; P < .001), but there was no difference in creatinine after 3 months (P = .565). This was not associated with a higher incidence of heart failure hospitalizations and mortality (P-interaction = .467). However, decongestion at discharge was associated with a lower incidence of adverse clinical outcomes irrespective of the onset of WRF (P-interaction = .805). CONCLUSIONS Acetazolamide is associated with a higher rate of successful decongestion across the entire range of renal function with more pronounced effects regarding natriuresis and diuresis in patients with a lower eGFR. While WRF occurred more frequently with acetazolamide, this was not associated with adverse clinical outcomes. CLINICALTRIALS.GOV IDENTIFIER NCT03505788.
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Affiliation(s)
- Evelyne Meekers
- Department of Cardiology, Ziekenhuis Oost-Limburg AV, Schiepse Bos 6, 3600 Genk, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Universiteitslaan, Diepenbeek, Belgium
| | - Jeroen Dauw
- Faculty of Medicine and Life Sciences, Hasselt University, Universiteitslaan, Diepenbeek, Belgium
- Department of Cardiology, AZ Sint-Lucas, Ghent, Belgium
| | - Pieter Martens
- Department of Cardiology, Ziekenhuis Oost-Limburg AV, Schiepse Bos 6, 3600 Genk, Belgium
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sebastiaan Dhont
- Department of Cardiology, Ziekenhuis Oost-Limburg AV, Schiepse Bos 6, 3600 Genk, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Universiteitslaan, Diepenbeek, Belgium
| | - Frederik H Verbrugge
- Centre for Cardiovascular Diseases, University Hospital Brussels, Jette, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Jette, Belgium
| | - Petra Nijst
- Department of Cardiology, Ziekenhuis Oost-Limburg AV, Schiepse Bos 6, 3600 Genk, Belgium
| | - Jozine M Ter Maaten
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Kevin Damman
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Alexandre Mebazaa
- Department of Anesthesia & Critical Care, Université Paris Cité, Inserm MASCOT, APHP, Paris, France
| | | | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Wai Hong Wilson Tang
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Matthias Dupont
- Department of Cardiology, Ziekenhuis Oost-Limburg AV, Schiepse Bos 6, 3600 Genk, Belgium
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg AV, Schiepse Bos 6, 3600 Genk, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Universiteitslaan, Diepenbeek, Belgium
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19
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Occhipinti G, Laudani C, Spagnolo M, Greco A, Capodanno D. Diuresis-matched versus standard hydration in patients undergoing percutaneous cardiovascular procedures: meta-analysis of randomized clinical trials. Rev Esp Cardiol (Engl Ed) 2023; 76:759-766. [PMID: 36801376 DOI: 10.1016/j.rec.2023.02.001] [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] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/01/2023] [Indexed: 02/18/2023]
Abstract
INTRODUCTION AND OBJECTIVES Contrast-associated acute kidney injury (CA-AKI) is a potential complication of procedures requiring administration of iodinated contrast medium. RenalGuard, which provides real-time matching of intravenous hydration with furosemide-induced diuresis, is an alternative to standard periprocedural hydration strategies. The evidence on RenalGuard in patients undergoing percutaneous cardiovascular procedures is sparse. We used a Bayesian framework to perform a meta-analysis of RenalGuard as a CA-AKI preventive strategy. METHODS We searched Medline, Cochrane Library and Web of Science for randomized trials of RenalGuard vs standard periprocedural hydration strategies. The primary outcome was CA-AKI. Secondary outcomes were all-cause death, cardiogenic shock, acute pulmonary edema, and renal failure requiring renal replacement therapy. A Bayesian random-effect risk ratio (RR) with corresponding 95% credibility interval (95%CrI) was calculated for each outcome. PROSPERO database number CRD42022378489. RESULTS Six studies were included. RenalGuard was associated with a significant relative reduction in CA-AKI (median RR, 0.54; 95%CrI, 0.31-0.86) and acute pulmonary edema (median RR, 0.35; 95%CrI, 0.12-0.87). No significant differences were observed for the other secondary endpoints [all-cause death (RR, 0.49; 95%CrI, 0.13-1.08), cardiogenic shock (RR, 0.06; 95%CrI, 0.00-1.91), and renal replacement therapy (RR, 0.52; 95%CrI, 0.18-1.18)]. The Bayesian analysis also showed that RenalGuard had a high probability of ranking first for all the secondary outcomes. These results were consistent in multiple sensitivity analyses. CONCLUSIONS In patients undergoing percutaneous cardiovascular procedures, RenalGuard was associated with a reduced risk of CA-AKI and acute pulmonary edema compared with standard periprocedural hydration strategies.
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Affiliation(s)
- Giovanni Occhipinti
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico-San Marco, University of Catania, Catania, Italy
| | - Claudio Laudani
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico-San Marco, University of Catania, Catania, Italy
| | - Marco Spagnolo
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico-San Marco, University of Catania, Catania, Italy
| | - Antonio Greco
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico-San Marco, University of Catania, Catania, Italy
| | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico-San Marco, University of Catania, Catania, Italy.
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20
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Lafuente JL, González S, Puertas E, Gómez-Tello V, Avilés E, Albo N, Mateo C, Beunza JJ. Development of a urinometer for automatic measurement of urine flow in catheterized patients. PLoS One 2023; 18:e0290319. [PMID: 37651353 PMCID: PMC10470914 DOI: 10.1371/journal.pone.0290319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023] Open
Abstract
Urinary flow measurement and colorimetry are vital medical indicators for critically ill patients in intensive care units. However, there is a clinical need for low-cost, continuous urinary flow monitoring devices that can automatically and in real-time measure urine flow. This need led to the development of a non-invasive device that is easy to use and does not require proprietary disposables. The device operates by detecting urine flow using an infrared barrier that returns an unequivocal pattern, and it is capable of measuring the volume of liquid in real-time, storing the history with a precise date, and returning alarms to detect critical trends. The device also has the ability to detect the color of urine, allowing for extended data and detecting problems in catheterized patients such as hematuria. The device is proposed as an automated clinical decision support system that utilizes the concept of the Internet of Medical Things. It works by using a LoRa communication method with the LoRaWAN protocol to maximize the distance to access points, reducing infrastructure costs in massive deployments. The device can send data wirelessly for remote monitoring and allows for the collection of data on a dashboard in a pseudonymous way. Tests conducted on the device using a gold standard medical grade infusion pump and fluid densities within the 1.005 g/ml to 1.030 g/ml urine density range showed that droplets were satisfactorily captured in the range of flows from less than 1 ml/h to 500 ml/h, which are acceptable ranges for urinary flow. Errors ranged below 15%, when compared to the values obtained by the hospital infusion pump used as gold standard. Such values are clinically adequate to detect changes in diuresis patterns, specially at low urine output ranges, related to renal disfunction. Additionally, tests carried out with different color patterns indicate that it detects different colors of urine with a precision in detecting RGB values <5%. In conclusion, the results suggest that the device can be useful in automatically monitoring diuresis and colorimetry in real-time, which can facilitate the work of nursing and provide automatic decision-making support to intensive care physicians.
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Affiliation(s)
- José-Luis Lafuente
- IASalud, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Engineering Department, School of Architecture, Engineering, & Design, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Samuel González
- IASalud, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Intensive Care Unit, Hospital Universitario HLA Moncloa, Madrid, Spain
- Department of Medicine, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Enrique Puertas
- IASalud, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Science, Computing and Technology, School of Engineering, Architecture & Design, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Vicente Gómez-Tello
- IASalud, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Department of Medicine, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Emergency Department, Hospital Universitario HLA Moncloa, Madrid, Spain
| | - Eva Avilés
- IASalud, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Engineering Department, School of Architecture, Engineering, & Design, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Niza Albo
- IASalud, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Engineering Department, School of Architecture, Engineering, & Design, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Claudia Mateo
- IASalud, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Engineering Department, School of Architecture, Engineering, & Design, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Juan-Jose Beunza
- IASalud, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Department of Medicine, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Research and Doctorate School, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
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21
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Bensimhon D, Weintraub WS, Peacock WF, Alexy T, McLean D, Haas D, Deering KL, Millar SJ, Goodwin MM, Mohr JF. Reduced heart failure-related healthcare costs with Furoscix versus in-hospital intravenous diuresis in heart failure patients: the FREEDOM-HF study. Future Cardiol 2023; 19:385-396. [PMID: 37609913 DOI: 10.2217/fca-2023-0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 08/24/2023] Open
Abstract
Aim: Compare heart failure (HF) costs of Furoscix use at home compared with inpatient intravenous (IV) diuresis. Patients & methods: Prospective, case control study of chronic HF patients presenting to emergency department (ED) with worsening congestion discharged to receive Furoscix 80 mg/10 ml 5-h subcutaneous infusion for ≤7 days. 30-day HF-related costs in Furoscix group derived from commercial claims database compared with matched historical patients hospitalized for <72 h. Results: Of 24 Furoscix patients, 1 (4.2%) was hospitalized in 30-day period. 66 control patients identified and were well-matched for age, sex, ejection fraction (EF), renal function and other comorbidities. Furoscix patients had reduced mean per patient HF-related healthcare cost of $16,995 (p < 0.001). Conclusion: Furoscix use was associated with significant reductions in 30-day HF-related healthcare costs versus matched hospitalized controls.
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Affiliation(s)
| | | | | | - Tamas Alexy
- University of Minnesota, Minneapolis, MN 55455, USA
| | | | | | | | | | | | - John F Mohr
- scPharmaceuticals, Burlington, MA 01803, USA
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22
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Vitali M, Fontana M, De Giorgi A, Marotta D, Crucianelli S, Antonucci A, Protano C. Natural Mineral Water and Diuresis: A Systematic Review. Int J Environ Res Public Health 2023; 20:ijerph20085527. [PMID: 37107810 PMCID: PMC10138893 DOI: 10.3390/ijerph20085527] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/15/2023] [Accepted: 04/13/2023] [Indexed: 05/11/2023]
Abstract
The present systematic review is aimed at evaluating the diuretic effects determined according to the natural mineral water consumption on healthy individuals. This systematic review has been performed following the guidelines of the PRISMA (preferred reporting items for systematic reviews and meta-analyses) Statement, investigating PubMed, Scopus, Web of Science and Cochrane Library from inception to November 2022. Studies performed both on animals and on humans were considered. After screening, a total of 12 studies have been identified. Of these, 11 studies were performed in Italy and 1 in Bulgaria. The time range of publication is very wide, ranging from 1962 to 2019 for human studies and from 1967 to 2001 for animal studies. All the included studies found an increase in diuresis determined according to the consumption of natural mineral water, in some cases after just one administration of the tested water. However, the quality of the studies is not so high, especially for the research conducted many years ago. Thus, it would be desirable to carry out new clinical studies using more appropriate methodological approaches and more refined methods of statistical data processing.
