成人原发性肾病综合征血容量与肾素,醛固酮,心钠素的关系

探讨成人原发性肾病综合征(NS)血容量与肾素、醛固酮及心钠素的关系。方法 应用~(113)mInCl标记转铁蛋白稀释法测定血容量,放免法测定血浆激素水平。对水肿期NS28例、正常26例及其中NS缓解期随访18例进行检测。结果 (1)水肿期NS血容量与正常组无差别,血浆肾素活性(PRA)、血管紧张素Ⅱ(ATⅡ)、醛固酮(Ald)、心钠素(ANP)水平均较正常组高,白蛋白、各激素水平与血容量无显著相关;(2)缓解期与水肿期比较,总的血容量无差异,Ald、ANP显著降低,PRA、ATⅡ则无明显差异;(3)Ald与24小时尿排钠(UNaV)显著负相关。结论 Ald和ANP是NS钠排泄的主要调节因子。     

Renal regulation of salt balance: a primer for non-purists

The greater than 40-fold range of voluntary salt intake in humans requires corresponding adjustments in renal excretion to maintain balance. Although many mechanisms have been implicated in the regulation of salt output by the kidney, surprisingly little consideration has been given to their quantitative significance and possible interaction. This survey summarizes the effects of changes in glomerular filtration rate, proximal peritubular physical factors, and plasma concentrations of aldosterone and atrial natriuretic factor (ANF), singly and in combination, on the level of salt excretion. Contrary to expectation, even large increases in filtration or decreases in proximal reabsorption have only minor natriuretic effects, due to constancy of fractional reabsorption in downstream nephron segments. Lack of aldosterone release increases salt excretion as much or more than the upstream mechanisms, whereas ANF-induced inhibition of reabsorption in the medullary collccting duct has the largest effect. It may be concluded, therefore, that the potency of these natriuretic factors increases with distance along the nephron, even though each is operating on a progressively small tubular load. However, none of the mechanisms, in isolation, is sufficient to explain salt balance over the range of voluntary intake. Combination of factors demonstrates synergism rather than simple additivity, resulting in more than enough reserve capacity for salt excretion.     

Aldosterone and its mechanism of action: more questions than answers

The physiology of the steroid hormone, aldosterone is well defined. The molecular events that mediate this response remain to be elucidated. Aldosterone binds to a specific mineralocorticoid receptor (MR) in sodium transporting epithelia. The structural determinants of ligand-binding have been explored through the analysis of steroid resistance syndromes, however, the molecular basis of resistance to aldosterone, pseudo-hypoaldosteronism remains an enigma. Cortisol also binds MR, access is however restricted by the enzyme 11β-hydroxysteroid dehydrogenase. The MR induces specific genes which regulate apical amiloride-sensitive epithelial sodium channels; the finding of activating mutations in Liddles syndrome (pseudoaldosteronism) has emphasised their key role. Such mechanisms may apply not only to the peripheral effects of aldosterone but also to the central regulation of blood pressure.     

氯沙坦长期治疗对自发性高血压大鼠血管结构的影响

目的 :评价血管紧张素Ⅱ受体 1(AT1)拮抗剂氯沙坦 (Losartan)对自发性高血压大鼠 (SHR)血管结构的影响及在减缓高血压血管损害中的潜在作用 ,并探讨在高血压血管壁增厚的过程中醛固酮所起的作用。方法 :采用 10周龄SHR 16只 ,随机分为Losartan(SHRLOS)治疗组和对照组 (SHR) ,另选 10只同龄Wistar鼠作为正常对照。腹主动脉插管测定收缩压 ,应用计算机图像分析 ,计算血管中膜 /内径比 ,用光镜观察各组主动脉的结构变化 ;行肠系膜动脉离体灌注、反向高效液相 (HPLC)纯化和放免检测氯沙坦对血管局部合成醛固酮的影响。结果 :SHRLOS组收缩压 (SBP)与SHR组相比明显下降 (P =0 .0 0 1) ;其血管中膜 /内径比较SHR组显著降低 ,但仍高于Wistar组 ,血管壁结构接近Wistar组 ;SHRLOS组血管AngⅡ与SHR组无差异 ,醛固酮水平降至Wistar组。结论 :氯沙坦抑制血管合成醛固酮 ,逆转血管重构是其治疗高血压的机理之一。     

