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One hundred consecutive patients admitted to the hospital with a diagnosis of exacerbation of multiple sclerosis were evaluated for an infectious process. All patients received a complete blood count, urinalysis, urine culture with susceptibility studies, blood cultures, and a chest x-ray at the time of admission. A control group of 55 patients carrying the diagnosis of multiple sclerosis but without symptoms of neurologic decline were also studied. Thirty-five percent of patients experiencing exacerbation of their disease were identified as having a significant bacterial infection compared with 11% in the control group with quiescent disease. These results were significant with a P value of < 0.001. When presumptive viral and bacterial infections diagnosed before admission were included, almost 50% of patients could have had an exacerbation of their disease in response to an infectious process. Bacterial infection might well play a role in precipitating relapse in multiple sclerosis as well as influencing treatment.

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Although the mechanical and positional stresses of pregnancy are the primary inciting factors contributing to lumbosacral pain accompanying gestation, in approximately 1:10,000 cases a herniated disk (HNP) can be identified as the proximal cause of pain. Six patients are described, all of whom without antecedent history of pain presented with acute, disabling, gestational lumbosacral, and sciatic radiculopathy. Their ages ranged from 29 to 36, their parity from 0 to 1, and their gestational age at onset of symptoms from 6 weeks to 32 weeks. Each by magnetic resonance imaging (MRI) was identified as having an HNP, 2 at the L4-5 level and 4 at the L5-S1 level. During pregnancy, an MRI evaluation permits a detailed spinal examination without the ionizing effects of x-ray and its acknowledged biological risk to the developing fetus. This potential for an immediate and accurate diagnosis has significant implications for the management and subsequent planning of delivery.

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Phosphorus is a well-known modulator of renal 1 alpha-hydroxylase activity. In early and moderate renal failure it is proposed that dietary Pi reduction ameliorates secondary hyperparathyroidism through increased circulating levels of calcitriol (i.e, 1 alpha, 25-dihydroxycholecalciferol). To gain further insight into the mechanisms by which a low-Pi diet ameliorates secondary hyperparathyroidism in advanced renal insufficiency, studies were performed in five dogs before and 6 mo after the induction of uremia by 5/6 nephrectomy. Glomerular filtration rate decreased from 69.0 +/- 2.3 to 10.5 +/- 0.5 ml/min, immunoreactive parathyroid hormone (irPTH) increased from 66.0 +/- 8.8 to 321.0 +/- 46 pg/ml, and calcitriol decreased from 39.0 +/- 10.4 to 27.0 +/- 6.2 pg/ml. Thereafter, dietary Pi was decreased gradually every 2 wk from 0.95% to 0.6, 0.45, and 0.3%, respectively. Dietary Ca was reduced from 1.6 to 0.6% to prevent development of hypercalcemia. Ionized Ca (ICa) decreased from 5.4 +/- 0.04 to 5.2 +/- 0.05 mg/dl (P less than 0.02), and plasma Pi decreased from 6.3 +/- 0.7 to 4.7 +/- 0.2 mg/dl (P less than 0.05). Calcitriol remained low (23.3 +/- 4.7 pg/ml). However, irPTH gradually decreased from 321.0 +/- 46.0 to 94.7 +/- 22.9 pg/ml (P less than 0.005). These studies indicate that a decrease in dietary Pi from 0.95 to 0.3% suppressed irPTH by approximately 70%. Reduction of irPTH was observed in the absence of a concomitant increase in levels of ICa or calcitriol. These studies suggest that reduction in dietary Pi in advanced renal insufficiency improves secondary hyperparathyroidism by a mechanism that is independent of the levels of calcitriol or plasma ICa.

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Korean hemorrhagic fever (KHF) is an epidemic viral disease characterized by high fever, hemorrhagic tendency and renal failure, and by hemorrhages of right atrium and renal medulla as well as necrosis of anterior hypophysis. Plasma immunoreactive atrial natriuretic peptide (irANP) levels of 15 patients in the oliguric phase was 94.8 +/- 8.4 pg/ml (mean +/- SEM), 80% higher than of the normal control group (53.0 +/- 4.7 pg/ml; n = 28). In the diuretic phase it declined to 63.7 +/- 5.3 pg/ml (n = 26). Plasma renin activity (PRA) in the oliguric phase was 19.0 +/- 1.3 ng AI/ml/h, and in the diuretic phase 5.3 +/- 0.9 ng AI/ml/h, significantly higher than the control value (2.5 +/- 0.1 ng AI/ml/h). Elevations of irANP and PRA were not correlated in each group. Also systemic blood pressure as well as heart beats were significantly increased in the oliguric phase. These findings suggest that the increased irANP may have resulted from increased circulatory volume and that the ANP secretory process may not be affected by the disease.