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Affiliation(s)
- Matteo Vitali
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
- Correspondence:
| | - Mario Fontana
- Department of Biochemical Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Andrea De Giorgi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Daniela Marotta
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Serena Crucianelli
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Arianna Antonucci
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Carmela Protano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
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23
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Lorenzin A, Sgarabotto L, Bacci ML, Elmi A, Ventrella D, Aniballi C, Zanella M, Brendolan A, Di Lullo L, Ronco C. Artificial Diuresis: Animal Studies on Efficacy and Safety of a New Miniaturized Device for Extracorporeal Ultrafiltration. Cardiorenal Med 2023; 13:167-175. [PMID: 36977396 DOI: 10.1159/000530382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/10/2023] [Indexed: 03/30/2023] Open
Abstract
INTRODUCTION We have recently developed a new miniaturized device for extracorporeal ultrafiltration (UF) to be used in patients with fluid overload: Artificial Diuresis-1 (AD1) (Medica S.p.A., Medolla, Italy). The device has a reduced priming volume, operates at very low pressures and flow regimes, and is designed to perform extracorporeal UF at bedside. After accurate experiments were carried out in vitro, we report in this paper the results of in vivo UF sessions carried out in selected animals according to veterinary best practice. MATERIALS AND METHODS The AD1 kit is pre-filled with sterile isotonic solution and operates with a polysulfone mini-filter, MediSulfone (polysulfone at 50,000 Dalton). A collection bag with a volumetric scale is connected to the UF line, and the ultrafiltrate is obtained by gravity based on the height at which the ultrafiltrate collection bag is placed. Animals were prepared and anesthetized. The jugular vein was cannulated with a double-lumen catheter. Three 6-h sessions of UF were scheduled with a target fluid removal of 1,500 mL. Heparin was used as anticoagulant. RESULTS In all treatments, the target value of UF was obtained in the absence of major clinical or technical problems with a maximum deviation from the scheduled UF rate lower than 10%. The device resulted to be safe, reliable, accurate, and easily usable thanks to a user-friendly interface and its very small dimensions. CONCLUSIONS This study opens the way for clinical trials in different settings including departments with low intensity of care and even in ambulatory centers or patient's home.
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Affiliation(s)
- Anna Lorenzin
- Department of Nephrology Dialysis and Transplant St. Bortolo Hospital, Vicenza, Italy
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Luca Sgarabotto
- Department of Nephrology Dialysis and Transplant St. Bortolo Hospital, Vicenza, Italy
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Maria Laura Bacci
- Department of Veterinary Medical Science, Bologna University, Bologna, Italy
| | - Alberto Elmi
- Department of Veterinary Medical Science, Bologna University, Bologna, Italy
| | - Domenico Ventrella
- Department of Veterinary Medical Science, Bologna University, Bologna, Italy
| | - Camilla Aniballi
- Department of Veterinary Medical Science, Bologna University, Bologna, Italy
| | - Monica Zanella
- Department of Nephrology Dialysis and Transplant St. Bortolo Hospital, Vicenza, Italy
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Alessandra Brendolan
- Department of Nephrology Dialysis and Transplant St. Bortolo Hospital, Vicenza, Italy
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | | | - Claudio Ronco
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
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24
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Valenzuela TF, Schinstock E, Kohnle S, Latib A, Bliagos D, Tunev S, Iaizzo PA. Preclinical research performed on reanimated/perfused swine kidneys: The Visible Kidney™ methodologies. Physiol Rep 2023; 11:e15630. [PMID: 36878878 PMCID: PMC9988650 DOI: 10.14814/phy2.15630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/27/2023] [Accepted: 02/09/2023] [Indexed: 03/08/2023] Open
Abstract
Preclinical research remains the essential platform in the development and optimization of medical therapies and advancements in translational medicines. However, specifically to animal research, federal laws, and institutional policies require investigators to apply the principles of the 3R's (replacement, reduction, and refinement). The concept of benchtop models utilizing isolated organs, in which multiple variables can be controlled to recreate human function, has been innovative advancements in preclinical research models that adhere to these principles. More specifically, isolated perfused kidney (IPK) models have been invaluable preclinical tools that have led to numerous advancements over the decades, including understanding renal physiology, pharmacologic therapies, and improvements in renal transplantation. However, pre-existing IPK models are not without their own limitations, leaving areas for improvement. An isolated perfused kidney apparatus was designed to best recreate human use conditions as a preclinical tool. Porcine renal blocks were chosen over the more commonly used rodent models, due to their greater similarities to human anatomies. Sixteen porcine kidney pairs obtained en bloc were extracted and placed onto an apparatus where aortic flows, pressures, and overall systemic temperatures were controlled. Organ viability was assessed in 10 renal blocks (n = 8 fresh and n = 2 previously frozen specimens) via both urinary flows and compositions at timepoints up to 180 min. Multimodality imaging, which included fluoroscopy, ultrasound, optical coherence tomography (OCT), and video scopes, was also employed to capture internal and external images to determine renal artery orientations and dimensions. Anatomical measurements and viability assessments of porcine renal blocks were successfully achieved in our perfusion model. Renal main artery diameters averaged smaller in our sample size than in human anatomy while also having more superior takeoff angles. Yet, the average lengths of each main segment were comparable to human anatomy: 32.09 ± 7.97 mm and 42.23 ± 7.33 mm in the left and right renal main artery, respectively. Urine production and urine composition of the fresh renal blocks, when compared to the frozen blocks and baseline perfusate, showed kidney viabilities of up to 3 h via excretion and retention of various metabolites. In this paper, we described a protocol for an isolated perfused kidney apparatus using large mammalian renal blocks. We believe this protocol to be an improvement from similar pre-existing models in better representing human physiologic function while allowing for multimodal imaging. The resulting Visible Kidney™ preclinical model, which has shown viability after isolation and reperfusion, can be a fast and reliable tool for the development of medical devices while also reducing the unnecessary use of animals for research.
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Affiliation(s)
| | | | - Samantha Kohnle
- The Department of Surgery's Visible Heart® Laboratories and the Institute for Engineering in MedicineUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Azeem Latib
- Montefiore Medical Center, Albert Einstein College of MedicineThe BronxNew YorkUSA
| | - Dimitrios Bliagos
- Montefiore Medical Center, Albert Einstein College of MedicineThe BronxNew YorkUSA
| | | | - Paul A. Iaizzo
- The Department of Surgery's Visible Heart® Laboratories and the Institute for Engineering in MedicineUniversity of MinnesotaMinneapolisMinnesotaUSA
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25
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Schulze PC, Bogoviku J, Westphal J, Aftanski P, Haertel F, Grund S, von Haehling S, Schumacher U, Möbius-Winkler S, Busch M. Response by Schulze et al to Letter Regarding Article, "Effects of Early Empagliflozin Initiation on Diuresis and Kidney Function in Patients With Acute Decompensated Heart Failure (EMPAG-HF)". Circulation 2023; 147:e75. [PMID: 36745697 DOI: 10.1161/circulationaha.122.062688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- P Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care (P.C.S., J.B., J.W., P.A., F.H., S.G., S.M-W.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Center for Clinical Studies (U.S.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Department of Internal Medicine III, Division of Nephrology (M.B.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Department of Cardiology and Pneumology, Georg-August-University, University Medical Centre Göttingen, Germany (S.v.H.)
- German Center for Cardiovascular Research, Partner Site Göttingen, Germany (S.v.H.)
| | - Jürgen Bogoviku
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care (P.C.S., J.B., J.W., P.A., F.H., S.G., S.M-W.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Center for Clinical Studies (U.S.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Department of Internal Medicine III, Division of Nephrology (M.B.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Department of Cardiology and Pneumology, Georg-August-University, University Medical Centre Göttingen, Germany (S.v.H.)
- German Center for Cardiovascular Research, Partner Site Göttingen, Germany (S.v.H.)
| | - Julian Westphal
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care (P.C.S., J.B., J.W., P.A., F.H., S.G., S.M-W.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Center for Clinical Studies (U.S.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Department of Internal Medicine III, Division of Nephrology (M.B.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Department of Cardiology and Pneumology, Georg-August-University, University Medical Centre Göttingen, Germany (S.v.H.)
- German Center for Cardiovascular Research, Partner Site Göttingen, Germany (S.v.H.)
| | - Pawel Aftanski
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care (P.C.S., J.B., J.W., P.A., F.H., S.G., S.M-W.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Center for Clinical Studies (U.S.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Department of Internal Medicine III, Division of Nephrology (M.B.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Department of Cardiology and Pneumology, Georg-August-University, University Medical Centre Göttingen, Germany (S.v.H.)
- German Center for Cardiovascular Research, Partner Site Göttingen, Germany (S.v.H.)
| | - Franz Haertel
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care (P.C.S., J.B., J.W., P.A., F.H., S.G., S.M-W.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Center for Clinical Studies (U.S.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Department of Internal Medicine III, Division of Nephrology (M.B.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Department of Cardiology and Pneumology, Georg-August-University, University Medical Centre Göttingen, Germany (S.v.H.)
- German Center for Cardiovascular Research, Partner Site Göttingen, Germany (S.v.H.)
| | - Sissy Grund
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care (P.C.S., J.B., J.W., P.A., F.H., S.G., S.M-W.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Center for Clinical Studies (U.S.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Department of Internal Medicine III, Division of Nephrology (M.B.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Department of Cardiology and Pneumology, Georg-August-University, University Medical Centre Göttingen, Germany (S.v.H.)
- German Center for Cardiovascular Research, Partner Site Göttingen, Germany (S.v.H.)
| | - Stephan von Haehling
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care (P.C.S., J.B., J.W., P.A., F.H., S.G., S.M-W.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Center for Clinical Studies (U.S.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Department of Internal Medicine III, Division of Nephrology (M.B.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Department of Cardiology and Pneumology, Georg-August-University, University Medical Centre Göttingen, Germany (S.v.H.)
- German Center for Cardiovascular Research, Partner Site Göttingen, Germany (S.v.H.)
| | - Ulrike Schumacher
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care (P.C.S., J.B., J.W., P.A., F.H., S.G., S.M-W.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Center for Clinical Studies (U.S.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Department of Internal Medicine III, Division of Nephrology (M.B.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Department of Cardiology and Pneumology, Georg-August-University, University Medical Centre Göttingen, Germany (S.v.H.)
