Clinical Significance of Urodynamic Study Parameters in Maintenance of Renal Function in Spinal Cord Injury Patients

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.

Magnésio urinário, plasmático e eritrocitário: validação do método de análise por espectrofotometria de absorção atômica com chama / Magnesium contents in urine, plasma and erythrocyte samples: validation of analytical methodology using flame atomic absorption spectrophotometry

Neste estudo foi validada a metodologia de análise de magnésio urinário, plasmático e eritrocitário por espectrofotometria de absorção atômica com chama. As análises foram realizadas em pools de amostras de urina, de plasma e de eritrócitos de humanos. Para a validação, foram considerados os parâmetros de linearidade da curva-padrão, faixa de trabalho, limite de detecção (LD), limite de quantificação (LQ), precisão e exatidão da medição. Os LD e LQ da curva foram, respectivamente, de 0,006 e 0,021 μg/mLde Mg para urina e plasma, e de 0,003 e 0,010 μg/mL de Mg para eritrócitos. A faixa linear de trabalho para determinação de Mg foi entre 0,05 e 0,5 μg/mL de Mg, e as curvas-padrão apresentaram coeficientes de correlação maiores do que 0,99, que demonstram a linearidade da metodologia. As precisões intra e interensaio superiores a 90 por cento foram consideradas adequadas. As recuperações obtidas, usando-se materiais de referência certificados, foram de 101 por cento e de 97 por cento, respectivamente, em urina e plasma. As médias de recuperação por adição de padrão foram de 87 por cento para urina e eritrócitos e de 91 por cento para plasma. A metodologia avaliada foi linear, sensível, seletiva, precisa e exata; portanto, são confiáveis os resultados obtidos.

Alteration of renal hemodynamic in adriamycin-induced nephrosis rats administrated with Wulingsan / 中国中药杂志

<p><b>OBJECTIVE</b>To investigate the effect of traditional classical compound Wulingsan on renal hemodynamic in rats with adriamycin (ADR)-induced nephrosis.</p><p><b>METHOD</b>After establishing a model of rats with adriamycin-induced nephrosis, we administrated wulin-san to the ADR rats via oral gavage for four weeks and measured mean arterial blood preasure (MABP) with manometer. Renal clearance of paraaminohippuric acid (PAH) and inulin were detected, then renal plasma flow (RPF) and glomerular filtration rate (GFR) were calculated. Renal vascular resistance (RVR) was calculated as the division of MABP by RPF. Renal endothelin (ET) and angiotensin II (Ang II) were detected with radioimmunity assay kits, and nitrous oxide (NO) was detected with biochemical kits.</p><p><b>RESULT</b>There was no significant change of GFR in ARD rats, but RPF and NO were decreased, which accompanied by enhanced RVR, ET and Ang II. RPF was increased in the administrated rats, in company with RVR, ET and Ang II decreased, whereas NO was not influenced after the administration.</p><p><b>CONCLUSION</b>Wulingsan can improve the renal hemodynamic in ADR rats, at least in part by modulating the levels of vasoactive factor.</p>

Effect of strenuous maternal exercise before and during pregnancy on rat progeny renal function