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Isolated rabbit renal papillary collecting tubule cells were used to examine the effects of phosphodiesterase inhibitors on intracellular cyclic AMP and prostaglandin synthesis. Experiments performed on confluent primary tissue cultures demonstrated that bradykinin increases intracellular cyclic AMP by a prostaglandin-dependent mechanism. Phosphodiesterase inhibitors induced a dose-dependent decrease in bradykinin-stimulated prostaglandin synthesis. Fifty percent inhibition occurred with approximately 0.7 mM 3-isobutyl-1-methylxanthine (IBMX). Inhibition was found to be reversible. IBMX did not inhibit bradykinin-induced prostaglandin synthesis as a result of increased intracellular cyclic AMP. The nonmethylxanthine phosphodiesterase inhibitor RO 20-1724 also reduced bradykinin-stimulated prostaglandin synthesis. IBMX inhibited calcium-ionophore-A23187-induced prostaglandin synthesis but did not inhibit arachidonic acid stimulation of prostaglandin synthesis. The data demonstrate that bradykinin increased renal papillary collecting tubule cell cyclic AMP in a prostaglandin-dependent manner. Based on the data presented, phosphodiesterase inhibitors act to decrease arachidonic acid availability for prostaglandin synthesis, independent of changes in cellular cyclic AMP content.

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The antithyroid drugs propylthiouracil and methimazole exert their effects on the thyroid gland by inhibiting thyroid peroxidase. In addition to this effect, these drugs have been reported to inhibit prostaglandin production in both the thyroid gland and the kidney. The purpose of our studies was to evaluate the mechanism of the effects of these drugs on prostaglandin production. Both propylthiouracil and methimazole reversibly inhibited prostaglandin E2 production in both inner medullary slices and isolated renal papillary collecting tubule cells. The inhibition of arachidonic acid-induced increases in PGE2 production indicated that the effects of methimazole and propylthiouracil were on the enzyme complex prostaglandin H synthase, and not on the phospholipase mechanisms responsible for the release of arachidonic acid from tissue phospholipids. Propylthiouracil inhibited both arachidonic acid and hydrogen peroxide-dependent binding of 14C-N-[4-(5-nitro-2-furyl)-2-thiazolyl]formamide to protein, indicating that the effect of propylthiouracil is on the hydroperoxidase and not on the cyclooxygenase component of prostaglandin H synthase. Our data also indicate the potential of the antithyroid drugs for inhibition of metabolism of drugs and xenobiotics by prostaglandin H synthase. Metabolism of both methimazole and propylthiouracil by the hydroperoxidase component of prostaglandin H synthase was demonstrated. It is proposed that this interaction with the hydroperoxidase component of prostaglandin H synthase is at least in part the mechanism by which propylthiouracil and methimazole inhibit prostaglandin production. The inhibition of tissue peroxidase provides these agents with the capability to prevent the peroxidatic metabolism of drugs and xenobiotics.

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Renal cortical metabolism of drugs and xenobiotics was assessed with microsomes prepared from normal, contralateral and 4-day postobstructive hydronephrotic kidneys. Microsomal mixed-function oxidase and prostaglandin H synthase systems were determined in control and 3-methylcholanthrene-treated rabbits. Cytochrome P450 content and biphenyl-4-hydroxylase activity but not cytochrome c reductase activity were reduced in the hydronephrotic kidney. 3-Methylcholanthrene treatment increased cytochrome P450 content and biphenyl-4-hydroxylase and acetanilide-4-hydroxylase activities in normal, contralateral, and hydronephrotic kidneys. However, even after 3-methylcholanthrene treatment, hydronephrotic kidney cytochrome P450 content and acetanilide-4-hydroxylase activity were not more than 20% of the corresponding normal kidney values. Prostaglandin H synthase metabolism of benzidine was observed in the hydronephrotic kidney but was at the limit of detection in normal or contralateral kidneys with or without 3-methylcholanthrene treatment. Characteristics of benzidine metabolism were consistent with the hydroperoxidase rather than the fatty acid cyclooxygenase activity of prostaglandin H synthase. Therefore, hydronephrosis alters the drug and xenobiotic metabolic profile of the renal cortex from a primarily mixed-function oxidase-dependent system to one with the potential for metabolism by the hydroperoxide component of prostaglandin H synthase.