- German Center for Cardiovascular Research, Partner Site Göttingen, Germany (S.v.H.)
| | - Sven Möbius-Winkler
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care (P.C.S., J.B., J.W., P.A., F.H., S.G., S.M-W.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Center for Clinical Studies (U.S.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Department of Internal Medicine III, Division of Nephrology (M.B.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Department of Cardiology and Pneumology, Georg-August-University, University Medical Centre Göttingen, Germany (S.v.H.)
- German Center for Cardiovascular Research, Partner Site Göttingen, Germany (S.v.H.)
| | - Martin Busch
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care (P.C.S., J.B., J.W., P.A., F.H., S.G., S.M-W.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Center for Clinical Studies (U.S.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Department of Internal Medicine III, Division of Nephrology (M.B.), Friedrich-Schiller-University, University Hospital Jena, Germany
- Department of Cardiology and Pneumology, Georg-August-University, University Medical Centre Göttingen, Germany (S.v.H.)
- German Center for Cardiovascular Research, Partner Site Göttingen, Germany (S.v.H.)
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Ekanayake P, Mudaliar S. Increase in hematocrit with SGLT-2 inhibitors - Hemoconcentration from diuresis or increased erythropoiesis after amelioration of hypoxia? Diabetes Metab Syndr 2023; 17:102702. [PMID: 36657305 DOI: 10.1016/j.dsx.2022.102702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS The SGLT2-inhibitors significantly reduce heart failure hospitalization and progression to end-stage kidney disease. An increase in hemoglobin/hematocrit is seen with SGLT2i-inhibitor treatment. This increase has been attributed to hemoconcentration resulting from a diuretic effect. In this review, we present evidence suggesting that the hematocrit increase is not due to hemoconcentration, but to an increase in erythropoiesis due to amelioration of hypoxia and more efficient erythropoietin production with SGLT2-inhibitor treatment. METHODS We performed a detailed review of the literature in PubMed for articles describing various mechanisms linking hematocrit increase with SGLT2-inhibitor use to their cardio-renal benefits. RESULTS The best predictor of cardio-renal benefits with SGLT2-inhibitors is an increase in hematocrit and hemoglobin. If this hemoconcentration is a results of diuresis, this would be associated with volume contraction and a deterioration in renal function, as seen with long-term diuretic use. This is the opposite of what is seen with the use of SGLT2-inhibitors, which are associated with long-term preservation of renal function. There is now growing evidence that the increase in hematocrit can be attributed to an increase in erythropoiesis due to amelioration of renal hypoxia and more efficient erythropoietin production with SGLT2-inhibitor treatment. Increased erythropoiesis leads to an increase in RBC count which improves myocardial/renal tissue oxygenation and function. CONCLUSION The increase in hematocrit with SGLT2i treatment is not due to hemoconcentration, but to an increase in erythropoiesis due to amelioration of hypoxia and more efficient erythropoietin production with SGLT2i treatment.
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Affiliation(s)
- Preethika Ekanayake
- Veterans Affairs Medical Center, San Diego, CA, USA; Department of Medicine, University of California, San Diego School of Medicine, USA
| | - Sunder Mudaliar
- Veterans Affairs Medical Center, San Diego, CA, USA; Department of Medicine, University of California, San Diego School of Medicine, USA.
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Yu L, Huang S, Wu S, Yue J, Yin L, Lin Z. Comparison of 18F-FDG PET/CT imaging with different dual time 18F-FDG PET/CT with forced diuresis in clinical diagnosis of prostate cancer. Medicine (Baltimore) 2023; 102:e32331. [PMID: 36637950 PMCID: PMC9839298 DOI: 10.1097/md.0000000000032331] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The aim of this study was to compare the capability of different dual time (interval 1, 2, 3, or 4 hours) 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) with forced diuresis to diagnose prostate cancer (PCa). A retrospective review of 273 male patients from March 2009 to June 2019, with any focal 18F-FDG uptake in the prostate gland during PET/CT imaging. Early PET/CT imaging was performed 60 minutes after FDG injection. Delayed imaging was performed 1 to 4 hours after diuretic injection. For prostate lesions with increased 18F-FDG uptake, a spheroid-shaped volume of interest was drawn, including the entire lesion, and the maximum standard uptake value (SUVmax) of the lesion was measured. The SUVmax > 2.5 after delayed imaging and the retention index > 15% were used as the diagnostic criteria for PET/CT in the diagnosis of PCa. Otherwise, it was diagnosed as the benign prostate disease. The final diagnosis was based on histological examination, associated imaging studies, or/and clinical follow-up. The results of inter-group comparison showed that the SUVmax of 1-, 2-, 3-, and 4-hour delayed imaging after diuresis in PCa group was significantly higher than that in control group (P < .05), but there was no statistical difference in SUVmax of early imaging between PCa and control group (P > .05). And the retention index of PCa group that delayed 1, 2, 3, and 4 hours after diuresis were significantly higher than those of control group, respectively (P < .05). The diagnostic sensitivity of imaging delayed 1, 2, 3, and 4 hours after diuresis was 68.8%, 81.2%, 85.7 %, and 71.4%, the specificity was 52.5%, 74.5%, 70.6%, and 65.0%, and the accuracy was respectively 58.2%, 77.4%, 76.4%, and 67.6%, the positive predictive values were 44.0%, 68.9%, 64.3%, and 58.8%, and the negative predictive value were 75.6%, 85.4%, 88.9%, and 76.5%, respectively. 18F-FDG PET/CT imaging as an imaging tool lacks certain specificity in the diagnosis of PCa, regardless of whether the imaging is delayed. The main advantage of delayed diuretic imaging in PCa is that it can significantly improve the sensitivity, especially the diagnostic effect delayed 2 hours after diuresis is better.
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Affiliation(s)
- Longhua Yu
- Department of Nuclear Medicine, Hospital 971 of The Navy of Chinese PLA, Qingdao, Shandong, China
| | - Shiming Huang
- Department of Nuclear Medicine, Pingjin Hospital, Characteristic Medical Center of Chinese People’s Armed Police Forces, Tianjin, China
| | - Siyu Wu
- Department of obstetrics and gynecology, Pingjin Hospital, Characteristic Medical Center of Chinese People’s Armed Police Forces, Tianjin, China
| | - Jianlan Yue
- Department of Nuclear Medicine, Pingjin Hospital, Characteristic Medical Center of Chinese People’s Armed Police Forces, Tianjin, China
| | - Liang Yin
- Department of Nuclear Medicine, Pingjin Hospital, Characteristic Medical Center of Chinese People’s Armed Police Forces, Tianjin, China
| | - Zhichun Lin
- Department of Nuclear Medicine, Pingjin Hospital, Characteristic Medical Center of Chinese People’s Armed Police Forces, Tianjin, China
- * Correspondence: Zhichun Lin, Department of Nuclear Medicine, Pingjin Hospital, Characteristic Medical Center of Chinese People’s Armed Police Forces, No.220 Chenglin Road, Hedong District, Tianjin 300162, China (e-mail: )
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Manvi, Khan MI, Badruddeen, Akhtar J, Ahmad M, Siddiqui Z, Fatima G. Role of Plant Bioactive as Diuretics: General Considerations and Mechanism of Diuresis. Curr Hypertens Rev 2023; 19:79-92. [PMID: 37309769 DOI: 10.2174/1573402119666230612115220] [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: 02/08/2023] [Revised: 03/22/2023] [Accepted: 04/03/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Medicinal plants have been found beneficial in the control and therapy of many ailments as they contain bioactive compounds, and many of them are used as precursors in the biosynthesis of natural medicines. Diuretics are used as a primary treatment in patients with edema associated with liver cirrhosis and kidney diseases, hyperkalemia, hypertension, heart failure, or renal failure. Furthermore, they are also used to increase the excretion of sodium and reduce blood volume. Due to various adverse events associated with synthetic diuretics, there is a need to investigate alternate plant-based bioactive components that have effective diuretic activity with minimal side effects. OBJECTIVE This review compiled the reported bioactive compounds from different plant sources along with their mechanisms of diuretic activity. METHODS Different sources were used to collect information regarding herbal plants with therapeutic value as diuretics. These included published peer-reviewed journal articles, scholarly articles from StatPearls, and search engines like Google Scholar, PubMed, Scopus, Springer, ScienceDirect, Wiley, etc. Results: In this review, it was found that flavonoids like rutin, acacetin, naringenin, etc. showed significant diuretic activity in experimental models by various mechanisms, but mostly by blocking the sodium-potassium-chloride co-transporter, while some bioactive compounds showed diuretic actions via other mechanisms as well. CONCLUSION Research on clinical trials of these isolated bioactive compounds needs to be further conducted. Thus, this review provides an understanding of the potential diuretic bioactive compounds of plants for further research and pharmaceutical applications.
