Abstract:
BACKGROUND:The pathophysiology of hypertension in patients with chronic kidney disease (CKD) is largely attributed to positive sodium balance. It is unclear how loop diuretics affect fluid volume compartments, especially with respect to their antihypertensive effect. METHODS:Subjects with CKD were administered a single therapeutically equivalent dose of an oral loop diuretic (furosemide or torsemide in randomized crossover design). We measured acute volume changes over 12 hours using biophysical and hormonal biomarkers and then 24-hour ambulatory blood pressure after daily diuretic therapy for 3 weeks. RESULTS:Single-dose administration of loop diuretic decreased extracellular water (ECW) by 1.7 L [95% confidence interval (95% CI) 1.2, 2.2, P < 0.001], total body water (TBW) by 1.2 L (95% CI 0.5, 1.9, P < 0.001), and increased natural log (ln) plasma renin activity (PRA) from -1.2 +/- 1.3 ng/mL/hour to -0.5 +/- 1.5 ng/mL/hour (P < 0.001). Daily loop diuretic administration resulted in reduced ECW from 24.2 +/- 6.4 L to 22.3 +/- 5.2 L (P = 0.02) and TBW from 54.3 +/- 12.7 L to 51.6 +/- 11.9 L (P < 0.001) in 1 week. After 3 weeks of diuretic therapy, whereas ECW reduction persisted at 22.8 +/- 5.1 L (P = 0.05), TBW trended toward baseline level at 52.7 +/- 11.8 L. A concomitant increase in ln PRA from -1.0 +/- 1.3 ng/mL/hour to 0.4 +/- 1.9 ng/mL/hour (P < 0.001) and ln plasma aldosterone (PA) from 2.0 +/- 0.8 ng/dL to 2.3 +/- 0.8 ng/dL (P < 0.005) and fall in ln brain natriuretic peptide (BNP) from 4.3 +/- 0.9 pg/mL to 3.7 +/- 1.0 pg/mL (P < 0.01) were seen at 1 week. Despite a trend toward restoration of TBW, changes in hormonal biomarkers were maintained at 3 weeks. Over these 3 weeks, furosemide reduced 24-hour ambulatory blood pressure from 147 +/- 17/78 +/- 11 mm Hg to 138 +/- 21/74 +/- 12 mm Hg (P = 0.021) and torsemide reduced it from 143 +/- 18/75 +/- 10 mm Hg to 133 +/- 19/71 +/- 10 mm Hg (P = 0.007). CONCLUSION:Patients with CKD have elevated extracellular fluid volume that can be corrected acutely with loop diuretics. Persistent diuretic use results in dynamic changes in ECW and other body fluid compartments that translate into chronic blood pressure reduction.
journal_name
Kidney Intjournal_title
Kidney internationalauthors
Vasavada N,Agarwal Rdoi
10.1046/j.1523-1755.2003.00273.xsubject
Has Abstractpub_date
2003-11-01 00:00:00pages
1772-9issue
5eissn
0085-2538issn
1523-1755pii
S0085-2538(15)49528-6journal_volume
64pub_type
临床试验,杂志文章,随机对照试验abstract::Renal fibrosis is a common pathway leading to the progression of chronic kidney disease, and bone marrow-derived fibroblasts contribute significantly to the development of renal fibrosis. However, the signaling mechanisms underlying the activation of these fibroblasts are not completely understood. Here, we examined t...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1016/j.kint.2017.04.021
更新日期:2017-12-01 00:00:00
abstract:BACKGROUND:Hyperoxaluria may be idiopathic, secondary, or due to primary hyperoxaluria (PH). Hepatic alanine:glyoxylate aminotransferase (AGT) or glyoxylate/hydroxypyruvate reductase (GR/HPR) deficiency causes PHI or PHII, respectively. Hepatic glycolate oxidase (GO) is a candidate enzyme for a third form of inherited ...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1046/j.1523-1755.2002.00468.x
更新日期:2002-08-01 00:00:00
abstract::Osteopontin is an arginine-glycine-aspartate (RGD) containing secreted phosphoprotein recently shown to stimulate a local macrophage influx when injected subcutaneously in mice. We examined the effect of angiotensin II infusion on renal injury and osteopontin expression in the rat kidney by in situ hybridization and i...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1038/ki.1994.67
更新日期:1994-02-01 00:00:00
abstract::Accumulation of extracellular matrix within the mesangium is an important event in the development of glomerular disease. In this report we have used indirect immunofluorescence to positively identify a number of constituents of the mesangial matrix synthesized by rat mesangial cells (RMC) in vitro including laminin, ...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1038/ki.1995.412
更新日期:1995-10-01 00:00:00
abstract::The application of our evolving knowledge of adhesion receptors to experimental models of immune complex glomerulonephritis has led to substantial advances in our understanding of how leukocytes emigrate from the vasculature into glomeruli and produce glomerular dysfunction. With respect to neutrophil (PMN) migration ...