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Bradykinin-stimulated increases in renal prostaglandin (PG) synthesis are thought to result in subsequent increases in cAMP content. This study assesses the relationship between bradykinin-stimulated increases in PGE2 and cAMP syntheses in renal inner medullary slices. Bradykinin-mediated increases in cAMP (2 min) preceded those in PGE2 (5 min) synthesis. Forskolin, an activator of adenylate cyclase, increased cAMP, while 2',5'-dideoxyadenosine, an adenylate cyclase inhibitor, reduced cAMP. However, neither agent altered bradykinin-stimulated PGE2 synthesis. Aspirin decreased basal and abolished bradykinin-stimulated PGE2 production, but did not alter bradykinin-induced increases in cAMP content. Maximal stimulatory concentrations of 1-methyl-3-isobutylxanthine, a cyclic nucleotide phosphodiesterase inhibitor, and bradykinin were additive in their capacity to increase inner medullary cAMP content. These results suggest that 1-methyl-3-isobutylxanthine and bradykinin increase cAMP by separate mechanisms and that bradykinin increases inner medullary cAMP by a direct effect on the production of that cyclic nucleotide. Bradykinin-mediated increases in cAMP and PGE2 syntheses by renal medullary slices are independent effects of this renally acting hormone.

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Certain carcinogens are thought to induce renal and bladder cancer following metabolic activation. We propose a model system for this activation and provide supporting experimental evidence. This model proposes that renal and bladder carcinogens' entry into the urinary tract is facilitated, that carcinogens are activated by the prostaglandin hydroperoxidase activity of prostaglandin endoperoxide synthetase (PES), and that activation results in covalent binding to nucleic acids which can initiate carcinogenesis. Benzidine and the 5-nitrofuran HMN were shown to inhibit uptake of organic anions and cations, respectively. Carcinogen binding to DNA was dependent upon specific unsaturated fatty acid substrates and prevented by specific inhibitors of PES, i.e., aspirin. Activation with organic peroxides or H(2)O(2) was inhibited by antioxidants but not aspirin. Horseradish peroxidase (HRP) metabolized benzidine but not ANFT. Acetaminophen and the 5-nitrofurans ANFT and HMN prevented PES (14)C-benzidine metabolism. However, only acetaminophen inhibited HRP metabolism of benzidine. The only aerobic metabolism we have observed of 5-nitrofurans is PES-catalyzed. Aspirin (0.5% in the diet) inhibited rat bladder hyperplastic lesions induced by feeding 0.1% or 0.2% FANFT for 6 or 12 weeks. Aspirin reduced bladder prostaglandin synthesis and PES metabolism of FANFT. After one year of an ongoing long-term study, gross examination reveals bladder tumors in 85% of the rats fed 0.2% FANFT and in only 37% of the rats fed FANFT plus 0.5% aspirin.

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The effect of in vivo and in vitro aspirin treatment on renal inner medullary prostaglandin hydroperoxidase-catalyzed metabolism of acetaminophen and benzidine was examined. Metabolism was assessed by the binding of [3H]acetaminophen and [14C]benzidine to TCA-precipitable material. Microsomes were prepared from control or aspirin-treated rabbits. Aspirin, whether administered in vivo (15 mg/kg i.v.) or added in vitro (2 mM), had no effect on peroxide-initiated metabolism. By contrast, arachidonic acid-initiated metabolism was completely prevented by both in vivo and in vitro aspirin. Salicylate did not inhibit either arachidonic acid- or peroxide-dependent metabolism. The antioxidant glutathione (1 mM) completely inhibited both peroxide- and arachidonic acid-initiated metabolism. Aspirin treatment completely inhibited metabolism of arachidonic acid by medullary microsomes. Thus aspirin does not inhibit the hydroperoxidase component of prostaglandin endoperoxide synthetase, and co-oxidation of acetaminophen and benzidine may proceed in the presence of aspirin. Co-oxidation may be involved in the genesis of the nephrotoxicity of mixed analgesic abuse.