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Affiliation(s)
- Manvi
- Faculty of Pharmacy, Integral University, Lucknow, India
| | | | - Badruddeen
- Faculty of Pharmacy, Integral University, Lucknow, India
| | - Juber Akhtar
- Faculty of Pharmacy, Integral University, Lucknow, India
| | - Mohammad Ahmad
- Faculty of Pharmacy, Integral University, Lucknow, India
| | - Zeba Siddiqui
- Faculty of Pharmacy, Integral University, Lucknow, India
| | - Gayyur Fatima
- Faculty of Pharmacy, Integral University, Lucknow, India
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Jackson EK, Menshikova EV, Ritov VB, Mi Z, Birder LA. 8-Aminoinosine and 8-Aminohypoxanthine Inhibit Purine Nucleoside Phosphorylase and Exert Diuretic and Natriuretic Activity. J Pharmacol Exp Ther 2022; 382:135-148. [PMID: 35609923 PMCID: PMC9639651 DOI: 10.1124/jpet.122.001221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/12/2022] [Indexed: 01/01/2023] Open
Abstract
8-Aminoguanine and 8-aminoguanosine (via metabolism to 8-aminoguanine) are endogenous 8-aminopurines that induce diuresis, natriuresis, and glucosuria by inhibiting purine nucleoside phosphorylase (PNPase); moreover, both 8-aminopurines cause antikaliuresis by other mechanisms. Because 8-aminoinosine and 8-aminohypoxanthine are structurally similar to 8-aminoguanosine and 8-aminoguanine, respectively, we sought to define their renal excretory effects. First, we compared the ability of 8-aminoguanine, 8-aminohypoxanthine, and 8-aminoinosine to inhibit recombinant PNPase. These compounds inhibited PNPase with a potency order of 8-aminoguanine > 8-aminohypoxanthine = 8-aminoinosine. Additional studies showed that 8-aminoinosine is a competitive substrate that is metabolized to a competitive PNPase inhibitor, namely 8-aminohypoxanthine. Administration of each 8-aminopurine (33.5 µmol/kg) reduced the guanine-to-guanosine and hypoxanthine-to-inosine ratios in urine, a finding confirming their ability to inhibit PNPase in vivo. All three 8-aminopurines induced diuresis, natriuresis, and glucosuria; however, the glucosuric effects of 8-aminohypoxanthine and 8-aminoinosine were less pronounced than those of 8-aminoguanine. Neither 8-aminohypoxanthine nor 8-aminoinosine altered potassium excretion, whereas 8-aminoguanine caused antikaliuresis. In vivo administration of 8-aminoinosine increased 8-aminohypoxanthine excretion, indicating that 8-aminohypoxanthine mediates, in part, the effects of 8-aminoinosine. Finally, 8-aminohypoxanthine was metabolized to 8-aminoxanthine by xanthine oxidase. Using ultraperformance liquid chromatography-tandem mass spectrometry, we identified 8-aminoinosine as an endogenous 8-aminopurine. In conclusion, 8-aminopurines have useful pharmacological profiles. To induce diuresis, natriuresis, glucosuria, and antikaliuresis, 8-aminoguanine (or its prodrug 8-aminoguanosine) would be preferred. If only diuresis and natriuresis, without marked glucosuria or antikaliuresis, is desired, 8-aminohypoxanthine or 8-aminoinosine might be useful. Finally, here we report the in vivo existence of another pharmacologically active 8-aminopurine, namely 8-aminoinosine. SIGNIFICANCE STATEMENT: Here, we report that a family of 8-aminopurines affects renal excretory function: effects that may be useful for treating multiple diseases including hypertension, heart failure, and chronic kidney disease. For diuresis and natriuresis accompanied by glucosuria and antikaliuresis, 8-aminoguanine (or its prodrug 8-aminoguanosine) would be useful; if only diuresis and natriuresis is called for, 8-aminohypoxanthine or 8-aminoinosine would be useful. Previously, we identified 8-aminoguanine and 8-aminoguanosine as endogenous 8-aminopurines; here, we extend the family of endogenous 8-aminopurines to include 8-aminoinosine.
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Affiliation(s)
- Edwin K Jackson
- Department of Pharmacology and Chemical Biology (E.K.J., E.V.M., V.B.R., Z.M.) and Department of Medicine (L.A.B.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Elizabeth V Menshikova
- Department of Pharmacology and Chemical Biology (E.K.J., E.V.M., V.B.R., Z.M.) and Department of Medicine (L.A.B.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Vladimir B Ritov
- Department of Pharmacology and Chemical Biology (E.K.J., E.V.M., V.B.R., Z.M.) and Department of Medicine (L.A.B.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Zaichuan Mi
- Department of Pharmacology and Chemical Biology (E.K.J., E.V.M., V.B.R., Z.M.) and Department of Medicine (L.A.B.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Lori A Birder
- Department of Pharmacology and Chemical Biology (E.K.J., E.V.M., V.B.R., Z.M.) and Department of Medicine (L.A.B.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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30
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Schulze PC, Bogoviku J, Westphal J, Aftanski P, Haertel F, Grund S, von Haehling S, Schumacher U, Möbius-Winkler S, Busch M. Effects of Early Empagliflozin Initiation on Diuresis and Kidney Function in Patients With Acute Decompensated Heart Failure (EMPAG-HF). Circulation 2022; 146:289-298. [PMID: 35766022 DOI: 10.1161/circulationaha.122.059038] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Effective diuretic regimens using loop diuretics in patients with acute decompensated heart failure are often limited by the development of worsening kidney function. Sodium-glucose cotransporter-2 inhibitors induce glucosuria and sodium excretion with nephroprotective effects in patients with stable heart failure but their role in acute decompensated heart failure is unclear. METHODS In this single-center, prospective, double-blind, placebo-controlled, randomized study, we randomly assigned patients with acute decompensated heart failure to empagliflozin 25 mg daily or placebo in addition to standard decongestive treatments that included loop diuretics. The primary end point was cumulative urine output over 5 days. Secondary end points included diuretic efficiency, dynamics in markers of kidney function and injury, and NT-proBNP (N-terminal pro-B-type natriuretic peptide). RESULTS Sixty patients were randomized within 12 hours of hospitalization for acute decompensated heart failure. Addition of empagliflozin daily to standard medical treatment of acute decompensated heart failure resulted in a 25% increase in cumulative urine output over 5 days (median 10.8 versus 8.7 L mL in placebo, group difference estimation 2.2 L [95% CI, 8.4 to 3.6]; P=0.003). Empagliflozin increased diuretic efficiency compared with placebo (14.1 mL urine per milligram furosemide equivalent [95% CI, 0.6-27.7]; P=0.041) without affecting markers of renal function (estimated glomerular filtration rate, 51±19 versus 54±17 mL/min per 1.73 m²; P=0.599) or injury (total urinary protein, 492±845 versus 503±847 mg/g creatinine; P=0.975; and urinary α1-microglobulin, 55.4±38.6 versus 31.3±33.6 mg/g creatinine; P=0.066) with more pronounced decrease in NT-proBNP in the empagliflozin group compared with placebo (-1861 versus -727.2 pg/mL after 5 days; quotient in slope, 0.89 [95% CI, 0.83-0.95]; P<0.001). There were no differences in the incidence of safety events between groups. CONCLUSIONS Early addition of empagliflozin to standard diuretic therapy increases urine output without affecting renal function in patients with acute decompensated heart failure. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT04049045.
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Affiliation(s)
- P Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care (P.C.S., J.B., J.W., P.A., F.H., S.G., S.M.-W.), Friedrich-Schiller-University, University Hospital Jena, Germany
| | - Jürgen Bogoviku
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care (P.C.S., J.B., J.W., P.A., F.H., S.G., S.M.-W.), Friedrich-Schiller-University, University Hospital Jena, Germany
| | - Julian Westphal
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care (P.C.S., J.B., J.W., P.A., F.H., S.G., S.M.-W.), Friedrich-Schiller-University, University Hospital Jena, Germany
| | - Pawel Aftanski
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care (P.C.S., J.B., J.W., P.A., F.H., S.G., S.M.-W.), Friedrich-Schiller-University, University Hospital Jena, Germany
| | - Franz Haertel
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care (P.C.S., J.B., J.W., P.A., F.H., S.G., S.M.-W.), Friedrich-Schiller-University, University Hospital Jena, Germany
| | - Sissy Grund
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care (P.C.S., J.B., J.W., P.A., F.H., S.G., S.M.-W.), Friedrich-Schiller-University, University Hospital Jena, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, Georg-August-University, University Medical Centre Göttingen, Germany (S.v.H.)
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Germany (S.v.H.)
| | - Ulrike Schumacher
- Center for Clinical Studies (U.S.), Friedrich-Schiller-University, University Hospital Jena, Germany
| | - Sven Möbius-Winkler
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care (P.C.S., J.B., J.W., P.A., F.H., S.G., S.M.-W.), Friedrich-Schiller-University, University Hospital Jena, Germany
| | - Martin Busch
- Department of Internal Medicine III, Division of Nephrology (M.B.), Friedrich-Schiller-University, University Hospital Jena, Germany
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Alwis US, Verbakel I, Pauwaert K, Delanghe J, Dossche L, Van Camp J, Roggeman S, Everaert K. The Influence of Salt Sensitivity Phenotype on Sodium Excretion and Diuresis: A Chrononutrition Pilot Study. Int J Clin Pract 2022; 2022:9608962. [PMID: 35685516 PMCID: PMC9159230 DOI: 10.1155/2022/9608962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chrononutrition studies on interaction of diet/nutrients on endogenous circadian clocks and meal timing on metabolic homeostasis may be of importance in the management of nocturnal polyuria (NP), owing to loss of circadian rhythm in nighttime urination. Dietary salt restriction is an increasingly popular lifestyle recommendation for NP patients. AIM This study aims to evaluate the effect of an acute salt load on diuresis and to study the phenomenon of salt sensitivity. Methodology. Young, healthy men (n = 21, fasted and sober) ingested 500 ml of water on the control day and 8 g and 12 g of salt with water (500 ml) on two other days. Blood and urine samples were collected at 0 hrs, 2 hrs, and 4 hrs and voided volumes were recorded. Diuresis, serum and urine osmolality, sodium, potassium, urea, and creatinine were measured. Salt sensitivity was determined based on the rate of sodium excretion. RESULTS Compared to 8 g, ingestion of 12 g of salt significantly increased diuresis after 4 hrs. Pure water load induced fast diuresis, whereas salt and water load initially reduced diuresis and promoted late increase in diuresis. The total voided volume was significantly lower in the salt sensitive individuals. CONCLUSION Taken together, salt sensitivity profile and type and time of fluid intake are important considerations to build effective personalized lifestyle recommendations for NP patients, which needs further investigation.
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Affiliation(s)
| | - Irina Verbakel
- Department of Human Structure and Repair, Ghent University, 9000 Ghent, Belgium
| | - Kim Pauwaert
- Department of Human Structure and Repair, Ghent University, 9000 Ghent, Belgium
| | - Joris Delanghe
- Department of Diagnostic Sciences, Ghent University, 9000 Ghent, Belgium
| | - Lien Dossche
- Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium
- Department of Pediatric Nephrology, Ghent University, 9000 Ghent, Belgium
| | - John Van Camp
- Department of Food Technology, Safety and Health, Ghent University, 9000 Ghent, Belgium
| | - Saskia Roggeman
- Research and Policy Department, Psychiatric Center Sint-Jan-Baptist, 9060 Zelzate, Belgium
| | - Karel Everaert
- Department of Human Structure and Repair, Ghent University, 9000 Ghent, Belgium
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Imamura H, Takahashi H, Wada H, Mukai Y, Asukai K, Hasegawa S, Yamamoto M, Takeoka T, Shinno N, Hara H, Kanemura T, Nakai N, Haraguchi N, Sugimura K, Nishimura J, Matsuda C, Yasui M, Omori T, Miyata H, Ohue M, Sakon M. Postoperative aggressive diuresis prevents postoperative tissue edema and complications in patients undergoing distal pancreatectomy. Langenbecks Arch Surg 2021; 407:645-654. [PMID: 34665325 DOI: 10.1007/s00423-021-02357-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/05/2021] [Accepted: 10/12/2021] [Indexed: 01/08/2023]
Abstract
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.