journal_title:Kidney international
pub_type: 杂志文章,评审
doi:10.1038/ki.1997.201
更新日期:1997-05-01 00:00:00
abstract::Autophagy is a dynamic and highly regulated process of self-digestion responsible for cell survival and reaction to oxidative stress. As oxidative stress is increased in uremia and is associated with vascular calcification, we studied the role of autophagy in vascular calcification induced by phosphate. In an in vitro...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1038/ki.2012.482
更新日期:2013-06-01 00:00:00
abstract:BACKGROUND:In uremic patients with secondary hyperparathyroidism (2HPT), nodular hyperplasia of parathyroid gland shows a monoclonal pattern of cell proliferation, in which a decreased density of vitamin D receptor (VDR) also is demonstrated. The present study aimed at elucidating the mechanism of parathyroid cell prol...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1111/j.1523-1755.2002.kid585.x
更新日期:2002-10-01 00:00:00
abstract::Atypical hemolytic uremic syndrome and thrombotic thrombocytopenic purpura have traditionally been considered separate entities. Defects in the regulation of the complement alternative pathway occur in atypical hemolytic uremic syndrome, and defects in the cleavage of von Willebrand factor (VWF)-multimers arise in thr...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1016/j.kint.2016.03.023
更新日期:2016-07-01 00:00:00
abstract::Hydrogen sulfide has recently been found decreased in chronic kidney disease. Here we determined the effect and underlying mechanisms of hydrogen sulfide on a rat model of unilateral ureteral obstruction. Compared with normal rats, obstructive injury decreased the plasma hydrogen sulfide level. Cystathionine-β-synthas...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1038/ki.2013.449
更新日期:2014-06-01 00:00:00
abstract::The clinical value of biocompatible peritoneal dialysis solutions is uncertain because of inconsistent findings in randomized controlled trials. A systematic review by Cho et al. examining 20 such trials suggests a beneficial effect on residual renal function. However, the finding is not robust and may relate to decre...
journal_title:Kidney international
pub_type: 评论,杂志文章
doi:10.1038/ki.2013.303
更新日期:2013-11-01 00:00:00
abstract:BACKGROUND:Poly (ADP-ribose) polymerase (PARP), a nuclear enzyme activated by strand breaks in DNA, plays an important role in the development of ischemia/reperfusion (I/R) injury. The aim of this study was to investigate the effects of a water-soluble and potent PARP inhibitor, 5-aminoisoquinolinone (5-AIQ), on the re...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1111/j.1523-1755.2004.00415.x
更新日期:2004-02-01 00:00:00
abstract:BACKGROUND:Regular monitoring of dialysis grafts is recommended, but the value of dialysis graft blood flow monitoring and venous pressures in predicting subsequent outcomes are controversial. METHODS:Over a period of one month, we performed simultaneous flow and venous pressure monitoring in 71 dialysis patients with...
journal_title:Kidney international
pub_type: 临床试验,杂志文章
doi:10.1046/j.1523-1755.2001.060002762.x
更新日期:2001-08-01 00:00:00
abstract::This study examined the expression of EPO, VEGF and VEGF receptor gene under conditions of reduced oxygen supply in primary cultures of rat hepatocytes, and compared it with the expression of these genes in hypoxic rat livers in vivo. To this end we exposed male Sprague-Dawley rats to hypoxia (10% and 8% O2), carbon m...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1038/ki.1997.60
更新日期:1997-02-01 00:00:00
abstract::The introduction of two-photon microscopy, along with the development of new fluorescent probes and innovative computer software, has advanced the study of intracellular and intercellular processes in the tissues of living organisms. Researchers can now determine the distribution, behavior, and interactions of labeled...
journal_title:Kidney international
pub_type: 杂志文章,评审
doi:10.1038/sj.ki.5002315
更新日期:2007-08-01 00:00:00
abstract:UNLABELLED:Hereditary systemic amyloidosis associated with a new apolipoprotein AII stop codon mutation Stop78Arg. BACKGROUND:Mutations in the gene for apolipoprotein AII (apoAII) have recently been found to cause hereditary renal amyloidosis. In each case amyloid deposition has been associated with a peptide extensio...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1046/j.1523-1755.2003.00047.x
更新日期:2003-07-01 00:00:00
abstract:BACKGROUND:Increasing proteinuria in kidney disease is associated with an increased risk of renal failure. Urinary proteins such as albumin induce inflammatory signaling and gene expression in tubular epithelial cells (TECs). Fibronectin is an extracellular matrix protein that can exist in soluble form and is excreted ...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1111/j.1523-1755.2005.00667.x
更新日期:2005-11-01 00:00:00
abstract::Kidney disease is associated with increased cardiovascular morbidity, but underlying mechanisms are poorly understood. We tested the hypothesis that chronic renal insufficiency impairs angioadaptation in a rat model of hindlimb ischemia. Twenty male Sprague-Dawley rats (8 weeks old) underwent subtotal nephrectomy (5/6...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1038/sj.ki.5000448
更新日期:2006-06-01 00:00:00
abstract::Platelet activating factor (PAF) is a potent lipid mediator with a broad range of biologic activities. Experimental evidence suggests that PAF plays a role in the pathogenesis of a variety of inflammatory processes including allograft rejection. In this study, we evaluated the effects of the PAF antagonist BN52021 on ...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1038/ki.1995.301
更新日期:1995-08-01 00:00:00
abstract::A substantial body of evidence has accumulated linking an increased incidence of cardiovascular disease in patients with acute kidney injury (AKI), chronic kidney disease (CKD), and end-stage renal disease (ESRD). A multitude of novel risk factors related to decreased kidney function might interact with the renal and ...
