Acute granulomatous interstitial nephritis and colitis in anticonvulsant hypersensitivity syndrome associated with lamotrigine treatment.

We present the case of a 17-year-old woman with a history of bipolar disorder, who developed a clinical syndrome manifested by fever, lymphadenopathy, skin rash, diarrhea, and acute renal failure requiring dialysis after the use of lamotrigine. Renal biopsy showed acute interstitial nephritis (AIN) with focal granulomas. Similarly, colonic biopsy specimens showed colitis and ileitis with non-necrotizing epithelioid granulomas. The patient had a complete recovery after withdrawal of the medication and steroid treatment. Although lamotrigine has been previously implicated in the development of anticonvulsant hypersensitivity syndrome, there have been no previous reports of acute granulomatous interstitial nephritis or colitis associated with the use of this drug.

Safety and tolerance of medical nutritional products as sole sources of nutrition in people on hemodialysis.

OBJECTIVE: Establish and compare the safety and tolerance of three medical nutritional products when used as sole sources of nutrition in stable hemodialysis patients. DESIGN: Prospectively randomized, controlled, single blind, parallel design. SETTING: Three outpatient hemodialysis clinics. PARTICIPANTS: Seventy-nine normally nourished, stable, anuric, adequately dialyzed, adult outpatients with end-stage renal disease (ESRD) and requiring thrice weekly hemodialysis. INTERVENTION: A 3-week trial was conducted. During the first week, baseline medical history and physical examination, gastrointestinal symptom, urea kinetic, bowel habit, and biochemical data were collected while participants ingested their usual diet. During the last 2 weeks, the same data were collected while participants orally ingested 35 kcal/kg actual weight/d of one of three medical nutritional products as a sole source of nutrition. Products were a standard medical nutritional (EN-9527) and two renal nutritionals (EN-9528 and EN-9529). The latter product was a reformulation of EN-9528 and contained added beta-carotene and fructooligosaccharides. MAIN OUTCOME MEASURES: Gastrointestinal symptoms, bowel habits (stool frequency and consistency), routine blood chemistries, urea kinetics, and normalized protein catabolic rate (nPCR) RESULTS: All three groups achieved a mean energy and protein intake of approximately 35 kcal/kg/d and 1.25 g protein/kg/d during the last 10 days of the sole source feeding period. Adherence with the formula ingestion targets was assessed using both a patient-completed product consumption log and nPCR. By intent to treat analysis, there were no changes in number or severity of gastrointestinal symptoms, stool frequency or stool consistency, or urea kinetics between the baseline week and during product consumption. In comparison to the standard formulation, the disease-specific formulations resulted in improved serum phosphorus and calcium-phosphorus product. Patients receiving the fructooligosaccharide-containing product (EN-9529), by Chi-squared analysis, had less constipation than for the comparable product without oligosaccharides (EN-9528) or the standard medical nutritional (EN-9527). CONCLUSION: Use of enteral nutritionals as a sole source of nutrition is both possible and well tolerated in hemodialyzed patients. Selection of a disease-specific formulation offered advantages over a standard formulation in the management of biochemical complications of renal disease when the products were used as a sole source of nutrition.

Altered renal calcium handling in hypercalcemia of malignancy.

It has been controversial whether increased renal tubular calcium reabsorption contributes to hypercalcemia in patients with malignancies. Moreover, whether this abnormality is associated with volume depletion, a parathyroid hormone-like effect, or other mechanisms has not been clarified. Eight consecutive patients with hypercalcemia due to a variety of tumor types were studied in detail. The glomerular filtration rate (iothalamate clearance) was reduced in all patients (0.98 +/- 0.10 (mean +/- SE) mL/s.1.73 m2; P less than 0.001) compared with normal controls (N = 9) (1.93 +/- 0.08 mL/s.1.73 m2), but it was similar to that in controls matched for renal insufficiency (N = 6) (1.15 +/- 0.05 mL/s.1.73 m2). During hypercalcemia produced by calcium infusion, urinary calcium excretion (millimoles of calcium per liter of glomerular filtrate) was increased in controls with renal insufficiency compared to those with normal renal function (P = 0.028). In all patients with hypercalcemia of malignancy, urinary calcium excretion was decreased compared with controls with renal insufficiency, but it was low in only five of eight patients compared with normal controls. Extracellular fluid volume (iothalamate volume of distribution) was not decreased in any patient, and urinary cAMP and/or plasma parathyroid hormone-like bioactivity were increased in six of eight patients. After treatment with an inhibitor of bone resorption, aminopropylidene 1,1 diphosphonate, abnormal renal calcium handling was not detected if the serum calcium normalized. It was concluded that increased renal tubular calcium reabsorption was consistently present in patients with hypercalcemia of malignancy compared with controls matched for renal insufficiency, but the proportion with the abnormality was underestimated if normal controls were used.(ABSTRACT TRUNCATED AT 250 WORDS)

Distal tubular acidification in the remnant kidney.

