RESUMEN
Sodium retention is a major clinical feature of nephrotic syndrome. The mechanisms responsible for sodium retention in this setting have been a subject of debate for years. Excessive sodium retention occurs in some individuals with nephrotic syndrome in the absence of activation of the renin-angiotensin-aldosterone system, suggesting an intrinsic defect in sodium excretion by the kidney. Recent studies have provided new insights regarding mechanisms by which sodium transporters are activated by factors present in nephrotic urine. These mechanisms likely have a role in the development of hypertension in nephrotic syndrome, where hypertension may be difficult to control, and provide new therapeutic options for the management of blood pressure and edema in the setting of nephrotic syndrome.
Asunto(s)
Hipertensión/metabolismo , Riñón/metabolismo , Síndrome Nefrótico/metabolismo , Sodio/metabolismo , Desequilibrio Hidroelectrolítico/metabolismo , Canales Epiteliales de Sodio/metabolismo , Humanos , Hipertensión/etiología , Síndrome Nefrótico/complicaciones , Proteinuria , Desequilibrio Hidroelectrolítico/complicaciones , Desequilibrio Hidroelectrolítico/tratamiento farmacológicoRESUMEN
The aim of this work was to study the role of local intrarenal angiotensin II (Ang II) and the oxidative stress in the up-regulation of pro-inflammatory cytokines expression observed in rats submitted to an acute sodium overload. Sprague-Dawley rats were infused for 2 h with isotonic saline solution (Control group) and with hypertonic saline solution alone (Na group), plus the AT1 receptor antagonist losartan (10 mg kg(-1) in bolus) (Na-Los group), or plus the superoxide dismutase mimetic tempol (0.5 mg min(-1) kg(-1)) (Na-Temp group). Mean arterial pressure, glomerular filtration rate, and fractional sodium excretion (FE(Na)) were measured. Ang II, NF-kappaB, hypoxia inducible factor-1 alpha (HIF-1 alpha), transforming growth factor beta1 (TGF-beta1), smooth muscle actin (alpha-SMA), endothelial nitric oxide synthase (eNOS), and RANTES renal expression was evaluated by immunohistochemistry. Ang II, NF-kappaB, and TGF-beta1 and RANTES early inflammatory markers were overexpressed in Na group, accompanied by enhanced HIF-1 alpha immunostaining, lower eNOS expression, and unmodified alpha-SMA. Losartan and tempol increased FE(Na) in sodium overload group. Although losartan reduced Ang II and NF-kappaB staining and increased eNOS expression, it did not restore HIF-1 alpha expression and did not prevent inflammation. Conversely, tempol increased eNOS and natriuresis, restored HIF-1 alpha expression, and prevented inflammation. Early inflammatory markers observed in rats with acute sodium overload is associated with the imbalance between HIF-1 alpha and eNOS expression. While both losartan and tempol increased natriuresis and eNOS expression, only tempol was effective in restoring HIF-1 alpha expression and down-regulating TGF-beta1 and RANTES expression. The protective role of tempol, but not of losartan, in the inflammatory response may be associated with its greater antioxidant effects.
Asunto(s)
Bloqueadores del Receptor Tipo 1 de Angiotensina II/farmacología , Antioxidantes/farmacología , Óxidos N-Cíclicos/farmacología , Mediadores de Inflamación/metabolismo , Riñón/efectos de los fármacos , Losartán/farmacología , Nefritis/prevención & control , Estrés Oxidativo/efectos de los fármacos , Desequilibrio Hidroelectrolítico/tratamiento farmacológico , Actinas/metabolismo , Angiotensina II/metabolismo , Animales , Presión Sanguínea/efectos de los fármacos , Quimiocina CCL5/metabolismo , Modelos Animales de Enfermedad , Tasa de Filtración Glomerular/efectos de los fármacos , Subunidad alfa del Factor 1 Inducible por Hipoxia/metabolismo , Riñón/metabolismo , Riñón/fisiopatología , Masculino , FN-kappa B/metabolismo , Natriuresis/efectos de los fármacos , Nefritis/etiología , Nefritis/metabolismo , Nefritis/fisiopatología , Óxido Nítrico Sintasa de Tipo III/metabolismo , Ratas , Ratas Sprague-Dawley , Solución Salina Hipertónica , Marcadores de Spin , Factores de Tiempo , Factor de Crecimiento Transformador beta1/metabolismo , Desequilibrio Hidroelectrolítico/etiología , Desequilibrio Hidroelectrolítico/metabolismo , Desequilibrio Hidroelectrolítico/fisiopatologíaRESUMEN
La diabetes insípida post-craneotomía se presenta hasta en 85% de los pacientes sometidos a cirugía para extirpar un tumor del área hipotálamo-hipofisaria. Esta complicación implica una pérdida de agua de tal magnitud, que ocasiona trastornos hidroelectrolíticos graves. Se presenta la experiencia obtenida con el uso de 1-desamino-8-D-arginina-vasopresina (DDAVP) en niños, para controlar el volumen urinario. En todos los nueve pacientes en que se utilizó hubo disminución del volumen urinario, de la natremia y de la osmolalidad del suero así como elevación de la densidad y osmolalidad urinaria a niveles normales. Se concluye que el DDAVP es un valioso instrumento para controlar esta complicación, sin que hayan observado reacciones secundarias de importancia
Asunto(s)
Preescolar , Niño , Adolescente , Humanos , Masculino , Femenino , Craneotomía/efectos adversos , Desamino Arginina Vasopresina/uso terapéutico , Desequilibrio Hidroelectrolítico/tratamiento farmacológico , Diabetes Insípida/complicaciones , Neoplasias Hipofisarias/cirugía , Desequilibrio Hidroelectrolítico/etiologíaRESUMEN
Plasma and urinary furosemide kinetics were assayed by high-power liquid chromatography in six newborn infants receiving furosemide (1 mg/kg body weight IV) for the treatment of fluid overload. Mean +/- SD for plasma half-life, apparent volume of distribution, and plasma clearance were, respectively, 9.5 +/- 4.4 hours, 173 +/- 28 ml/kg, and 15.3 +/- 8.4 ml/hr/kg. There was close correspondence between plasma and urinary half-lives and between plasma clearance and renal clearance. In the first 24 hours, mean estimated urinary recovery of unchanged furosemide was 90% of the injected dose (range 61% to 106%). The results suggest that in the newborn infant furosemide is virtually all excreted unchanged in the urine and that the absence of significant nonrenal elimination, together with the immaturity of neonatal renal function, accounts for its prolonged half-life in newborn infants.