The effects of strenuous exercise before and during pregnancy on the renal function and morphological alterations of the progeny were determined in a study on female Wistar rats. This research was done based on a previous study carried out in our laboratory, which showed morphological alterations in rats submitted to this kind of exercise. As the form is related to the function, the physiological relevance of submitting a pregnant female to a high-intensity exercise training regimen could be explained by the fact that morphological alterations can influence kidney function. The animals were assigned to one of two groups: control animals that did not exercise during pregnancy and trained animals that swam for 120 min 5 days a week for 8 weeks before pregnancy and daily for 60 min over a period of 8 weeks starting on the second day of pregnancy. Seven rats of each group were analyzed for morphological alterations and for renal function. The progeny of the rats used for morphological evaluation were born by cesarean section and the progeny of the animals used to evaluate renal function were born normally. The progeny were two months old when renal function was evaluated. Fertility and morbidity were the same for both groups. Strenuous maternal exercise had no significant influence on glomerular filtration rate (GFR) but renal plasma flow was lower in the progeny of the trained group (mean ñ SD, 16.65 ñ 3.77 ml min-1 kg-1) compared to the progeny of the control group (33.42 ñ 2.56 ml min-1 kg-1). Antidiuretic and antinatriuretic effects on the progeny of the trained group were observed, since urine flow as percentage of GFR and the fraction of urinary sodium excretion were lower in this group (1.38 ñ 0.10 and 0.60 ñ 0.04 percent, respectively) compared to the progeny of the control group (2.36 ñ 0.11 and 1.55 ñ 0.20 percent, respectively). Moreover, in this exercise program, fetuses from trained animals were small-sized (2.45 ñ 0.19 vs 4.66 ñ 2.45 g for control animals) and showed lower differentiation compared to fetuses from the control group. These effects were probably caused by caloric restriction, hypoxia and reduction of umbilical cord length.

Reposiçäo volêmica no choque hemorrágico: a soluçäo empregada faz diferença em relaçäo aos efeitos hemodinâmicos e renais? / Hemorrhagic shock volume replacement: does the solution make a difference in hemodynamic and renal effects?

Justificativa e objetivos - O emprego de pequenos volumes de soluçäo hipertônica (SH) isoladamente ou em associaçäo à soluçäo de dextran 70 a 6 por cento (SHD), abre novas perpectivas no manuseio da reposiçäo volêmica durante o choque hipovolêmico, em relaçäo ao emprego de soluçöes cristalóides. A pesquisa experimental tem como objetivo verificar se o tipo de soluçäo empregada na reposiçäo do choque hemorrágico apresenta alguma diferença em relaçäo aos efeitos hemodinâmicos e renais. Método - Foram utilizados 24 cäes anestesiadoscom pentobarbital sódico. Após retirada de 40 por cento do volume sanguíneo, os cäes foram distribuídos de forma aleatória em grupos de 8 animais, de acordo com a soluçäo empregada para a reposiçäo volêmica: G1 - SH a 7,5 por cento em volume de 4ml.kg-1; G2 - soluçäo de Ringer com lactato (RL) na proporçäo 2:1 em relaçäo ao volume de sangue retirado; e G3 - SHD em volume de 4ml.kg-1. Foram estudados os seguintes atributos: frequência cardíaca (FC), pressäo arterial média (PAM), pressäo venosa central (PVC), fluxo sanguíneo aortico (FAo), resistência vascular aórtica (RvAo), fluxo plasmático renal (FPR), ritmo de filtraçäo glomerular (RFG), fluxo sanguíneo renal, débito urinário (DU), resistência vascular renal, excreçäo urinária de sódio (EFNa), depuraçäo osmolar (Dosm) e depuraçäo de água livre (DH2O). Os atributos PAM, PVC, FAo foram estudados nos momentos: M1 (controle); M2 - após a retirada dos 40 por cento da volemia; M3, M4 e M5 - imediatamente e após 15 e 60 min da reposiçäo volêmica, respectivamente. Os demais atributos estudados nos momentos: M1 (controle); M2 e M3-15 e 60 min da reposiçäo volêmica, respectivamente. Resultados - A reposiçäo com RL (G2) aumentou o FAo e a PVC em M3 e M4, em níveis superiores aos determinados pela reposiçäo com pequenos volumes (G1 e G3). Näo houve diferença significante da PAM entre os grupos, que se elevou após a reposiçäo, mas näo retornou aos níveis do controle. O DU aumentou significativamente em G2 (RL), com aumento da DH2O nesse grupo em G3 (SHD). Conclusöes - A reposiçäo com RL determina excessiva expansäo volêmica, enquanto a reposiçäo com SH e SDH determina boa expansäo volêmica, sem diferença significante entre elas. Todas as soluçöes mantêm a hemodinâmica e funçäo renais, com o RL provocando aumento do débito urinário