The present studies examined the effect of three-fourths nephrectomy on the rate of acidification, i.e., total CO2 (tCO2) absorption (JtCO2) in the superficial distal tubule of the rat. Total glomerular filtration rate following three-fourths nephrectomy was 1.29 +/- 0.06 vs. 3.29 +/- 0.08 ml/min in sham controls, P less than 0.001. Systemic acid-base parameters were the same in both groups, but urine pH was lower in nephrectomized rats. In vivo microperfusion with identical isohydric solutions revealed that the JtCO2, fluid absorption (Jv), lumen-negative transepithelial potential difference (VT) were all significantly greater in the distal tubule of remnant kidneys. As the relative increase in Jv exceeded JtCO2, the perfusate tCO2 concentration increased markedly in remnant kidney distal tubules from 30.3 +/- 0.59 to 39.9 +/- 1.73 mM. To determine if the increase in tCO2 concentration accounted for the difference in JtCO2, a second control group was studied using a perfusate tCO2 concentration of 39.6 +/- 0.79 mM. Distal tubular JtCO2, Jv, and VT were significantly less in this control group than in the remnant kidney group. In separate studies, 10(-4) M amiloride was added to the perfusate used in remnant kidneys and controls studied with the elevated perfusate tCO2 concentration. The addition of 10(-4) M amiloride to the perfusate reduced VT and JtCO2. At identical values for VT, JtCO2 was higher in the distal tubule of remnant kidneys than in controls. We conclude the following. 1) The rate of acidification is increased in the distal tubule of remnant kidneys.(ABSTRACT TRUNCATED AT 250 WORDS)

Dopamine stimulates cAMP production in canine afferent arterioles via DA1 receptors.

Dopamine increases renal blood flow and dilates isolated afferent and efferent arterioles preconstricted with norepinephrine via dopamine 1 (DA1) receptors. DA1-receptor stimulation also results in dopamine-induced elevation of adenosine 3'5'-cyclic monophosphate (cAMP) in dog and rat renal arteries. The present study was undertaken to determine the effects of dopamine on cAMP accumulation in isolated canine superficial cortical afferent arterioles. The effect of Sch 23390, a specific DA1-receptor antagonist, on dopamine-stimulated cAMP accumulation was also examined. Forskolin (10(-5) M), a potent stimulator of adenylate cyclase, produced a greater than 11-fold increase in cAMP production compared with control. Dopamine produced a dose-dependent increase in cAMP accumulation in afferent arterioles at concentrations of 10(-4) M and 10(-6) M, Sch 23390 (2 x 10(-4) M) abolished dopamine (10(-4) M)-stimulated cAMP accumulation in afferent arterioles. The dopamine-induced increase in arteriolar cAMP accumulation was unaffected by propranolol (10(-4) M). Our results suggest that dopamine increases cAMP production in afferent arterioles via the DA1 receptor. Increased cAMP production may be responsible for dopamine-induced vasodilation in the afferent arteriole.

Angiotensin II-stimulated prostaglandin production by canine renal afferent arterioles.