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Affiliation(s)
- Hiroki Imamura
- Department of Surgery, Osaka International Cancer Institute, 3-1-69, Ohtemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Hidenori Takahashi
- Department of Surgery, Osaka International Cancer Institute, 3-1-69, Ohtemae, Chuo-ku, Osaka, 541-8567, Japan.
| | - Hiroshi Wada
- Department of Surgery, Osaka International Cancer Institute, 3-1-69, Ohtemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Yosuke Mukai
- Department of Surgery, Osaka International Cancer Institute, 3-1-69, Ohtemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Kei Asukai
- Department of Surgery, Osaka International Cancer Institute, 3-1-69, Ohtemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Shinichiro Hasegawa
- Department of Surgery, Osaka International Cancer Institute, 3-1-69, Ohtemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Masaaki Yamamoto
- Department of Surgery, Osaka International Cancer Institute, 3-1-69, Ohtemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Tomohira Takeoka
- Department of Surgery, Osaka International Cancer Institute, 3-1-69, Ohtemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Naoki Shinno
- Department of Surgery, Osaka International Cancer Institute, 3-1-69, Ohtemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Hisashi Hara
- Department of Surgery, Osaka International Cancer Institute, 3-1-69, Ohtemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Takashi Kanemura
- Department of Surgery, Osaka International Cancer Institute, 3-1-69, Ohtemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Nozomu Nakai
- Department of Surgery, Osaka International Cancer Institute, 3-1-69, Ohtemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Naotsugu Haraguchi
- Department of Surgery, Osaka International Cancer Institute, 3-1-69, Ohtemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Keijiro Sugimura
- Department of Surgery, Osaka International Cancer Institute, 3-1-69, Ohtemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Junichi Nishimura
- Department of Surgery, Osaka International Cancer Institute, 3-1-69, Ohtemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Chu Matsuda
- Department of Surgery, Osaka International Cancer Institute, 3-1-69, Ohtemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Masayoshi Yasui
- Department of Surgery, Osaka International Cancer Institute, 3-1-69, Ohtemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Takeshi Omori
- Department of Surgery, Osaka International Cancer Institute, 3-1-69, Ohtemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Hiroshi Miyata
- Department of Surgery, Osaka International Cancer Institute, 3-1-69, Ohtemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Masayuki Ohue
- Department of Surgery, Osaka International Cancer Institute, 3-1-69, Ohtemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Masato Sakon
- Department of Surgery, Osaka International Cancer Institute, 3-1-69, Ohtemae, Chuo-ku, Osaka, 541-8567, Japan
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Ruetten HM, Henry GH, Liu TT, Spratt HM, Ricke WA, Strand DW, Vezina CM. A NEW approach for characterizing mouse urinary pathophysiologies. Physiol Rep 2021; 9:e14964. [PMID: 34337899 PMCID: PMC8326900 DOI: 10.14814/phy2.14964] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/03/2021] [Accepted: 06/14/2021] [Indexed: 12/22/2022] Open
Abstract
The void spot assay (VSA) is a cost-effective method for evaluating and quantifying mouse urinary voiding phenotypes. The VSA has been used to differentiate voiding behaviors between experimental groups, but not as a diagnostic assay. To build toward this goal, we used the VSA to define voiding patterns of male mice with diabetic diuresis (BTBR.Cg-Lepob /WiscJ mice), irritative urinary dysfunction (E. coli UTI89 urinary tract infection), and obstructive urinary dysfunction (testosterone and estradiol slow-release implants) compared to their respective controls. Many studies compare individual VSA endpoints (urine spot size, quantity, or distribution) between experimental groups. Here, we consider all endpoints collectively to establish VSA phenomes of mice with three different etiologies of voiding dysfunction. We created an approach called normalized endpoint work through (NEW) to normalize VSA outputs to control mice, and then applied principal components analysis and hierarchical clustering to 12 equally weighted, normalized, scaled, and zero-centered VSA outcomes collected from each mouse (the VSA phenome). This approach accurately classifies mice based on voiding dysfunction etiology. We used principal components analysis and hierarchical clustering to show that some aged mice (>24 m old) develop an obstructive or a diabetic diuresis VSA phenotype while others develop a unique phenotype that does not cluster with that of diabetic, infected, or obstructed mice. These findings support use of the VSA to identify specific urinary phenotypes in mice and the continued use of aged mice as they develop urinary dysfunction representative of the various etiologies of LUTS in men.
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Affiliation(s)
- Hannah M. Ruetten
- Department of Comparative BiosciencesUniversity of Wisconsin‐MadisonMadisonWIUSA
- University of Wisconsin‐Madison/UMASS Boston/UT Southwestern George M. O’Brien Center for Benign Urologic ResearchMadisonWIUSA
| | - Gervaise H. Henry
- University of Wisconsin‐Madison/UMASS Boston/UT Southwestern George M. O’Brien Center for Benign Urologic ResearchMadisonWIUSA
- Department of UrologyUT Southwestern Medical CenterDallasTXUSA
| | - Teresa T. Liu
- University of Wisconsin‐Madison/UMASS Boston/UT Southwestern George M. O’Brien Center for Benign Urologic ResearchMadisonWIUSA
- Department of UrologyUniversity of Wisconsin‐MadisonMadisonWIUSA
| | - Heidi M. Spratt
- Department of Preventive Medicine and Population HealthUniversity of Texas Medical BranchGalvestonTXUSA
| | - William A. Ricke
- University of Wisconsin‐Madison/UMASS Boston/UT Southwestern George M. O’Brien Center for Benign Urologic ResearchMadisonWIUSA
- Department of UrologyUniversity of Wisconsin‐MadisonMadisonWIUSA
| | - Douglas W. Strand
- University of Wisconsin‐Madison/UMASS Boston/UT Southwestern George M. O’Brien Center for Benign Urologic ResearchMadisonWIUSA
- Department of UrologyUT Southwestern Medical CenterDallasTXUSA
| | - Chad M. Vezina
- Department of Comparative BiosciencesUniversity of Wisconsin‐MadisonMadisonWIUSA
- University of Wisconsin‐Madison/UMASS Boston/UT Southwestern George M. O’Brien Center for Benign Urologic ResearchMadisonWIUSA
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Faisal MS, Singh T, Amin H, Esfeh JM. A guide to diagnosing and managing ascites in cirrhosis. J Fam Pract 2021; 70:174-181. [PMID: 34339360 DOI: 10.12788/jfp.0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Combined serum and ascites fluid measurements point to the cause of ascites. For patients with modest edema, a reduced weight-loss target with diuresis may be acceptable.
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Affiliation(s)
- Muhammad Salman Faisal
- Department of Internal Medicine (Dr. Faisal) and Department of Gastroenterology, Hepatology and Nutrition (Drs. Singh, Amin, and Modaresi Esfeh), Cleveland Clinic, Ohio
| | - Tavankit Singh
- Department of Internal Medicine (Dr. Faisal) and Department of Gastroenterology, Hepatology and Nutrition (Drs. Singh, Amin, and Modaresi Esfeh), Cleveland Clinic, Ohio
| | - Hina Amin
- Department of Internal Medicine (Dr. Faisal) and Department of Gastroenterology, Hepatology and Nutrition (Drs. Singh, Amin, and Modaresi Esfeh), Cleveland Clinic, Ohio
| | - Jamak Modaresi Esfeh
- Department of Internal Medicine (Dr. Faisal) and Department of Gastroenterology, Hepatology and Nutrition (Drs. Singh, Amin, and Modaresi Esfeh), Cleveland Clinic, Ohio
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Abstract
Heart failure (HF) continues to be a serious public health challenge despite significant advancements in therapeutics and is often complicated by multiple other comorbidities. Of particular concern is type 2 diabetes mellitus (T2DM) which not only amplifies the risk, but also limits the treatment options available to patients. The sodium-glucose linked cotransporter subtype 2 (SGLT2)-inhibitor class, which was initially developed as a treatment for T2DM, has shown great promise in reducing cardiovascular risk, particularly around HF outcomes - regardless of diabetes status.There are ongoing efforts to elucidate the true mechanism of action of this novel drug class. Its primary mechanism of inducing glycosuria and diuresis from receptor blockade in the renal nephron seems unlikely to be responsible for the rapid and striking benefits seen in clinical trials. Early mechanistic work around conventional therapeutic targets seem to be inconclusive. There are some emerging theories around its effect on myocardial energetics and calcium balance as well as on renal physiology. In this review, we discuss some of the cutting-edge hypotheses and concepts currently being explored around this drug class in an attempt better understand the molecular mechanics of this novel agent.
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Affiliation(s)
- Amir Fathi
- Department of Neuroanaesthesia and Critical Care, National Hospital for Neurology and Neurosurgery, University College London, London, UK
| | - Keeran Vickneson
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - Jagdeep S Singh
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK.
- Department of Cardiology, The Edinburgh Heart Center, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK.
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Imbett-Yepez S, Peña-Vélez R, Zárate-Mondragón F, Ramírez-Mayans J. [Hyponatremia in children with liver cirrhosis: Treatment strategies]. Andes Pediatr 2021; 92:117-121. [PMID: 34106192 DOI: 10.32641/andespediatr.v92i1.2669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/08/2020] [Indexed: 06/12/2023]
Abstract
Hyponatremia is a common hydroelectrolytic disorder in pediatric patients with advanced cirrhosis. This complication is related to the alteration in the renal capacity to eliminate free water with solutes such as sodium, which leads to disproportionate water retention, a condition known as dilutional hyponatremia. The main pathogenic factors are the non-osmotic secretion of antidiuretic hormone and the activation of the renin-angiotensin-aldosterone axis and the sympathetic nervous system. Given that hyponatremia in cirrhosis is associated with an increase in morbidity and mortality, the objective of this review is to propose a systematic approach, based on the level of serum sodium, assessment of hemodynamic status and diuresis, which allows precise modifications that minimize negative impacts on survival and neurological sequelae.