Effects of dietary lipids on renal function of aged rats

Normal aging is accompanied by renal functional and morphological deterioration and dietetic manipulation has been used to delay this age-related decline. We examined the effects of chronic administration of diets containing 5 percent lipid-enriched diet (LD, w/w) on renal function of rats at different ages. Three types of LD were tested: canola oil, fish oil and butter. Mean systemic tail-cuff blood pressure and glycemia remained within the normal range whatever the age and the diet of the animals. Proteinuria began to rise from the 8th month in the groups ingesting LD, while in the control group it increased significantly (above 10 mg/24 h) only after the 10th month. With age, a significant and progressive decline in glomerular filtration rate (GFR) and renal plasma flow was observed in the LD groups but after 6 months of lipid supplementation, the decline in these parameters was more marked in the butter and fish oil groups. By the 18th month, the lowest GFR level was observed in the group ingesting the butter diet (2.93 + or - 0.22 vs 5.01 + or - 0.21 ml min-1 kg-1 in control, P<0.05). Net acid excretion, evaluated in 9- and 18-month-old rats, was stimulated in the fish oil group when compared both to control and to the other two LD groups. These results suggest that even low levels of LD in a chronic nutritional regimen can modify the age-related changes in renal function and that the impact of different types of lipid-supplemented diets on renal function depends on the kind of lipid present in the diet

Effects of Renal Mass Reduction and Method of Reduction in the Polycystic Rats / 대한비뇨기과학회지

PURPOSE: Nephrectomy or decortication is used to relieve pain in clinical autosomal dominant polycystic kidney disease (ADPKD). We evaluated the renal adaptation to unilateral nephrectomy, and segmental renal artery infarction in APDKD rats. MATERIALS AND METHODS: At 6 weeks of age, cystic Han: Sprague-Dawley (SPRD) rats and unaffected controls were subjected to renal mass reduction by uninephrectomy, by infarction of half of each kidney or sham operation. Most groups were followed up to the age of 20 weeks, with serial measurements of blood pressure and proteinuria. At 20 weeks, glomerular filtration rate (GFR) and renal plasma flow (RPF) rate were measured. Similar studies to 12 weeks of age were performed in additional groups of control and cystic rats with either sham operation or half renal infarction. RESULTS: In the uninephrectomized control rats, the values for systemic blood pressure and proteinuria increased, but not significantly. Renal compensatory hyperfiltration and hyperperfusion were observed. GFR and RPF exceeded those seen in sham operated rats (p< 0.05). In infarcted control rats showed significantly increased values for blood pressure and proteinuria and a marked reduction in GFR and RPF (p< 0.05). In the uninephrectomized cystic rats, at baseline, increased values for blood pressure and proteinuria, and a significant reduction in GFR and RPF were observed (p< 0.05). In infarcted cystic rats, at baseline, significant increased values for blood pressure and proteinuria were observed. And there was a marked reduction in GFR and RPF associated with a significant increase in renal vascular resistance (p<0.05). However, in both cystic groups, no compensatory hyperfiltration or hyperperfusion was observed after renal mass reduction. CONCLUSIONS: APDKD is vulnerable state to additional renal injury. When treatment is required for patients with symptomatic APDKD, clinical need to conserve renal function should be considered, especially such as cyst marsupialization.