Production of prostaglandin E2 (PGE2) and prostacyclin (PGI2) as 6-ketoprostaglandin F1 alpha (PGF1 alpha) in isolated canine superficial and juxtamedullary afferent arterioles was measured in the basal state and after administration of angiotensin II and bradykinin. Individual afferent arterioles were obtained by microdissection, and pooled collections were incubated at 37 degrees C for two consecutive 30-min periods. Prostaglandin content of the incubation media was measured by radioimmunoassay and expressed as picograms prostaglandin per incubation vial per 30-min period. Bradykinin (10(-7) M) produced significant stimulation of both PGE2 and 6-keto-PGF1 alpha production in superficial (PGE2 from 0.44 +/- 0.32 to 5.46 +/- 3.77 pg/period and 6-keto-PGF1 alpha from 6.5 +/- 5.0 to 104.5 +/- 25.5 pg/period) and juxtamedullary afferent arterioles (PGE2 from 0.31 +/- 0.06 to 7.47 +/- 1.55 pg/period and 6-keto-PGF1 alpha from 12.0 +/- 0.01 to 184.4 +/- 14.8 pg/period). Angiotensin II in concentrations of 10(-12) M to 10(-7) M produced no stimulation of prostaglandin production. Angiotensin II (10(-6) M) produced significant stimulation of 6-keto-PGF1 alpha production only in superficial afferent arterioles (from 4.4 +/- 0.8 to 17.3 +/- 3.1 pg/period). Angiotensin II-stimulated 6-keto-PGF1 alpha production was blocked by saralasin (2 X 10(-6) M). A heterogeneous renal vascular response to angiotensin II is demonstrated, since the latter stimulated PGI2 production in superficial afferent arterioles only. PGI2 could potentially antagonize the vasoactive effect of angiotensin II in superficial afferent arterioles.

Total CO2 absorption in the distal tubule of the rat.

By use of in vivo microperfusion methodology, we assessed proton secretion (acidification) in the superficial distal tubule of the rat by determining the rate of total CO2 (tCO2) absorption (JtCO2). In these studies, we compared the JtCO2 in rats fed a diet that increased urine pH to the JtCO2 in rats fed a high-protein diet that reduced urine pH. The effect of amiloride added to the perfusate, used in rats fed the high-protein diet, was also examined. In rats, Group 1, fed a commercial diet, urine pH was 6.9; plasma tCO2 was 30.0 mM, and JtCO2 was 15.5 +/- 5.3 pmol X mm-1 X min-1. Following the ingestion of a high-protein diet the night before study, the urine pH fell to 5.6 and the plasma tCO2 to 28.2 mM. The JtCO2 in this group, Group 2, 41.1 +/- 4.8 was significantly greater than Group 1, P less than 0.05. The late distal transepithelial potential difference was comparable in both groups, -50.3 +/- 4.3 vs. -45.2 +/- 3.1 mV, P not significant. In a third group, Group 3, amiloride (10(-4) M) was added to the perfusate of rats prepared as in Group 2. JtCO2 was 23.4 +/- 0.4 pmol X mm-1 X min-1, significantly less than Group 2, P less than 0.05. The transepithelial potential difference was reduced to -4.0 +/- 2.3 mV, P less than 0.01 vs. Group 2. We conclude that the superficial distal tubule of the rat responds to subtle stimuli to increase proton secretion and contributes to urinary acidification. The rate of acidification can be influenced by alterations in the electrical profile across the acidifying epithelium.

Effect of acute hypercapnia on renal and proximal tubular total carbon dioxide reabsorption in the acetazolamide-treated rat.

The present study evaluates the effect of acute hypercapnia on renal total CO2 (tCO2) reabsorption after inhibition of renal carbonic anhydrase. Simultaneous renal clearance studies and free-flow micropuncture studies of the superficial proximal tubule were performed on plasma-repleted Sprague-Dawley rats treated with acetazolamide, 50 mg/kg body weight. Acute hypercapnia (arterial PCO2, 120 mmHg; blood pH, 7.02) was induced by ventilation with a 10% CO2-90% O2 gas mixture. Control rats (PCO2, 49.5 mmHg, pH 7.34) were ventilated with room air. The renal fractional excretion of tCO2 was approximately 20% lower in the hypercapnic group compared with the rats given acetazolamide alone. Acute hypercapnia reduced the fractional delivery of tCO2 to the late proximal tubule by a comparable amount. The absolute proximal reabsorption of tCO2 was increased by hypercapnia to 410 +/- 47 vs. 170 +/- 74 pmol X min-1, P less than 0.05. The single nephron glomerular filtration rate was 32.6 +/- 0.7 nl X min-1 in the hypercapnic group and 43.8 +/- 1.7 nl X min-1 in the rats given acetazolamide only, P less than 0.01. Acute hypercapnia enhances renal sympathetic nerve activity. To eliminate this effect, additional experiments were performed in which the experimental kidney was denervated before study. Denervation prevented the change in the single nephron filtration rate during acute hypercapnia, but absolute and fractional proximal tCO2 reabsorption remained elevated in comparison to denervated controls. The concentration of H2CO3 in the late proximal tubule, calculated from the measured luminal pH and bicarbonate concentration and the estimated cortical PCO2, was higher in the hypercapnic group, which was a finding compatible with H2CO3 cycling from lumen into proximal tubular cell, which provided a source of hydrogen ions for secretion.