journal_title:Kidney international
pub_type: 杂志文章,评审
doi:10.1038/ki.2011.178
更新日期:2011-09-01 00:00:00
abstract:BACKGROUND:The relationship between low hematocrit and contrast-induced nephropathy has not been investigated. METHODS:Of 6,773 consecutive patients treated with percutaneous coronary intervention, contrast-induced nephropathy (an increase of >/=25% or >/=0.5 mg/dL in preprocedure serum creatinine, at 48 hours postpro...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1111/j.1523-1755.2005.67131.x
更新日期:2005-02-01 00:00:00
abstract::The adjuvanted hepatitis B vaccine, HB-AS04, elicits more rapid and persistent protective antibody concentrations than double doses of conventional recombinant vaccines in patients with renal insufficiency. We compared the immunogenicity, reactogenicity, and safety of the AS02(V)-adjuvanted hepatitis B vaccine HB-AS02...
journal_title:Kidney international
pub_type: 杂志文章,随机对照试验
doi:10.1038/ki.2009.454
更新日期:2010-02-01 00:00:00
abstract::Lithium therapy frequently induces nephrogenic diabetes insipidus; amiloride appears to prevent its occurrence in some clinical cases. Amiloride blocks the epithelial sodium channel (ENaC) located in the apical membrane of principal cells; hence one possibility is that ENaC is the main entry site for lithium and the b...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1038/ki.2009.91
更新日期:2009-07-01 00:00:00
abstract:BACKGROUND:The superiority of renin-angiotensin system (RAS) blockade in providing renoprotection has been attributed to class-specific blood pressure "(BP)-independent" mechanisms. However, the conventional BP measurement methodology on which such conclusions are based is inherently limited for an accurate assessment ...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1046/j.1523-1755.2000.00009.x
更新日期:2000-04-01 00:00:00
abstract::Neuropilin1 (Nrp1) is a co-receptor best known to regulate the development of endothelial cells and is a target of anticancer therapies. However, its role in other vascular cells including pericytes is emergent. The kidney is an organ with high pericyte density and cancer patients develop severe proteinuria following ...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1016/j.kint.2016.10.010
更新日期:2017-04-01 00:00:00
abstract::Since the kidney medulla was reported to generate platelet activating factor (PAF), we investigated a possible effect of this agent on the reabsorptive function of in vitro microperfused medullary thick ascending limbs from mouse kidney (mTAL). PAF, 10(-7) M in the bath, significantly decreased the net chloride flux (...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1038/ki.1992.38
更新日期:1992-02-01 00:00:00
abstract:BACKGROUND:Patients initiating dialysis after a failed kidney transplant are a subgroup of chronic kidney disease (CKD) patients who have not been characterized. Exposure to immunosuppressive medications differentiates these patients from the general incident end-stage renal disease (ESRD) population. METHODS:Data fro...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1046/j.1523-1755.2002.00373.x
更新日期:2002-06-01 00:00:00
abstract::The X-linked Hyp and Gy mutations are murine homologues of X-linked hypophosphatemia (XLH), a dominant disorder of phosphate (Pi) homeostasis characterized by growth retardation, rickets, hypophosphatemia and decreased renal tubular maximum for Pi reabsorption relative to glomerular filtration rate (Tmp/GFR). In Hyp a...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1038/ki.1996.149
更新日期:1996-04-01 00:00:00
abstract:BACKGROUND:Autosomal-dominant medullary cystic kidney disease (ADMCKD), a hereditary chronic interstitial nephropathy, recently attracted attention because of the cloning or mapping of certain gene loci, namely NPHP1, NPHP2 and NPHP3 for familial juvenile nephronophthisis (NPH) and MCKD1 and MCKD2 for the adult form of...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1111/j.1523-1755.2002.kid581.x
更新日期:2002-10-01 00:00:00
abstract::Hypoalbuminemia is the most powerful predictor of mortality in end-stage renal disease. Since protein-calorie malnutrition can decrease albumin synthesis it is assumed that hypoalbuminemia results principally from malnutrition in these patients, but albumin synthesis may also be decreased as part of the acute-phase re...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1038/ki.1995.321
更新日期:1995-08-01 00:00:00
abstract::We previously reported that oxidative stress and renal tubular damage occur in chronic hyperoxaluric rats. However, the in vivo responses of renal epithelial cells after vitamin E administration and their correlations with calcium oxalate (CaOx) crystal formation have not been evaluated. Male Wistar rats received 0.75...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1038/sj.ki.5001651
更新日期:2006-08-01 00:00:00