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Affiliation(s)
- Sharon Imbett-Yepez
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Ciudad de México, México
| | - Rubén Peña-Vélez
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Ciudad de México, México
| | - Flora Zárate-Mondragón
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Ciudad de México, México
| | - Jaime Ramírez-Mayans
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Ciudad de México, México
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Ritter JK, Ahmad A, Mummalaneni S, Daneva Z, Dempsey SK, Li N, Li PL, Lyall V. Mechanism of Diuresis and Natriuresis by Cannabinoids: Evidence for Inhibition of Na +-K +-ATPase in Mouse Kidney Thick Ascending Limb Tubules. J Pharmacol Exp Ther 2021; 376:1-11. [PMID: 33087396 PMCID: PMC7745087 DOI: 10.1124/jpet.120.000163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/06/2020] [Indexed: 12/11/2022] Open
Abstract
The endocannabinoid, anandamide (AEA), stimulates cannabinoid receptors (CBRs) and is enriched in the kidney, especially the renal medulla. AEA infused into the renal outer medulla of mice stimulates urine flow rate and salt excretion. Here we show that these effects are blocked by the CBR type 1 (CB1) inverse agonist, rimonabant. Immunohistochemical analysis demonstrated the presence of CB1 in thick ascending limb (TAL) tubules. Western immunoblotting demonstrated the presence of CB1 (52 kDa) in the cortex and outer medulla of mouse kidney. The effect of direct [CP55940 (CP) or AEA] or indirect [fatty acyl amide hydrolase (FAAH) inhibitor, PF3845 (PF)] cannabinoidimetics on Na+ transport in isolated mouse TAL tubules was studied using the Na+-sensitive dye, SBFI-AM. Switching from 0 Na+ solution to control Ringer's solution (CR) rapidly increased TAL cell [Na+]i Addition of CP to CR produced a further elevation, similar in magnitude to that of ouabain, a Na+-K+-ATPase inhibitor. This [Na+]i-elevating effect of CP was time-dependent, required the presence of Na+ in the bathing solution, and was insensitive to Na+-K+-2Cl- cotransporter inhibition. Addition of PF to CR elevated [Na+]i in FAAH wild-type but not FAAH knockout (KO) TALs, whereas the additions of CP and AEA to PF-treated FAAH KO TALs increased [Na+]i An interaction between cannabinoidimetics and ouabain (Ou) was observed. Ou produced less increase in [Na+]i after cannabinoidimetic treatment, whereas cannabinoidimetics had less effect after Ou treatment. It is concluded that cannabinoidimetics, including CP and AEA, inhibit Na+ transport in TALs by inhibiting Na+ exit via Na+-K+-ATPase. SIGNIFICANCE STATEMENT: Cannabinoids including endocannabinoids induce renal urine and salt excretion and are proposed to play a physiological role in the regulation of blood pressure. Our data suggest that the mechanism of the cannabinoids involves inhibition of the sodium pump, Na+-K+-ATPase, in thick ascending limb cells and, likely, other proximal and distal tubular segments of the kidney nephron.
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Affiliation(s)
- Joseph K Ritter
- Departments of Pharmacology and Toxicology (J.K.R., A.A., Z.D., S.K.D., N.L., P.-L.L.) and Physiology and Biophysics (S.M., V.L.), Virginia Commonwealth University, Richmond, Virginia
| | - Ashfaq Ahmad
- Departments of Pharmacology and Toxicology (J.K.R., A.A., Z.D., S.K.D., N.L., P.-L.L.) and Physiology and Biophysics (S.M., V.L.), Virginia Commonwealth University, Richmond, Virginia
| | - Shobha Mummalaneni
- Departments of Pharmacology and Toxicology (J.K.R., A.A., Z.D., S.K.D., N.L., P.-L.L.) and Physiology and Biophysics (S.M., V.L.), Virginia Commonwealth University, Richmond, Virginia
| | - Zdravka Daneva
- Departments of Pharmacology and Toxicology (J.K.R., A.A., Z.D., S.K.D., N.L., P.-L.L.) and Physiology and Biophysics (S.M., V.L.), Virginia Commonwealth University, Richmond, Virginia
| | - Sara K Dempsey
- Departments of Pharmacology and Toxicology (J.K.R., A.A., Z.D., S.K.D., N.L., P.-L.L.) and Physiology and Biophysics (S.M., V.L.), Virginia Commonwealth University, Richmond, Virginia
| | - Ningjun Li
- Departments of Pharmacology and Toxicology (J.K.R., A.A., Z.D., S.K.D., N.L., P.-L.L.) and Physiology and Biophysics (S.M., V.L.), Virginia Commonwealth University, Richmond, Virginia
| | - Pin-Lan Li
- Departments of Pharmacology and Toxicology (J.K.R., A.A., Z.D., S.K.D., N.L., P.-L.L.) and Physiology and Biophysics (S.M., V.L.), Virginia Commonwealth University, Richmond, Virginia
| | - Vijay Lyall
- Departments of Pharmacology and Toxicology (J.K.R., A.A., Z.D., S.K.D., N.L., P.-L.L.) and Physiology and Biophysics (S.M., V.L.), Virginia Commonwealth University, Richmond, Virginia
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Grist JT, Riemer F, Hansen ESS, Tougaard RS, McLean MA, Kaggie J, Bøgh N, Graves MJ, Gallagher FA, Laustsen C. Visualization of sodium dynamics in the kidney by magnetic resonance imaging in a multi-site study. Kidney Int 2020; 98:1174-1178. [PMID: 32585166 PMCID: PMC7652549 DOI: 10.1016/j.kint.2020.04.056] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 04/24/2020] [Accepted: 04/30/2020] [Indexed: 12/23/2022]
Abstract
Sodium magnetic resonance imaging (MRI) is a powerful, non-invasive technique to assess sodium distribution within the kidney. Here we undertook pre-clinical and clinical studies to quantify the corticomedullary sodium gradient in healthy individuals and in a porcine model of diuresis. The results demonstrated that sodium MRI could detect spatial differences in sodium biodistribution across the kidney. The sodium gradient of the kidney changed significantly after diuresis in the pig model and was independent of blood electrolyte measurements. Thus, rapid sodium MRI can be used to dynamically quantify sodium biodistribution in the porcine and human kidney.
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Affiliation(s)
- James T Grist
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Frank Riemer
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Esben S S Hansen
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Rasmus S Tougaard
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mary A McLean
- Department of Radiology, University of Cambridge, Cambridge, UK; Cancer Research UK, Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Joshua Kaggie
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Nikolaj Bøgh
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Martin J Graves
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Christoffer Laustsen
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Alwis US, Haddad R, Monaghan TF, Abrams P, Dmochowski R, Bower W, Wein AJ, Roggeman S, Weiss JP, Mourad S, Delanghe J, Everaert K. Impact of food and drinks on urine production: A systematic review. Int J Clin Pract 2020; 74:e13539. [PMID: 32441853 DOI: 10.1111/ijcp.13539] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/14/2020] [Indexed: 12/09/2022] Open
Abstract
CONTEXT The impact of food and drinks on body fluid metabolism is of direct clinical relevance but current evidence remains fragmented. AIM Synthesise current evidence on the role of food and drinks in urine production. METHODS Systematic review as per PRISMA guidelines using MEDLINE and EMBASE databases (completed October 2019). Studies reporting on the effect of food, food constituents, and drinks on urine production were included. Two authors performed an independent extraction of relevant articles using predetermined data sets and completed quality-of-study indicators. RESULTS A total of 49 studies were included, of which 21 enroled human subjects, and 28 were clinically relevant animal studies (all of which utilised rodent models). The included studies were determined to be of variable quality. High dietary sodium, as well as wine, spirits, high-caffeine coffee, and caffeinated energy drinks, increased urine production in human studies. Decreased urine production was associated with low dietary sodium and consumption of milk, orange juice, and high-salt/high-sugar drinks. In animal models, a variety of fruits, vegetables, herbs, spices, and honey were associated with increased urine production. CONCLUSION Current evidence suggests that although several types of food and drinks may impact body fluid metabolism, the quality of the data is variable. Urine production appears to be influenced by multiple factors including composition (ie, moisture, macronutrients, and electrolytes), metabolite load, and the presence of specific diuresis-promoting substances (eg, caffeine, alcohol) and other bioactive phytochemicals. Future research is needed to support current evidence and the physiologic mechanisms underlying these findings.
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Affiliation(s)
- Upeksha S Alwis
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
| | - Rebecca Haddad
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
- Sorbonne Université, GRC 001, GREEN Groupe de recherche en Neuro-Urologie, AP-HP, Hôpital Rothschild, Paris, France
| | - Thomas F Monaghan
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Paul Abrams
- Department of Urology, Bristol Urological Institute, Bristol, UK
| | - Roger Dmochowski
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wendy Bower
- Department of Medicine and Community Care, University of Melbourne, Melbourne, Australia
| | - Alan J Wein
- Department of Urology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Saskia Roggeman
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Sherif Mourad
- Department of Urology, Ain Shams University, Cairo, Egypt
| | - Joris Delanghe
- Department of Diagnostic Sciences, Ghent University Hospital, Ghent, Belgium
| | - Karel Everaert
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
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Balsa IM, Culp WTN, Palm CA, Hopper K, Hardy BT, Ben-Aderet DG, Mayhew PD, Drobatz KJ. Factors associated with postobstructive diuresis following decompressive surgery with placement of ureteral stents or subcutaneous ureteral bypass systems for treatment of ureteral obstruction in cats: 37 cases (2010-2014). J Am Vet Med Assoc 2020; 254:944-952. [PMID: 30938617 DOI: 10.2460/javma.254.8.944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe postobstructive diuresis (POD) in cats undergoing surgical placement of ureteral stents or subcutaneous ureteral bypass systems for treatment of ureteral obstruction in cats and to identify factors associated with duration and maximum severity of POD. DESIGN Retrospective case series. ANIMALS 37 client-owned cats with ureteral obstruction treated between August 2010 and December 2014. PROCEDURES Medical records were reviewed, and data extracted included signalment, history, results from physical examinations and clinical laboratory analyses, treatment, urine output, and outcome. Data were evaluated to identify factors associated with POD duration and maximum severity, alone or in combination. RESULTS Serum concentrations of creatinine, potassium, phosphorus, and BUN before surgery positively correlated with duration and maximum severity of POD. Absolute changes in serum concentrations of creatinine, potassium, and BUN from before surgery to after surgery positively correlated with POD duration. Cats with anuria before surgery had longer POD than did other cats; however, there was no difference in POD duration or maximum severity with unilateral versus bilateral ureteral obstruction. Thirty-four of 37 (92%) cats survived to hospital discharge, which was not associated with whether ureteral obstruction was unilateral or bilateral. Azotemia resolved in 17 of the 34 (50%) cats that survived to hospital discharge. CONCLUSIONS AND CLINICAL RELEVANCE Results of the present study indicated that several factors were associated with POD duration and maximum severity, alone or in combination, and that with intensive management of fluid and electrolyte derangements, regardless of the extent of the original azotemia, a high percentage of cats survived to hospital discharge.