Effect of Arginine Vasotocin on the Rabbit Renal Function / 대한신장학회잡지

Arginine vasotocin has long been known as an antidiuretic hormone in non-mammalian vertebrates. The peptide has also been found in mammalian tissues. The physiological significance of the peptide, however, has not yet been clarified in mammals. To define the effect of arginine vasotocin on the water and electrolyte balance in mammalian vertebrates, experiments have been done. Intrarenal arterial infusion of arginine vasotocin, 0.01-10ng/kg/min resulted in dose-dependent decreases in urine volume and free water clearance and an increase in urinary osmolarity. Arginine vasotocin, in a dose of 0.03ng/kg/min, induced an increase in water reabsorption without changes in glomerular filtration rate. Intrarenal infusion of arginine vasotocin in doses ranging from 0.1 to 3.0 or 10.0ng/kg/min resulted in decreases in glomerular filtration rate and renal plasma flow. However, no dose dependence were observed. Intrarenal infusion of arginine vasotocin from 0.3 to 10 ng/kg/min induced dose-dependent natriuretic and kaliuretic effects with concomitant suppression of renin secretion. The renal effects of arginine vasotocin were blocked by arginine vasopressin V2-receptor antagonist [d(CH2)5, D-Phe2, Ile4, Ala9-NH2]-vasopressin but were not blocked by[d(CH2)5, D-Ile2, Ile4, Arg8]- vaso pression. These data suggest that the effect of arginine vasotocin on the renal function are similar to that of vasopressin in mammalian vertebrates. The data also suggest that the renal effects of arginine vasotocin may be coupled to the receptor system which is similar, if not identical, to that of arginine vasopressin.

Effects of Acetylcholine on the Renal Function in Renal Hypertensive Rabbits / 대한신장학회잡지

It has long been known that acetylcholine infusion resulted in increases in urine volume, urinary excretion of Na and renal plasma flow. Exact mechanism of renal effects of acetylcholine, however, has not yet been clarified. Since the discovery of endothelium-derived relaxing factor/nitric oxide system, the vascular endothelium has been considered as an endocrine gland. The purpose of the present study was to define the effect of acetylcholine on the renal hemodynamic and tubular function, and the modification of the renal effects of acetylcholine in two- kidney one clip Goldblatt hypertensive rabbits. Intrarenal acetylcholine(0.03-0.3ug/kg/min) increased glomerular filtration rate(GFR, CCr), renal plasma flow (RPF, CPAH), urine volume(UV), free water clearance (CH2O), urinary excretion of electrolytes(UNaV, UKV) and nitrate(UNO3V) and fractional excretion of Na+ (FENa) in unanesthetized rabbits. No change in filtration fraction was observed. Pretreatment with N omega- nitro-L-arginine methyl ester(L-NAME) blocked the acetylcholine-induced renal effects. Acetylcholine infused into the contralateral kidney elicited increases in GFR, RPF, UV, CH2O, UNaV, UKV, UNO3V and FENa in hypertensive rabbits. The hemodynamic effect was not different between normotensive sham-operated and unilateral nephrectomized rabbits. Acetylcholine-induced tubular effect, however, was significantly accentuated in hypertensive rabbits. Neither the renal hemodynamic nor tubular effects of acetylcholine were observed with pretreatment of L-NAME. These results suggest that the renal tubular effect as well as hemodynamic effect of acetylcholine is mediated through the NO system and that the tubular effect of acetylcholine is accentuated in the early phase of renal hypertension.

Renal blood flow in cirrhotic patients and hepatorenal syndrome [HRS]

This work aimed to assess the effect of liver cirrhosis and ascites on renal blood flow. The study included 40 consecutive patients with liver cirrhosis divided into two groups according to presence or absence of renal dysfunction in addition to ten normal volunteers taken as controls. All patients were subjected to clinical, laboratory, ultrasonographic, duplex study on renal artery and isotopic study for the estimation of total effective renal plasma flow [ERPF]. The results showed that the mean total ERPF was significantly lower in group B [HRS] compared to group A [cirrhotics]. The mean ERPF/CO was significantly lower in group B compared with group A. It was concluded that patients with HRS showed a marked diminution in total ERPF and ERPF/CO when compared with normal volunteers, while cirrhotic patients only showed mild diminution in total ERPF and ERPF/CO compared with the volunteers. However, renal blood flow when measured by duplex showed a similar elevation in renal vascular resistance in both HRS and cirrhotics

