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OBJECTIVE: To analyze association between urodynamic study (UDS) parameters and renal function in spinal cord injured (SCI) patients with neurogenic detrusor overactivity. METHODS: Patients with a suprasacral SCI, who underwent UDS and radioisotope renogram at least twice between January 1, 2006 and January 31, 2013, were included. UDS (cystometric capacity, reflex volume, compliance, and maximal detrusor pressure) and radioisotope renogram (total effective renal plasma flow [ERPF] of both kidneys) data were collected. The following were conducted to reanalyze any association between reflex volume and ERPF: initial and follow-up results of consecutive evaluations were compared; a mixed-model regression analysis to account for clustered data was conducted to evaluate the association between UDS parameters and ERPF; and finally, a mixed-model analysis type 3 test with data pairs, of which the first evaluation showed involuntary detrusor contraction. RESULTS: A total of 150 patients underwent 390 evaluations which were arranged into 240 pairs of consecutive evaluations, of which 171 had first evaluations with observed involuntary detrusor contraction. The following results were obtained: cystometric capacity was significantly larger and maximal detrusor pressure was significantly lower on follow-up; on univariate analysis, reflex volume and maximal detrusor pressure were significant, and multivariate analysis using these two parameters showed that maximal detrusor pressure is significantly associated with total ERPF; and no significant differences were observed. CONCLUSION: Maximal detrusor pressure should be closely monitored in the urologic management of neurogenic detrusor overactivity in SCI patients. The results also may serve as a reference for regular UDS follow-up.
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Humans , Compliance , Follow-Up Studies , Multivariate Analysis , Reflex , Renal Plasma Flow , Renal Plasma Flow, Effective , Spinal Cord , Spinal Cord Injuries , Urinary Bladder, Neurogenic , UrodynamicsABSTRACT
Objective To investigate the influence and mechanism of erythropoietin (EPO) in renal blood flow after limb ischemia reperfusion (LIR). Methods Thirty male SD rats were randomly divided into control group, LIR group and EPO+LIR group with ten in each group. The values of renal blood flow, plasma creatinine (Cr), urea nitrogen (BUN) content in plasma, kidney tissue wet to dry ratio (W/D), nitric oxide (NO), nitric oxide synthase (NOS) and endothelin-1 (ET-1) in re-nal tissue were detected in three groups. The immunohistochemistry assay was used to detect the expression of intercellular adhesion molecule (ICAM-1) and vascular cell adhesion molecule (VCAM-1) in renal tissue. The morphological changes of renal tissue were observed with light microscope. Results The renal blood flow was significantly decreased, while the val-ues of Cr, BUN, W/D, NO, ET-1, NOS, expressions of ICAM-1 and VCAM-1 was significantly increased in LIR group than those of control group (P<0.05). Broaden interstitial and infiltration of inflammatory cells were observed in the renal tissue under light microscope. In the EPO+LIR group, the renal blood flow increased, the values of Cr, BUN, W/D, NO, ET-1 and NOS, expressions of ICAM-1 and VCAM-1 decreased significantly compared with those of LIR group (P<0.05). The patho-logical changes were alleviated in EPO+LIR group. Conclusion EPO can improve renal function, increase renal blood flow in rats after LIR. The mechanism may be related to the decreased edema, changed renal vasomotor function and decreased in-flammation.
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Renal plasma flow (RPF) and glomerular filtration rate (GFR) are decreased in patients with heat stroke. Heat stroke after prolonged exercise under high temperatures is usually associated with hypotension and dehydration, leading to decreased RPF. However, whether renal blood flow (RBF), RPF, and GFR are increased or decreased during immersion in mild warm water remains unknown.<br>Para-aminohippurate clearance (C<sub>PAH</sub>), sodium thiosulfate clearance (C<sub>thio</sub>), and creatinine clearance (C<sub>cr</sub>) were determined in 14 healthy men aged 19 to 27 years old (mean±SD, 22±2), 161 to 181cm (171.5±6.3) tall, and weighing 52 to 78kg (64.2±7.4) without immersion at about 25°C (room temperature) and during immersion in water at 41±0.5°C.<br>C<sub>PAH</sub>, C<sub>thio</sub>, and RBF significantly increased during immersion compared with those without immersion (P<0.0001, P<0.03, P<0.0001, respectively). C<sub>cr</sub> did not change (P=0.108). The filtration fraction (FF) was significantly decreased (P<0.001). Levels of plasma atrial natriuretic peptide, aldosterone, anti-diuretic hormone and renin did not significantly differ between these two conditions.<br>This investigation suggests that daily immersion at 41°C is beneficial for renal function.