Effect of indomethacin on papillary solute concentration in the potassium-deficient rat.

Administration of indomethacin or meclofenamate to normal rats increases renal papillary solute concentration primarily by enhancing solute addition. A reduction in papillary solute concentration is characteristic of potassium deficiency. Of the multiple factors probably responsible for this reduction, several can be influenced by indomethacin or meclofenamate. The present study examined the effect of indomethacin on papillary solute concentration in the potassium-deficient rat. Indomethacin increased papillary solute concentration in normal but not potassium-deficient rats when studied in the conscious hydropenic state. Since indomethacin could increase papillary plasma flow in the potassium-deficient rat, potentially negating any enhancement of solute transport into the papilla, papillary plasma flow and papillary Cl concentration were determined in anesthetized surgically manipulated rats. Base-line papillary Cl concentrations were reduced in this setting. Indomethacin increased papillary plasma flow only in potassium-deficient rats but increased papillary Cl concentration equivalently in normal and potassium-deficient rats. The ability of indomethacin to increase papillary solute concentration in the potassium-deficient rat seemingly depends upon the experimental setting.

Effect of metabolic acidosis on proximal tubular total CO2 absorption.

In vivo microperfusion studies of the proximal convoluted tubule of the rat were performed to determine the effect of metabolic acidosis on total CO2 (tCO2) absorption. In series I, tubular perfusion was performed in control and acidotic rats in a manner by which similar mean total CO2 concentrations in the proximal tubule were maintained. Comparable ranges of perfusion rate were studied in both groups. Following 3 days of HCl ingestion, plasma tCO2 was 20.0 +/- 0.9 mM in the acidotic rats whereas it was 29.6 +/- 0.53 mM in control rats. The arterial blood pH values were 7.25 +/- 0.02 vs. 7.43 +/- 0.01. Starting tCO2 perfusate concentrations were identical in both groups, 29.3 and 29.7 mM, as were the concentrations at the end of the perfused segments, 21.2 and 21.9 mM. The absorption of tCO2 (JtCO2, pmol X mm-1 X min-1) was significantly greater in the acidotic rats than in the controls, 576 +/- 39 vs. 256 +/- 21. At all perfusion rates studied, proximal tubular JtCO2 was higher in the acidotic than in the control rats. In series II, similar lengths of the late proximal tubule were perfused at the same rate in control and acidotic rats. Again, JtCO2 was higher in the acidotic rats, 352 +/- 19 vs. 198 +/- 13. The results indicate that at comparable luminal tCO2 concentration and tubular fluid flow rates, tCO2 absorption is significantly increased in the acidotic state. Although other mechanisms cannot be excluded, the finding of an increase in proximal tCO2 absorption in the acidotic rats is in agreement with the presence of an accelerated Na+/H+ exchange rate in brush border membrane vesicles obtained from the renal cortex of animals with metabolic acidosis.

Bicarbonate reabsorption in the papillary collecting duct: effect of acetazolamide.

The present study was designed to characterize bicarbonate (total CO2) reabsorption in the papillary collecting duct of the kidney of the Munich-Wistar rat when total CO2 delivery to this segment was increased by the systemic infusion of a bicarbonate-rich solution. Additional studies examined the effect of the systemic administration of acetazolamide, a carbonic anhydrase inhibitor, on total CO2 reabsorption. Employing free-flow micropuncture techniques, tubular fluid samples were obtained from the base and tip of the exposed papilla and subsequently analyzed for total CO2 and inulin. Total CO2 reabsorption increased in a linear fashion, approximating 34% of that delivered to the base, as total CO2 delivery increased from 3 to 20% of the filtered load. When examined at comparable absolute rates of total CO2 delivery (mumol/min) to the papillary collecting duct, acetazolamide administration resulted in marked inhibition of total CO2 reabsorption. The results of these studies suggest that the papillary collecting duct of the rat kidney possesses a significant capacity for reabsorption of total CO2 and that this reabsorption is diminished by the administration of acetazolamide.

Effect of potassium deficiency on papillary plasma flow in the rat.