Beta-blockers and renal ablated rats

This study was conducted to compare the effects of carvedilol, celiprolol and propranolol on some renal function parameters, oxidative stress profile and histopathological features in renal ablated rats and to evaluate the effects of supplementation of celiprolol or propranolol treatment with vitamin E on the previously mentioned parameters. It was concluded that vasodilator beta-blockers with antioxidant activity as carvedilol offered renoprotective effects more than propranolol. Carvedilol exhibited an increasing histopathological and functional end-organ protection in renal ablated rats. The reduction of plasma renin activity and lipid peroxidation may contribute to its renoprotective effects. The addition of vitamin E to celiprolol or propranolol treatment was mandatory to improve renal function and lipid peroxidation in partially ablated rats

Renografía radioisotópica con diurético en la evaluación de los procesos obstructivos del tracto urinario superior en pacientes pediátricos / Diuresis renography in the evaluation of pediatric patients with dilated upper urinary tract

La renografía con diurético es una evaluación no invasiva aceptada para distinguir entre procesos obstructivos y procesos no obstructivos causantes de la dilatación del tracto urinario superior en pacientes pediátricos. La detección de las alteraciones obstructivas como resposables de la dilatación de los sistemas colectores renales es muy importante ya que éstas son causas previsibles de la insuficiencia renal. La utilización conjunta de estudios morfológicos como el ultrasonido, y de evaluaciones funcionales como la gammagrafía, proporcionan información anatomofuncional que nos permite conocer el verdadero estado morfológico y funcional de los riñones de forma objetiva. El 99mTc-MAG 3 es actualmente el radionúclido preferido para la renografía con diurético. En infantes como obstrucción de la unión pieloureteral, el renograma con diurético se manifiesta de formas distintas. Desde el punto de vista clínico, los casos se clasifican en aquellos con evidencia precisa de obstrucción grave y no hay daño renal. Las intervenciones quirúrgicas quedan indicadas en pacientes con obstrucción completa. La gran mayoría de los renogramas con diurético pueden ser correctamente interpretados con el simple análisis visual de las curvas de tiempo/actividad generadas por computadora, sin la ayuda de otros cálculos más complejos

Effect of thyroparathyroidectomy on urinary acidification in diabetic rats

In previous studies we have shown stimulation of renal acid excretion in the proximal tubules of rats with diabetes of short duration, with no important alterations in glomerular hemodynamics; on the other hand, in thyroparathyroidectomized rats (TPTX model), a significant decrease in renal acid excretion, glomerular filtration rate (GFR) and renal plasma flow (RPF) was detected. Since important changes in the parathyroid hormone-vitamin D-Ca axis are observed in the diabetic state, the present study was undertaken to investigate the renal repercussions of thyroparathyroidectomy in rats previously made diabetic by streptozotocin (45 mg/kg). Four to 6 days after the induction of diabetes (DM), a group of rats were thyroparathyroidectomized (DM + TPTX). Renal functional parameters were evaluated by measuring the inulin and sodium para-aminohippurate clearance on the tenth day. The decrease in the GFR and RPF observed in TPTX was not reversed by diabetes since the same alterations were observed in DM + TPTX. Net acid (NA) excretion was unchanged in DM (6.19 ± 0.54), decreased in TPTX (3.76 ± 0.25) and returned to normal levels in DM + TPTX (5.54 ± 0.72) when compared to the control group (6.34 ± 0.14 µmol min-1 kg-1). The results suggest that PTH plays an important vasodilator role regarding glomerular hemodynamics, since in its absence the impairment in GFR and RPF was not reversed by the diabetic state. However, with respect to acid excretion, the presence of diabetes was able to overcome the negative stimulus represented by TPTX

Nonimmunological Factors Influencing Serum Creatinine on Discharge after Kidney Transplantation / 대한신장학회잡지