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The effects of the bathing on renal function were studied in 12 healthy men (32.3±7.7y. o.). The subjects took 41°C, 10min bathing and kept warm by a blanket for 30min, and then a mixture of 10% para-aminohippurate (PAH, 0.3<i>ml</i>/kg) and 10% sodium thiosulfate (NTS, 80<i>ml</i>) was infused intravenously. Clearance of PAH and NTS was calculated as the index of renal plasma flow (RPF) and glomerular filtration rate (GFR). PAH and NTS clearance test was also done at rest without bathing in another day. Blood Pressure (BP), Heart rate (HR), cardiac output (CO), sublingual temperature by electric thermista as deep body temperature were measured during the experiment. 30min after bathing, sublingual temperature was significantly increased by 0.9°C, and CO by +40%. After bathing, renal plasma flow (PAH clearance) significantly increased from 388.5±158.9<i>ml</i>/min to 572±170.7<i>ml</i>/min. Glomerular filtration rate (NTS clearance) was, however, unchanged from 115.6±37.3<i>ml</i>/min to 119.3±51.3<i>ml</i>/min. Filtration fraction (GFR/RPF) was significantly decreased. These results indicated that GFR was not improved by bathing although CO and RPF was increased by thermal vasodilation effect. The mechanism of unchanged GFR, despite of increased RPF, is probably that glomerular filtration pressure unchanged by thermal vasodilation of glomerular efferent and afferent arterioles.
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El papel del riñón en la génesis de la hipertensión arterial esencial se ha venido investigando desde hace más de 3 décadas. El propósito del presente trabajo fue valorar el comportamiento de algunas variables morfofuncionales renales en pacientes hipertensos. A voluntarios normales (40) y pacientes hipertensos (45), se les estudió el flujo plasmático renal efectivo (FPRE) mediante aclaramiento de paraminohipurato, intensidad de filtración glomerular (IFG) mediante aclaramiento de creatinina; el aclaramiento plasmático de litio (ApLi), la fracción de reabsorción de litio (FRLi), el manejo renal de sodio y potasio; así como la medición ultrasónica de los diámetros renales anteroposteriores, transversal y longitudinal con los cuales se determinó el volumen de los riñones mediante un programa de computación. Los resultados mostraron diferencias significativas en el FPRE, los diámetros renales y el volumen integrado, así como en el manejo renal del sodio. Estos resultados sugieren una retención hidrosalina en los hipertensos, lo que apoya las hipótesis que establecen la participación del riñón en la génesis de la hipertensión arterial.
The role of the kidney in the genesis of essential arterial hypertension, has been investigated since more than three decades. The purposes of this article was to assess the behaviour of some renal morphofunctional variables in hypertensive patients. The effective renal plasma flow (ERPF) was studied in 40 normal volunteers and 45 hypertensive patients, by means of the paraamino-hippurate clearance, glomerular filtration rate (GFR) by means of creatinine clearance, lithium plasma clearance LiPC), lithium reabsorption fraction (LiRF), sodium and potassium renal management, as well as the ultrasonographic measurement of anteroposterior, transverse and longitudinal renal diameters, with which the kidneys volume was determined by a computed program. The results showed significant differences in ERPF, the renal diameters and the integrated volume, as well as in the sodium management. These outcomes suggest a hydrosaline retention in the hypertensive patients, and this advocates the hypothesis that they restore the kidney participation in the genesis of arterial hypertension.
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A study was designed to examine the effects of exercise intensity on renal clearance parameters. Five healthy male subjects underwent exercise tests on an bicycle ergometer at 4 different work loads for 15 min. The indicators of exercise intensity employed were the percentage of maximal oxygen uptake (%VO<SUB>2</SUB>max), heart rate (HR) and blood lactate level (La) . As parameters of renal clearance, para-aminohippurate clearance (CPAH), thiosulfate clearance (C<SUB>thio</SUB>) and creatinine clearance (C<SUB>cr</SUB>) were measured by the continuous infusion technique during the exercise.<BR>1) The renal clearance parameters during exercise decreased linearly as the exercise intensity increased. The percentage of maximal oxygen uptake at the onset of the decreases in %C<SUB>PAH</SUB>, %C<SUB>chiu</SUB> and %C<SUB>cr</SUB> were 36, 45 and 47%VO<SUB>2</SUB>max, respectively.<BR>2) Among the indicators of exercise intensity, the decrease in La showed the closest correlation with renal clearance during the exercise.<BR>3) The renal plasma flow, which was measured as C<SUB>PAH</SUB>, began to decrease linearly at a significantly lower exercise intensity than the glomerular filtration rate, which was measured as both C<SUB>thio</SUB> and C<SUB>cr</SUB>.<BR>The above results suggest that renal clearance parameters begin to decrease at the threshold as exercise intensity increases.
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Dynamic renal imaging studies were performed in 132 patients using 99m Tc DTPA and 131 I OIH. Effective renal plasma flow(ERPF) and glomerular filtration rate(GFR) was obtained. GFRs were calculated with 2 background regions of interest(ROI),conventional subrenal areas(SB) and suprarenal areas(SP). The relative renal functions(RR) obtained by GFRs determination was significantly higer compared with that by ERPF. These results suggested that the RR of impaired kidney determined by GFR(SB) was obviously higher than that assessed by ERPF. Higher coefficient( r value) was gotten with GFR(SP) than with GFR(SB).Results suggested that the GFR obtained with conventional subrenal background ROI might overestimate individual renal function of the poorly functional kidney and the GFR estimated by suprarenal background ROI might be more accurate.