Asunto(s)
Furosemida/metabolismo , Enfermedades del Recién Nacido/tratamiento farmacológico , Desequilibrio Hidroelectrolítico/tratamiento farmacológico , Furosemida/sangre , Furosemida/uso terapéutico , Furosemida/orina , Semivida , Humanos , Recién Nacido , CinéticaAsunto(s)
Furosemida/metabolismo , Enfermedades del Prematuro/metabolismo , Riñón/metabolismo , Desequilibrio Hidroelectrolítico/metabolismo , Femenino , Furosemida/análogos & derivados , Furosemida/uso terapéutico , Furosemida/orina , Humanos , Recién Nacido , Enfermedades del Prematuro/tratamiento farmacológico , Masculino , Factores de Tiempo , Desequilibrio Hidroelectrolítico/tratamiento farmacológicoAsunto(s)
Humanos , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/complicaciones , Diabetes Mellitus/tratamiento farmacológico , Obstrucción Intestinal/etiología , Obstrucción Intestinal/complicaciones , Obstrucción Intestinal/cirugía , Insuficiencia Respiratoria , Insuficiencia Renal , Enfermedad Aguda , Enfermedad Crónica , Desequilibrio Hidroelectrolítico/tratamiento farmacológico , Uruguay , CongresoAsunto(s)
Hiperplasia Suprarrenal Congénita , Trastornos del Desarrollo Sexual , Cromatina Sexual/análisis , Análisis para Determinación del Sexo , Desequilibrio Hidroelectrolítico , Hiperplasia Suprarrenal Congénita/sangre , Hiperplasia Suprarrenal Congénita/complicaciones , Trastornos del Desarrollo Sexual/sangre , Trastornos del Desarrollo Sexual/complicaciones , Femenino , Humanos , Recién Nacido , Desequilibrio Hidroelectrolítico/complicaciones , Desequilibrio Hidroelectrolítico/tratamiento farmacológico , Desequilibrio Hidroelectrolítico/fisiopatologíaRESUMEN
The leucocyte data on four malnourished children who died suddenly when high-energy feeding was started were retrospectively analysed. The pretreatment rate constant for sodium efflux in leucocytes was higher and the intracellular sodium concentration lower in this group than in 13 malnourished children who recovered uneventfully with feeding. Two other children with unusual leucocyte electrolyte values and sodium pump activity were identified and closely monitored when high-energy treatment was begun. They rapidly developed the syndrome of extracellular fluid overload but were successfully treated with diuretics and digoxin. Though the precise relation between the findings in the leucocytes and the development of this overload syndrome is not clear, the pretreatment leucocyte values are nevertheless valuable in predicting which malnourished children are at risk of sudden death when refeeding is started.(AU)
Asunto(s)
Humanos , Lactante , Preescolar , Masculino , Femenino , Muerte Súbita/etiología , Trastornos Nutricionales/complicaciones , Sodio/metabolismo , Digoxina/uso terapéutico , Furosemida/uso terapéutico , Trastornos Nutricionales/dietoterapia , Potasio/metabolismo , Muerte Súbita del Lactante/etiología , Desequilibrio Hidroelectrolítico/tratamiento farmacológicoAsunto(s)
Desequilibrio Ácido-Base/tratamiento farmacológico , Deshidratación/tratamiento farmacológico , Diarrea Infantil/complicaciones , Riñón/metabolismo , Magnesio/uso terapéutico , Desequilibrio Hidroelectrolítico/tratamiento farmacológico , Desequilibrio Ácido-Base/etiología , Deshidratación/etiología , Electrólitos/orina , Humanos , Lactante , Masculino , Desequilibrio Hidroelectrolítico/etiologíaRESUMEN
Gastro-enteritis, occurring in a typical country amongst malnourished infants, presents a special problem. Mortality is high and, since those cases which gain admission to hospital must form only a small percentage of the overall incidence prevailing in Jamaica, the control of gastro-enteritis is a serious challenge. Experience gained in the Paediatic Department of the University College Hospital forms the basis of this discussion of the management of infantile gastro-enteritis. The common presenting symptoms and aetiological agents are described and the use of laboratory investigations is discussed in relation to the management of the case. Special emphasis is laid on the management of fluid and electrolyte disturbances, both in a hospital with adequate laboratory facilities and in one which has not these advantages. No detailed discussion of prophylaxis has been attempted, but it is obvious that measures to reduce the incidence of gastro-enteritis are of primary importance in the control of this disease; such measures include the establishment of infant welfare clinics throughout the country where advice on infant feeding and general hygiene can be given. (AU)