Chronic potassium (K+) deficiency has been shown previously to cause a reduction in solute content in the renal papilla, an effect that is potentially important as a contributing factor to the concentrating defect seen in this circumstance. The cause of the decrease in papillary solute content has not been adequately explained. Because alterations in the blood flow rate through the renal papilla may affect the solute content of the papilla, the present experiments examined the effect of chronic K+ deficiency on papillary plasma flow (PPF) in the rat. PPF was measured by the radioactive albumin accumulation technique. Sprague-Dawley rats were fed identical quantities of water and either a normal or a K+-deficient diet for 21 days. Total GRR in the control rats, 1.7 +/- 0.17 (SE) ml/min, was similar to that in K+-deficient rats, 1.4 +/- 0.14 ml/min (P greater than 0.01). Total [3H]PAH clearance was also comparable in the two groups, i.e., 4.4 +/- 0.47 in control and 4.7 +/- 0.45 ml/min in K+-deficient rats (P greater than 0.06). PPF was significantly lower in K+-deficient rats, 19.7 +/- 1.1 ml-min-1-100 g-1, than in control rats, 59.8 +/- 1.6 ml-min-1-100 g-1 (P less than 0.001). The decrease in PPF in the K+-deficient rat may reflect a reduction in perfusion to the juxtamedullary nephrons, thereby resulting in a diminution in both solute delivery and blood flow to the papilla.

Studies on the mechanism of reduced urinary osmolality after exposure of renal papilla.

Studies were performed in Munich-Wistar rats to determine whether changes in papillary plasma flow might be responsible for the concentrating defect which occurs after exposure of the extrarenal papilla. Papillary plasma flow was measured by (125)I-albumin accumulation. Initial studies in hydropenic animals revealed that papillary plasma flow was 40% higher in the kidney with the exposured papilla, 41 vs. 29 ml/min per 100 g of papilla (P < 0.001). This increase in papillary plasma flow was detectable 15 or 45 min after removing the ureter. Because it was unclear whether the rise in papillary plasma flow was a cause or the result of the fall in urine osmolality, similar studies were performed in animals undergoing a water diuresis. In this setting, papillary plasma flow still increased on the exposed side compared to the control side, 81 vs. 60 ml/min per 100 g, despite similarly low urine osmolalities of 155 and 174 mosmol/kg, respectively. This finding is compatible with the possibility that papillary exposure per se causes an increase in papillary plasma flow and that this hemodynamic alteration may lead to a reduction in urinary osmolality secondary to washout of the medullary interstitium. A final group of hydropenic rats was given either indomethacin or meclofenamate before removing the ureter. In these studies, there was no difference in either the papillary plasma flow or the urine osmolality between control and exposed kidneys. It is therefore suggested that opening the ureter induces an increase in papillary plasma flow by some mechanism which may involve an alteration in prostaglandin synthesis.

Disorders of hypo- and hyperkalemia.

Hypokalemia or hyperkalemia may be present as an important feature of a large number of clinical entities. To understand the means by which a hypokalemia or hyperkalemic state may be generated, it is necessary to appreciate those factors which influence the external balance of potassium and the entities which effect its transcellular distribution. In this review the role of the kidney and the gastrointestinal tract in the regulation of the external balance of potassium is briefly discussed. This is followed by a description of the clinical disorders associated with hypokalemia and hyperkalemia.

The effect of an acute increase in renal perfusion pressure on sodium transport in the rat kidney.

We used micropuncture techniques to examine the intrarenal response to an acute elevation of the renal perfusion pressure. In one series of studies (epinephrine, group I) the renal perfusion pressure was acutely increased by intravenous epinephrine infusion; in another series, by bilateral carotid occlusion and vagotomy. A third series of studies (epinephrine, group II) was performed identically to the epinephrine, group I, studies except that the renal perfusion pressure was held constant during the epinephrine infusion by suprarenal aortic constriction. After epinephrine infusion (group I) and following bilateral carotid occlusion and vagotomy the renal perfusion pressure increased, from 119 +/- 1.0 (SEM) to 166 +/- 1.85 mm Hg and from 122 +/- 5.9 to 168 +/- 3.1 mm Hg, respectively. Fractional sodium excretion rose from 2.31 +/- 0.34% to 5.09 +/- 0.58% (P less than 0.001) after epinephrine and from 1.80 +/- 0.71 to 6.40 +/- 1.0% (P less than 0.01) following carotid occlusion and vagotomy. In neither study, however, did we find that the increase in renal perfusion pressure changed the glomerular filtration rate (GFR) (both kidneys) or fractional sodium delivery from the superficial cortical late distal tubule. Furthermore, we found that epinephrine infusion at a constant renal perfusion pressure (epinephrine, group II) did not affect fractional sodium excretion, although a small, but significant, decrease in the GFR and sodium delivery from the superficial late distal tubule occurred. These data suggest that the natriuresis which follows an acute elevation of the renal perfusion pressure cannot be attributed to enhanced sodium delivery from superficial nephrons but must result from (1) inhibition of sodium reabsorption in inner cortical nephrons or (2) an effect on sodium transport in the collecting system.