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Barbanti P, Aurilia C, Egeo G, Fofi L, Guadagni F, Ferroni P. Dopaminergic symptoms in migraine: A cross-sectional study on 1148 consecutive headache center-based patients. Cephalalgia 2020; 40:1168-1176. [PMID: 32484361 DOI: 10.1177/0333102420929023] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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] [Indexed: 12/31/2022]
Abstract
BACKGROUND Dopaminergic symptoms may be extremely pronounced in some migraine patients during the attack, representing a major source of disability. OBJECTIVES We aimed to carefully characterize the clinical picture of migraine patients with dopaminergic symptoms in a large patients' population as a putative migraine endophenotype, allowing more precise disease management, treatment and outcome prediction. METHODS We screened 1148 consecutive tertiary care episodic and chronic migraine patients with face-to-face interviews collecting thorough data on lifestyle, socio-demographic factors, and clinical migraine features. RESULTS We identified 374 patients with migraine with dopaminergic symptoms (32.6%). The most frequent dopaminergic symptom was yawning followed by somnolence, nausea, vomiting, fatigue, mood changes and diuresis. Migraine patients with dopaminergic symptoms had longer attack duration (OR: 1.82; 95% CI: 1.41-2.36, p < 0.0001), more frequent osmophobia (OR: 2.01; 95% CI: 1.50-2.69, p < 0.0001), allodynia (OR: 1.43; 95% CI: 1.10-1.85, p = 0.0071) and unilateral cranial autonomic symptoms (OR: 1.31; 95% CI: 1.01-1.68, p = 0.045), but used less preventative treatments (OR: 0.74; 95% CI: 0.57-0.98, p = 0.033) than patients without dopaminergic symptoms. CONCLUSIONS Migraine patients with dopaminergic symptoms are characterized by a full-blown, more disabling migraine. Dopaminergic system modulation should be carefully considered in individuals with migraine with dopaminergic symptoms for both acute and preventative treatments in future ad hoc designed studies.
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Affiliation(s)
- Piero Barbanti
- Headache and Pain Unit, 46729IRCCS San Raffaele Pisana, Rome, Italy
- Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy
| | - Cinzia Aurilia
- Headache and Pain Unit, 46729IRCCS San Raffaele Pisana, Rome, Italy
| | - Gabriella Egeo
- Headache and Pain Unit, 46729IRCCS San Raffaele Pisana, Rome, Italy
| | - Luisa Fofi
- Headache and Pain Unit, 46729IRCCS San Raffaele Pisana, Rome, Italy
| | - Fiorella Guadagni
- Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy
- InterInstitutional Multidisciplinary Biobank (BioBIM), 46729IRCCS San Raffaele Pisana, Rome, Italy
| | - Patrizia Ferroni
- Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy
- InterInstitutional Multidisciplinary Biobank (BioBIM), 46729IRCCS San Raffaele Pisana, Rome, Italy
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42
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Affiliation(s)
- Amos Lal
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN USA
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43
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Abstract
This article reports the case of a 42-year-old male patient, who sustained a gluteal compartment syndrome after drug-induced immobilization with subsequent rhabdomyolysis and sciatic nerve palsy. Unlike compartment syndrome of the forearm or lower leg, this is a rare condition. After immediate surgical decompression and installation of negative pressure wound treatment, hemofiltration in acute renal failure could be averted using forced diuresis. The sensorimotor function of the lower extremity improved already after the first treatment and secondary wound closure was possible after 1 week. The patient was discharged 11 days after admission with complete recovery of sensorimotor and renal functions.
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Affiliation(s)
- J Gleich
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, Campus Innenstadt und Großhadern, Marchioninistraße 17, 81377, München, Deutschland.
| | - J Fürmetz
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, Campus Innenstadt und Großhadern, Marchioninistraße 17, 81377, München, Deutschland
| | - C Kamla
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, München, Deutschland
| | - V Pedersen
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, Campus Innenstadt und Großhadern, Marchioninistraße 17, 81377, München, Deutschland
| | - W Böcker
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, Campus Innenstadt und Großhadern, Marchioninistraße 17, 81377, München, Deutschland
| | - A M Keppler
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, Campus Innenstadt und Großhadern, Marchioninistraße 17, 81377, München, Deutschland
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Heyman SN, Bursztyn M, Szalat A, Muszkat M, Abassi Z. Fasting-Induced Natriuresis and SGLT: A New Hypothesis for an Old Enigma. Front Endocrinol (Lausanne) 2020; 11:217. [PMID: 32457696 PMCID: PMC7221140 DOI: 10.3389/fendo.2020.00217] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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] [Received: 12/02/2019] [Accepted: 03/26/2020] [Indexed: 11/17/2022] Open
Abstract
For years, physicians and scientists were enthralled by the enigmatic phenomenon of fasting-associated diuresis and natriuresis and their reversal by feeding. This abrupt response is most prominent in obese and hypertensive individuals, and if repeated once and again may lead to the attenuation of blood pressure and improve insulin sensitivity. The mechanisms involved in early natriuresis and diuresis remain speculative as the renin-angiotensin-aldosterone axis and natriuretic peptides are initially suppressed. Based on gained insight using sodium-glucose transporter 2 (SGLT-2) inhibitors, herein, we propose a role for enhanced post-prandial proximal tubular sodium uptake, mediated by increased glucose-sodium co-transport, as daily filtered glucose increases, and reduced sodium uptake when glucose reabsorption diminishes. This phenomenon might be more pronounced in diabetics due to prolonged post-prandial hyperglycemia and intense SGLT-driven transport. Our hypothesis may also provide a physiologic basis for fasting-related reduced blood pressure in hypertension. This theory deserves challenging by experimental and clinical studies.
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Affiliation(s)
- Samuel N. Heyman
- Department of Medicine, Hadassah Hebrew University Hospital, Mt. Scopus, Jerusalem, Israel
- *Correspondence: Samuel N. Heyman
| | - Michael Bursztyn
- Department of Medicine, Hadassah Hebrew University Hospital, Mt. Scopus, Jerusalem, Israel
| | - Auryan Szalat
- Department of Medicine, Hadassah Hebrew University Hospital, Mt. Scopus, Jerusalem, Israel
| | - Mordechai Muszkat
- Department of Medicine, Hadassah Hebrew University Hospital, Mt. Scopus, Jerusalem, Israel
| | - Zaid Abassi
- Department of Physiology and Biophysics, Ruth and Bruce Rappaport Faculty of Medicine, Technion-IIT, Haifa, Israel
- Department of Laboratory Medicine, Rambam Health Care Campus, Haifa, Israel
- Zaid Abassi
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Arbel Y, Ben-Assa E, Puzhevsky D, Litmanowicz B, Galli N, Chorin E, Halkin A, Sadeh B, Konigstein M, Bassat OKB, Steinvil A, Bazan S, Banai S, Finkelstein A. Forced diuresis with matched hydration during transcatheter aortic valve implantation for Reducing Acute Kidney Injury: a randomized, sham-controlled study (REDUCE-AKI). Eur Heart J 2019. [PMID: 31120108 DOI: 10.1093/eurheartj/ehz1343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
AIMS Acute kidney injury (AKI) is a common complication following transcatheter aortic valve implantation (TAVI) and is associated with increased risk for short- and long-term mortality. In patients undergoing percutaneous coronary intervention (PCI), forced diuresis with matched hydration has been shown to reduce the incidence of AKI by ∼50%. The aim of the present study was to evaluate whether forced diuresis with matched intravenous hydration reduces AKI in patients undergoing TAVI. METHODS AND RESULTS Reducing Acute Kidney Injury (REDUCE-AKI) was a single-centre, prospective, randomized, double-blind sham-controlled clinical trial, designed to examine the effect of an automated matched saline infusion with urine output for the prevention of AKI in patients undergoing TAVI. A total of 136 TAVI patients were randomized, 68 in each group. Mean age was 83.9 ± 5 years and 41.2% were males. There were no differences in baseline characteristics between the two groups. The rate of AKI was not statistically different between the groups (25% in the active group vs. 19.1% in the sham group, P = 0.408). There was a significant increase in long-term mortality in the active group (27.9% vs. 13. 2% HR 3.744, 95% CI 1.51-9.28; P = 0.004). The study was terminated prematurely by the Data Safety Monitoring Board for futility and a possible signal of harm. CONCLUSIONS Unlike in PCI, forced diuresis with matched hydration does not prevent AKI in patients undergoing TAVI, and might be associated with increased long-term mortality. Future studies should focus on understanding the mechanisms behind these findings. CLINICALTRIALS.GOV REGISTRATION NCT01866800, 30 April 2013.
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Affiliation(s)
- Yaron Arbel
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Eyal Ben-Assa
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Daniela Puzhevsky
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Batia Litmanowicz
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Naama Galli
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Ehud Chorin
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Amir Halkin
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Ben Sadeh
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Maayan Konigstein
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Orit Kliuk-Ben Bassat
- Department of Nephrology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Arie Steinvil
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Samuel Bazan
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Shmuel Banai
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
| | - Ariel Finkelstein
- Department of Cardiology, Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Tel-Aviv, Israel
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46
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Hervé F, Delabie L, Mylle T, Weiss J, Bower W, Everaert K. Effect of diuresis on bother related to lower urinary tract symptoms. Int J Clin Pract 2019; 73:e13299. [PMID: 30489004 DOI: 10.1111/ijcp.13299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/19/2018] [Accepted: 11/24/2018] [Indexed: 12/01/2022] Open
Abstract
AIMS To explore and objectify the impact of diuresis on the presence of daytime and nighttime LUTS, and associated bother. METHODS Participants (healthy volunteers and patients referred to our hospital for a urologic consultation) were asked to complete a 72-hour bladder diary and also had to fill in a Likert scale (0: no bother; 10: maximal bother) to evaluate the LUTS-associated bother during daytime and nighttime. Three groups were defined: no/mild bother (Bother ≤2), moderate bother (3 ≤ Bother ≤ 6), and strong bother (Bother ≥7). Questionnaires in order to assess LUTS (ICIQ MLUTS and ICIQ FLUTS), quality of life (SF-36, NqOL), and quality of sleep (PSQI) were completed. RESULTS During daytime and nighttime, the study of participants with a strong bother associated with LUTS revealed a statistically significant higher fluid intake than those without bother (1640 mL vs 1800 mL during daytime, P = 0.007). Also, those with higher diuresis rate had more bother related to LUTS than the others (71.3 mL/h in group 1 vs 87.3 mL/h in group 3 (P < 0.001) during daytime). As might be expected, lower urinary tract such as bladder, for example, studied through maximal voided volume does play a role. The lower the maximal voided volume is, the more bother the participants described. CONCLUSIONS This study pointed out the implication of diuresis in bother related to LUTS. Our findings showed that there was an increase in bother by 1 when diuresis increased by 100 mL/h.