There are two factors which influence the long term outcome of renal transplantation. One is the immunological factor such as HLA typing, the other is the nonimmunological factor such as physiologic match of the donor kidney to the recipient. We analyzed the relation between serum creatinine on the day of discharge which is known as a good predictor of long term graft survival and several nonimmunological factors influencing long term outcome of renal transplantation. One hundred fourteen renal transplanted patients in Yeungnam university hospital for 3 years after 1994 were included except the patients had experienced rapid deterioration of renal function like acute graft rejection. Several indices(KW/R.BSA, KW/R.BW, KW/ R.BMI, D.BSA/R.BSA, D.BW/R.BW : KW=kidney weight, R=recipient, D=donor, BSA=body surface area, BMI=body mass index, BW=body weight) representing relative kidney size to recipient were significantly correlated with serum creatinine on the day of discharge(KW/R.BSA : r=-0.30, KW/R.BW : r=-0.35, KW/R.BMI : r=-0.41, D.BSA/R.BSA : r=-0.47, D.BW/R.BW : r=-0.44). Serum creatinine levels on the day of discharge were lower at the male kidney donated to female recipient than the female kidney donated to male recipient (0.89 vs. 1.22mg%, P<0.05). The age of donors had positive correlation with serum creatinine on the day of discharge (r=0.28). That was, when donor is more younger person, renal function after transplantation is better. But several indices by renal scan(effective renal plasma flow, perfusion index, peak renal uptake, T1/2) done after transplantation, urine output of the next day after transplantaton, renal function of donor before transplantation(creatinine level) were not correlated with serum creatinine on the day of discharge. In conclusion, nonimmunological factor such as nephron mass size, age, gender should be considered when selecting renal donor, and the more actual, new criteria for kidney transplantation and long term prognosis should be worked out by further study.

Heterogeneity of glomerular perfusion and filtration induced by epinephrine and norepinephrine

The role of catecholamines in the distribution of intrarenal blood flow and in single-nephron glomerular filtration rate (SNGFR) was evaluated in anesthetized Wistar rats by the Hanssen technique. Epinephrine (EPI) and norepinephrine (NOR) were infused to produce elevations of 20-30 mmHg in mean arterial pressure. Superficial and juxtamedullary nephron perfusion and filtration were determined by the presence of Prussian blue dye. In the control group, 100 per cent of the nephrons presented a homogeneous pattern of perfusion and filtration. In contrast, a heterogenous distribution of the dye was found even in the larger arteries (arciform and radial), indicating variable perfusion and filtration in both superficial and juxtamedullary nephrons. The effects of EPI and NOR were also evaluated in the superficial cortex by the micropuncture technique in two additional groups of Munich-Wistar rats. Mean SNGFR was 27 per cent and 54 per cent lower in the EPI-and NOR-treated groups, respectively. No change in mean intraglomerular hydraulic pressure was observed after EPI or NOR infusion in spite of a highly scattered pattern, indicating an important variability in perfusion along the superficial cortex, and/or different sensitivity of the pre-and post-glomerular arterioles. The present data suggest that EPI and NOR may affect intrarenal hemodynamics by modifying perfusion and filtration in both superficial and juxtamedullary glomeruli and not by shifting blood folow from superficial to juxtamedullary nephrons. The heterogenous pattern of perfusion was a consequence of differential vasoconstriction along the intrarenal arteries, probably due to different density and/or sensitivity of the adrenergic receptor subtypes present in the intrarenal vascular tree.