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The relationship between bradykinin-mediated prostaglandin (PG)E2 and cyclic GMP syntheses was investigated using rabbit renal inner medullary slices. Media PGE2 and slice cyclic GMP content were determined by specific radioimmunoassays. Effects of the time of incubation, the cyclic nucleotide phosphodiesterase inhibitor 1-methyl-3-isobutylxanthine, the prostaglandin synthesis inhibitor aspirin and calcium exclusion were examined. Maximal bradykinin-mediated increases in cyclic GMP preceded increases in PGE2 synthesis. 1-Methyl-3-isobutylxanthine increased basal and bradykinin-mediated cyclic GMP content 6- to 10-fold, but reduced basal and bradykinin-mediated PGE2 synthesis. 1-Methyl-3-isobutylxanthine did not alter arachidonic acid-mediated PGE2 synthesis and did not uncover an arachidonic acid-dependent increase in the cyclic GMP content. Aspirin completely inhibited basal, bradykinin- and arachidonic acid-mediated PGE2 synthesis but did not alter basal or bradykinin-dependent cyclic GMP production. Neither exogenous cyclic GMP nor dibutyryl cyclic GMP altered basal or bradykinin-mediated increases in PGE2 synthesis. Exclusion of calcium from the media resulted in reduced basal synthesis of both PGE2 and cyclic GMP and prevented the increases caused by bradykinin. Arachidonic acid increases in PGE2 were not altered by calcium exclusion. The results indicate that bradykinin-dependent renal medullary slice synthesis of cyclic GMP and PGE2 are not dependent upon one another. However, they both require calcium. Some of the physiological effects of bradykinin on renal function may be mediated by cyclic GMP and others by PGs.

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The effects of solute concentration on the bradykinin-mediated increase in inner medullary slice prostaglandin E2 (PGE2) synthesis were investigated. PG content was determined by specific RIA. Bradykinin stimulation was prevented by the addition of the following solutes to Krebs buffer: 1.0 M urea, 0.5 or 1.0 M NaCl, 0.5 or 1.0 M mannitol, 1.0 M urea plus 0.5 M NaCl, or 1.0 M mannitol plus 0.5 M NaCl. By contrast, basal PGE2 synthesis was increased by 1.0 M mannitol or by 1.0 M mannitol plus 0.5 M NaCl, but decreased by 1.0 M urea. Urea elicited a concentration-dependent, reversible inhibition of bradykinin stimulation, with 0.01 M urea being the lowest effective concentration. By contrast, basal PGE2 synthesis was only reduced at a urea concentration greater than 0.6 M. Arachidonic acid-mediated increases in both PGE2 and PGF2 alpha synthesis were not prevented by 1.0 M urea. The latter suggests that neither PG endoperoxide synthetase nor PG endoperoxide E isomerase are inhibited by urea. The data indicate that different hypertonic solutions have different effects on basal PG production, but all inhibit bradykinin stimulation.

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Effects of phosphodiesterase inhibitors DL-4-(3-butoxy-4-methoxybenzyl)-2-imidazolidinone (Ro-20) and 1-methyl-3-isobutylxanthine (MIX) on prostaglandin E2 (PGE2) synthesis were examined using rabbit renal inner medullary slices incubated in Krebs' buffer with or without 1 mM RO-20 or 2 mM MIX. Basal and bradykinin-mediated PGE2 synthesis were inhibited in a dose-dependent, reversible manner by both RO-20 and MIX. Arachidonic acid-mediated increases in PGE2 synthesis were not inhibited. By contrast, 1 mM aspirin completely inhibited PGE2 synthesis. Phosphodiesterase inhibitors increased slice cyclic AMP content more than 6-fold. However, this elevation in tissue cyclic AMP content did not appear to be the cause of decreased PGE2 synthesis. Exogenous 3 mM cyclic AMP and 3 mM dibutyryl cyclic AMP did not alter PGE2 synthesis. 2',5'-Dideoxyadenosine, an inhibitor of adenylate cyclase, prevented RO-20 and MIX-mediated increases in cyclic AMP but had no effect on PGE2 synthesis. Exogenous 3 mM cyclic GMP and dibutyryl cyclic GMP did not alter PGE2 synthesis. Neither RO-20 nor MIX had a direct effect on PG endoperoxide synthetase. These results indicate MIX and RO-20 inhibit renal medullary PGE2 production by limiting the availability of arachidonic acid. These effects of MIX and RO-20 on PGE2 synthesis are not secondary to their effects on cyclic nucleotide phosphodiesterase.