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Affiliation(s)
- François Hervé
- Urology Department, Ghent University Hospital, Gent, Belgium
| | | | - Toon Mylle
- Ghent University Hospital, Ghent, Belgium
| | - Jeff Weiss
- Department of Urology, SUNY Downstate College of Medicine, New York City, New York
| | - Wendy Bower
- Department of Medicine and Community Care, Faculty of Medicine, Dentistry and Health Science, Melbourne Health, University of Melbourne, Melbourne, Vic., Australia
| | - Karel Everaert
- Urology Department, Ghent University Hospital, Gent, Belgium
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He P, Chen W, Qiu XX, Xi YB, Guan H, Xia J. A Rare High-Grade Glioma with a Histone H3 K27M Mutation in the Hypothalamus of an Adult Patient. World Neurosurg 2019; 128:527-531. [PMID: 31048046 DOI: 10.1016/j.wneu.2019.04.172] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 02/06/2019] [Revised: 04/19/2019] [Accepted: 04/20/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diffuse midline glioma H3 K27M mutant is a new tumor entity described in the revised 2016 World Health Organization classification. It is most frequently observed in children and develops in midline structures, including the brainstem, thalamus, and spine. We describe a rare diffuse midline glioma with an H3 K27M mutation arising in the hypothalamus of an adult. CASE DESCRIPTION A 27-year-old woman was admitted to our department complaining of amenorrhea, polydipsia, and diuresis for the previous 3 months, and headache and lethargy for approximately 10 days. Computed tomography scan showed an oval isodense solid mass extending from the pituitary toward the suprasellar cistern. A gadolinium-enhanced magnetic resonance imaging (MRI) showed a strongly heterogeneous enhanced solid lesion and nonenhanced cystic lesion. The patient underwent surgery and chemoradiotherapy with temozolomide. Histologic and immunohistochemical analyses revealed H3 K27M-mutant diffuse midline glioma. The patient underwent another resection for a recurrent tumor 5 months after the first surgery. Three months after the second operation, the patient relapsed, with MRI revealing spinal cord and meningeal metastases; she died shortly afterward. CONCLUSIONS Diffuse midline glioma with an H3 K27M mutation occurring in the hypothalamus of an adult is rare but should be considered in differential diagnoses. Because histone H3 K27M mutations are associated with aggressive clinical behavior and poor prognosis, molecular analyses should be used to determine the clinical and histopathologic features of such tumors. This will contribute to developing targeted drugs and gene therapy going forward.
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Affiliation(s)
- Pin He
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, China; Shenzhen Second People's Hospital, Shenzhen, China
| | - Wei Chen
- Department of Radiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China; Department of Radiology, Pingshan District People's Hospital, Hubei University of Medicine, Shenzhen, Guangdong, China
| | - Xi Xiong Qiu
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, China; Shenzhen Second People's Hospital, Shenzhen, China
| | - Yi Bin Xi
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - Hong Guan
- Department of Pathology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, China; Shenzhen Second People's Hospital, Shenzhen, China
| | - Jun Xia
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, China; Shenzhen Second People's Hospital, Shenzhen, China.
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Tartaglione G, Townsend DM, Bassi PF, Delgado Bolton RC, Giammarile F, Rubello D. Diuresis renography in equivocal urinary tract obstruction. A historical perspective. Biomed Pharmacother 2019; 116:108981. [PMID: 31136948 PMCID: PMC7104806 DOI: 10.1016/j.biopha.2019.108981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/13/2019] [Indexed: 11/05/2022] Open
Abstract
Obstructive nephropathy may be suspected for the incidental detection of dilated renal collecting system at ultrasonography, CT or MRI. A dilated renal collecting dilation (calyco-pelvis or ureteres) might be related 1) to an anatomical variant of the excretory tract without obstruction and, therefore, without consequence on renal function, or 2) to an obstruction/stenosis of the urinary tract that may cause a damage of kidney function. In the present review we annotated the various methods proposed for Diuresis Renography (DR) used with the purpose to make early diagnosis of obstructive nephropathy. First, the F + 20 method (i.e. furosemide 40 mg injected IV 20 min after radiotracer injection) in seated position (sp) (F + 20(sp)) was reported to distinguish between an anatomical dilation from an anatomical obstruction of the urinary tract. It was also suggested to perform DR with the patient in supine or prone position in order to minimize possible furosemide-induced hypotension and patient's movements during exam. Other DR methods were proposed administering furosemide EV to the patient in supine position at different times: F-15 (furosemide injected IV 15 min prior to radiotracer), F0 (furosemide injected contemporary to radiotracer), F + 20 (furosemide injected 20 min after the radiotracer), F-20 and Well Tempered (other than F + 20 this modality requires saline infusion for all duration of the test plus bladder catheterization). Unfortunately, in all the above described DR methods with patientin supine position, despite the furosemide administration, a sensitive slowing down of urinary outflow could be related to the supine position itself of the patient during the examination. Lastly, there are reports of a new DR method based on furosemide IV injection 10 min after radiotracer with the patient in seated position, F+10(sp). This method allows a better timing between hydration (400 mL of water) at 5 min, and the injection of relatively low dose of furosemide (20 mg), thus avoiding side effects as diuretic-induced hypotension and favouring bladder filling, therefore ameliorating patient compliance and reducing equivocal responses.
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Affiliation(s)
| | - Danyelle M Townsend
- Department of Drug Discovery & Pharmaceutical Sciences, Medical University of South Carolina, USA
| | | | | | - Francesco Giammarile
- International Atomic Energy Agency (IAEA), Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria
| | - Domenico Rubello
- Department of Nuclear Medicine, Radiology, Neuroradiology, and Clinical Pathology, Santa Maria della Misericordia Hospital, Rovigo, Italy.
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Ietto G, Raveglia V, Zani E, Iovino D, Parise C, Soldini G, Delfrate NW, Latham L, Saredi G, Benedetti F, Tozzi M, Carcano G. Pretransplant Nephrectomy for Large Polycystic Kidneys in ADPKD (Autosomal Dominant Polycystic Kidney Disease) Patients: Is Peritoneal Dialysis Recovery Possible after Surgery? Biomed Res Int 2019; 2019:7343182. [PMID: 31019972 PMCID: PMC6452549 DOI: 10.1155/2019/7343182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/06/2018] [Accepted: 12/05/2018] [Indexed: 11/22/2022]
Abstract
The choice of modality for renal replacement therapy in patients with ADPKD varies, often based on patient choice, physician-related factors, and resource availability. For a long time peritoneal dialysis (PD) was considered as relative contraindication due to the possible limited intraperitoneal space. In recent years, some studies suggested it is a valid option also in patients with ADPKD to be considered as a first line treatment in potentially fit patients. Diuresis volume lowering and potential permanent damage of peritoneal integrity, both leading to a necessary switch to haemodialysis, are the two most important dangers after nephrectomy, especially if bilateral, in PD patients. We performed a retrospective analysis of patient underwent native polycystic kidney nephrectomy in order to state the possibility to recover peritoneal dialysis after surgery.
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Affiliation(s)
- Giuseppe Ietto
- General, Emergency and Transplant Surgery Department, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | - Veronica Raveglia
- General, Emergency and Transplant Surgery Department, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | - Elia Zani
- General, Emergency and Transplant Surgery Department, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | - Domenico Iovino
- General, Emergency and Transplant Surgery Department, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | - Cristiano Parise
- General, Emergency and Transplant Surgery Department, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | - Gabriele Soldini
- General, Emergency and Transplant Surgery Department, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | - Nicholas Walter Delfrate
- General, Emergency and Transplant Surgery Department, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | - Lorenzo Latham
- General, Emergency and Transplant Surgery Department, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | - Giovanni Saredi
- Urology Department, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Fabio Benedetti
- General, Emergency and Transplant Surgery Department, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | - Matteo Tozzi
- General, Emergency and Transplant Surgery Department, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | - Giulio Carcano
- General, Emergency and Transplant Surgery Department, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
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Friedman S, Zac L, Cattan A, Ovadia D, Lebel DE, Matot I. Hyperchloremia and Diuresis in Children Undergoing Scoliosis Surgery: A Retrospective Cohort Study. Isr Med Assoc J 2019; 21:94-99. [PMID: 30772959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Hyperchloremia is frequent in adult surgical patients and is associated with renal dysfunction. Studies in surgical pediatric patients are lacking. OBJECTIVES To identify both the incidence of postoperative hyperchloremia in children undergoing surgery for idiopathic and non-idiopathic scoliosis, and the association of postoperative hyperchloremia with intraoperative fluid management and postoperative diuresis. METHODS The records of 74 children and adolescents who underwent elective scoliosis surgery were retrospectively evaluated. The primary endpoint was the incidence of serum chloride level ≥ 110 mEq/L at the end of surgery and 12 hours postoperatively. Secondary endpoints were the type and volume of administered fluids, 12 hours postoperative diuresis, and the incidence of postoperative oliguria. RESULTS Hyperchloremia occurred in 55% of the patients at the end of surgery and in 52% 12 hours postoperatively. Hyperchloremic patients received larger intraoperative volume of 0.9% NaCl diluted cell-saver blood and 10% HAES than did normochloremic patients [median (interquartile range) 6.8 (2.5-11.0) ml/kg vs. 0 (0-7.3), P = 0.003 and 10.0 (0-12.8) vs. 4.4 (0-9.8), P = 0.02, respectively]. Additionally, when compared with normochloremic patients, diuresis during the first 12 hours postoperatively was lower in hyperchloremic patients. Postoperative oliguria (urine output < 0.5 ml/kg/hr for 12 hours) was diagnosed in 7 children (9%), of whom 6 were hyperchloremic at the end of surgery. CONCLUSIONS Early postoperative hyperchloremia is common in children undergoing scoliosis repair surgery and may be attributed to the administration of 0.9% NaCl diluted cell-saver blood and 10% HAES. Postoperative hyperchloremia might be associated with postoperative oliguria.
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Affiliation(s)
- Shirley Friedman
- Department of Pediatric Intensive Care, Dana Dwek Childrens Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Lilach Zac
- Division of Anesthesiology, Critical Care and Pain Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Anat Cattan
- Division of Pediatric Orthopedics, Dana Dwek Childrens Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dror Ovadia
- Division of Pediatric Orthopedics, Dana Dwek Childrens Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - David E Lebel
- Division of Pediatric Orthopedics, Dana Dwek Childrens Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Idit Matot
- Division of Anesthesiology, Critical Care and Pain Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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