Evaluación no invasiva del transporte de oxígeno renal en el paciente crítico / Non-invasive evaluation of the reanl oxygen transport in the critically ill patient

Introducción: las alteraciones en el flujo sanguíneo renal juegan un papel importante en la fisiopatología de la falla renal aguda (FRA) en el paciente crítico. Objetivo: evaluar mediante procedimientos no invasivos el transporte de oxígeno renal en el paciente crítico. Pacientes y métodos: se hicieron pruebas hemodinámicas renales (PHR) a 23 pacientes: 17 (grupo A, control) y seis (grupo B, con falla renal aguda, FRA): flujo plasmático efectivo (FPER), gasto renal (GR), disponibilidad de O2 (DO2r), consumo de O2 (VO2rc), fracción de filtración (FF) y diferencia arteriovenosa de O2 (D[av]O2r), pruebas de función renal (PFR). Resultados: el grupo A mostró: FPER 472 ñ 141 mL/min, GR 753 ñ 182 mL/min, RVR 143 ñ 29.7 U y 22.8 ñ 4.7 mmHg/mL, DO2r 113.5 ñ 3.1 mL/min, VO2rd 11.1 ñ4.5 mL/min, FF 21.9 ñ 9.3 por ciento, D(a - v)O2rc 1.42 ñ 0.03 mL/min (inferiores a los valores de referencia) y PFR normales, y el grupo B FPER 219 ñ 81 mL/min, VO2rc 0.13 ñ 0.06 mL/min, FF 0.81 ñ 0.32 por ciento y D(a - v)O2rc 0.04 ñ 0.02 mL/min (p<0.001). Conclusiones: este estudio demuestra que pueden ocurrir anormalidades del flujo sanguíneo renal aun con PFR normales

Función renal en el infarto agudo del miocardio / Renal function in acute myocardial infarction

Introducción. El infarto agudo del miocardio frecuentemente se asocia a disfunción renal. Objetivo. Reportar las alteraciones de la función renal en pacientes con infarto agudo del miocardio. Pacientes y métodos. Estudiamos prospectivamente 25 pacientes que ingresaron a una unidad de cuidados coronarios/unidad de cuidados intensivos (UCC/UCI) con infarto agudo del miocardio no complicado. Se hizo seguimiento de la función renal a las 24 y 72 horas de evolución a través de la evaluacion de las fuciones glomerular y tubular. Resultados. La diuresis disminuyó significativamente después de 72 horas; la función glomerular no cambió a las 24 horas pero se deterioró 72 horas más tarde; la función tubular se alteró durante las primeras horas y se normalizó al final del estudio; solo un paciente se complicó con isuficiencia renal aguda. Conclusión. La función renal se alteró transitoriamente durante las primeras 72 horas de evolución del infarto agudo del miocardio. La insuficiencia renal es poco frecuente

Efeitos do captopril sobre a excreçäo urinária de albumina e sobre a hemodinâmica renal em pacientes diabéticos do tipo I portadores de nefropatia diabética / Effects of captopril on albumin urinary excretion and on renal hemodynamic in diabetic patients type I with diabetic nephropathy

Em diabéticos hipertensos com nefropatia diabética, a administraçao de hidroclortiazida (HDMH,n = 6) ou captopril (HDMC,n = 5) por 12 semanas provocou reduçoes na albuminúria (Ualb) que se correlacionaram com as reduçoes nos níveis da pressao arterial (PA) no HDMH, mas nao no HDMC. No HDMH, houve queda no fluxo plasmático renal (FPR) (p < O,O5) e no ritmo de filtraçao glomerular (RFG) (p < O,01), enquanto a fraçao de filtraçao (FF) permaneceu inalterada. No grupo HDMC, alteraçoes na hemodinâmica renal nao foram observadas. Em diabéticos normotensos com microalbuminúria, a administraçao de captopril (NDMC,n = 7) ou placebo (NDMP,n = 5) por 20 semanas nao alterou a PA ou a Ualb, embora no NDMC as taxas da Ualb se mantivessem sempre abaixo dos valores basais, o que nao ocorreu no NDMP. Os valores do FPR, RFG e FF nao se alteraram nos dois grupos. Assim, demonstramos um efeito antiproteinúrico do captopril, que, ao contrário do observado com hidroclortiazida, nao parece depender exclusivamente de sua açao antihipertensiva ou de alteraçoes na hemodinâmica renal.