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The effects of aspirin on N-[4-(5-nitro-2-furyl)-2-thiazolyl]-formamide (FANFT) -induced urinary bladder lesions, endogenous bladder prostaglandin E2 synthesis, and the metabolism of FANFT by bladder epithelial microsomes were examined. Rats were fed 0.5% aspirin and/or a diet containing 0.1% or 0.2% FANFT. Bladder lesions were observed with light and scanning electron microscopy, and the prostaglandin E2 content of rat bladder was measured by radioimmunoassay. Metabolism of FANFT was measured by decreased absorbance at 400 nm. Aspirin inhibited the appearance of hyperplastic lesions induced by feeding 0.1% or 0.2% FANFT for 6 or 12 weeks. Aspirin reduced bladder prostaglandin E2 content at 1, 2, 6, and 13 weeks compared to corresponding control values. Rat and rabbit microsomal metabolism of FANFT were dependent upon specific fatty acid substrate and prevented by specific inhibitors (including aspirin) of prostaglandin endoperoxide synthetase. Other inhibitor and substrate specificity studies suggest that FANFT was not metabolized by xanthine oxidase, lipoxygenase, lipid peroxidation, or mixed-function oxidases. These results suggest that the metabolism of FANFT by prostaglandin endoperoxide synthetase may be involved in the metabolic activation of FANFT necessary for the induction of bladder cancer in rats.

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6-Ketoprostaglandin E1 effects on rat and rabbit renal adenylate cyclase-cyclic AMP systems were examined. Adenylate cyclase activity was assessed in the 1000 X g fractions prepared from different areas of kidney. 6-Ketoprostaglandin E1 caused a dose-dependent increase in rat cortical and medullary adenylate cyclase activity with 8 x 10(-6) M being the lowest effective concentration. Combinations of maximal stimulatory concentrations of 6-ketoprostaglandin E1 and prostaglandin I2 caused stimulation similar to that seen with either agent alone. In contrast, the combination of either prostaglandin with parathyroid hormone (cortex) or antidiuretic hormone (medulla) resulted in enzyme activity significantly greater than with either agent alone. Similar results were observed in the rabbit. In addition, rabbit cortical and medullary slice cyclic AMP content was increased by 6-ketoprostaglandin E1. Maximal stimulatory effects of 6-ketoprostaglandin E1 on adenylate cyclase activity and cyclic AMP content were similar to prostaglandin I2. Therefore, the similarity in physiologic actions of 6-ketoprostaglandin E1 and prostaglandin I2 may be due to the stimulation of adenylate cyclase by both agents. These prostaglandins and the polypeptide hormones appear to activate different renal adenylate cyclase-cyclic AMP systems.

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Soluble guanylate cyclase (GTP pyrophosphate-lyase (cyclizing), EC 4.6.1.2) from rat lung demonstrated concentration-dependent stimulation, that is, an increase in specific activity with increasing enzyme (protein) concentration. This phenomenon persisted through several steps of enzyme purification and was apparently due to the presence of a macromolecular activator, similar in size to the enzyme. Treatment of partially purified enzyme with N-ethylmaleimide destroyed catalytic activity, but did not effect the ability of the preparation to stimulate activity. Kinetic analysis demonstrated that the stimulation was due to an increased V value with no change in the apparent Km value for MnGTP. Stimulation occurred without a time lag, the activator apparently interacting reversibly with the enzyme to increase catalytic capability. Some nonionic detergents of the Triton series inhibited enzyme activity by decreasing the V value, with no change in the Km value, and also decreased concentration-dependent stimulation. However, the two phenomena were not directly related. While the physiological significance of the activator is unclear, its presence affects estimations of recovery during enzyme purification, V determinations, and determinations of the effect of hormone or drug treatment on the activity of tissue extracts.

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Renal inner medullary slices were used to investigate the metabolism and subsequent binding to tissue of [14C]-benzidine metabolite(s) and the effect of benzidine on radioimmunoassayable prostaglandin (PG) E2 synthesis. Benzidine elicited a dose-dependent, reversible inhibition of PGE2 synthesis. By contrast, aspirin inhibition of PGE2 synthesis was not reversible. Binding of [14C]-benzidine metabolite(s) to medullary tissue was observed. This binding was increased by arachidonic acid. Arachidonic acid-mediated binding was prevented by inhibitors of prostaglandin endoperoxide synthetase. Metyrapone and SKF-525A, inhibitors of mixed function oxidase activity, did not inhibit binding of benzidine metabolite(s). Fatty acids which are not substrates for prostaglandin endoperoxide synthetase did not increase binding. These results are consistent with previous studies demonstrating inner medullary microsomal cooxidative metabolism of benzidine by prostaglandin endoperoxide synthetase and document the cooxidative process proceeds in an intact cell preparation, the tissue slice. The renal inner medulla is a potential site for the cooxidative metabolism of drugs and xenobiotics which require activation before eliciting their toxic effects on the urinary tract.

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