Direct measurement of papillary collecting duct sodium transport in the rat. Evidence for heterogeneity of nephron function during Ringer loading.

It has been suggested that collecting duct sodium transport was inhibited by extracellular volume expansion. To directly evaluate this possibility, micropuncture of the papillary collecting duct of young rats was performed during hydropenia and Ringer loading. The possibility of heterogeneity of nephron function was evaluated during Ringer and hyperoncotic albumin loading by comparing the delivery of sodium to the end of the distal tubule of superficial nephrons with papillary base delivery. During hydropenia (n = 14), sodium delivery to the base averaged 0.95% of the filtered sodium load and reabsorption along the collecting duct was noted from base to tip in each collection pair averaging 0.80% of the filtered load. During Ringer loading, sodium delivery to the base was markedly greater than in hydropenia, 11.8 vs. 0.95% of the filtered load (P less than 0.001). Yet, sodium reabsorption was also much greater, 6 vs. 0.8% (P less than 0.001). In 13 paired collections, during Ringer loading, sodium delivery to the papillary base, 12.2% of the filtered load, was consistently greater than late distal tubular delivery from superficial nephrons. 8% (P less than 0.005). In contrast, reabsorption of sodium from late distal tubule to papillary base was found during albumin infusion, 6.2 vs. 3.1% (P less than 0.001). Therefore, these studies demonstrate that: (a) the delivery of sodium to and reabsorption along the papillary collecting duct were markedly greater during Ringer loading than in hydropenia; (b) the amount of sodium delivered to the papillary base was greater than the delivery to the end of the distal tubule of superficial nephrons during Ringer loading, suggesting that deeper nephrons deliver more sodium to the collecting duct in this setting; and (c) the difference in sodium excretion between Ringer loading and hyperoncotic albumin infusion is due to events occurring between the late distal tubule of superficial nephrons and the base of the papillary collecting duct.

Clarification of the site of action of chlorothiazide in the rat nephron.

The saluretic effect of the thiazide diuretics has been attributed to inhibition of sodium reabsorption in the distal nephron of the kidney. Recent micropuncture studies have shown, however, that chlorothiazide administration can also inhibit sodium reabsorption in the proximal convolution. To clarify the site of the saluretic effect of chlorothiazide, these micropuncture studies examined the effect of chlorothiazide on chloride transport in the nephron. The effect of chlorothiazide on chloride transport was studied because chlorothiazide's effectiveness as a saluretic is largely due to its ability to enhance sodium chloride excretion; if only changes in sodium transport are examined, it would be then difficult to determine if sodium as bicarbonate or as chloride is affected, since chlorothiazide can inhibit carbonic anhydrase. One group of rats was studied before and after 15 mg/kg per h chlorothiazide. For comparison, another group of rats was studied before and after 2 mg/kg per h benzolamide, a carbonic anhydrase inhibitor. Fractional chloride delivery from the proximal tubule was similarly increased in both groups from 59.4 to 71.0% by chlorothiazide administration, Pless than 0.0001, and from 54.3 to 68.2% by benzolamide administration, P less than 0.001. The increased delivery very of chloride from the proximal tubule was largely reabsorbed before the early distal tubule as fractional chloride delivery to this site increased only from 5.08 to 7.40% after chlorothiazide administration, P less than 0.001, and from 4.50 to 6.29% after benzolamide administration, P less than 0.01. Benzolamide had no effect on chloride reabsorption in the distal convoluted tubule. However, chlorothiazide administration resulted in a marked decrease in distal tubular chloride reabsorption, the fraction of filtered chloride present at the late distal tubule incresing from 1.24 to 6.25%, P less than 0.001. Fractional chloride excretion in the urine increased from 0.29 to 3.44%, P less than 0.001, after chlorothiazide, but did not change after benzolamide. The influence of chlorothiazide on proximal chloride transport presumably is related to its ability to inhibit renal carbonic anhydrase. However, it is not the effect of chlorothiazide in the proximal convolution but rather its effect in the distal convoluted tubule which is primarily responsible for its ability to be an effective saliuretic.