Increase of cytochromes a and a3 in rat kidney mitochondria in response to administration of aldosterone in vivo

Summary The influence of aldosterone in vivo on cytochromes in rat kidney mitochondria is studied, comparing rats in normal state, adrenalectomized state, and adrenalectomized rats 2 hours after administration of adlosterone (7.5 g per 100 g rat as single dose plus infusion of 0.125 g per hour and 100 g rat).No significant changes between these states are observed of either cytochrome b, cytochrome c₁, or cytochrome c content.Cytochrome a, as estimated from the 605 m band of the difference spectrum (reduced vs. oxidized), decreases from 508±51 nanomoles per g protein (n=12) in the controls to 273±65 (n=12) nanomoles per g protein in the adrenalectomized state.After administration of aldosterone to adrenalectomized rats the concentration of cytochrome a increased to 464±38 nanomoles per g protein (n=12).The difference spectrum (anaerob vs aerob+Antimycin A) shows that the absorbancy maximum at 444 m (more specific for cytochrome a₃) is also considerably decreased after adrenalectomy, and increased after administration of aldosterone to adrenalectomized rats. Hence the contents of both compounds of cytochrome oxidase, cytochrome a and cytochrome a₃, appear to be controlled by aldosterone.The molar ratio of cytochrome c to cytochrome a is 1.1 in the controls, 1.8 after adrenalectomy, and 1.1 after administration of aldosterone to adrenalectomized rats.Possible relations of this effect to the previously observed increase of tricarboxylic acid cycle enzyme activities under aldosterone are discussed.The 46% decrease of the cytochrome a content in mitochondria from the whole kidney of adrenalectomized rats, which is restored to the normal level in response to aldosterone, is difficult to reconcile with the concept that the hormone acts on distal tubules only, as these constitute only about 10% of the material used. Therefore, the present result is considered to support the concept that the hormone acts on both distal and proximal tubules.     

Change in sympathetic activity,cardiovascular functions and plasma hormone concentrations due to cold water immersion in men

The purpose of this study was to determine whether or not repeated short-term cold water immersions can induce a change in the activity of the sympathetic nervous system and, consequently, in cardiovascular functions in healthy young athletes. Changes in some plasma hormone concentrations were also followed. A single cold water immersion (head-out, at 14°C, for 1 h) increased sympathetic nervous system activity, as evidenced by a four-fold increase (P < 0.05) in plasma noradrenaline concentration. Plasma adrenaline and dopamine concentrations were not increased significantly. Plasma renin-angiotensin activity was reduced by half (P < 0.05) during immersion but plasma aldosterone concentration was unchanged. Stimulation of the sympathetic nervous system during immersion did not induce significant changes in heart rate, but induced peripheral vasoconstriction (as judged from a decrease in skin temperature) and a small increase (by 10%) in systolic and diastolic blood pressures. No clear change in reactivity of the sympathetic nervous system was observed due to repeated cold water immersions (three times a week, for 6 weeks). Neither the plasma renin-angiotensin activity, aldosterone concentration nor cardiovascular parameters were significantly influenced by repeated cold water immersions. A lowered diastolic pressure and an increase in peripheral vasoconstriction were observed after cold acclimation, however. Evidently, the repeated cold stimuli were not sufficient to induce significant adaptational changes in sympathetic activity and hormone production.     

Renal function in relation to three candidate genes in a Chinese population

We recently found in a white population that the genes encoding angiotensin-converting enzyme (ACE, I/D polymorphism), -adducin (Gly460Trp), and aldosterone synthase (–344C/T) jointly influence renal function. We therefore investigated in a Chinese population the associations between the serum concentrations of creatinine and uric acid and these three genetic polymorphisms. We genotyped 471 ethnic Han Chinese subjects from 125 nuclear families recruited in northern China via random population sampling (75%) and at specialized hypertension clinics (25%). We performed population-based and family-based association analyses using generalized estimating equations (GEE) and quantitative transmission disequilibrium test (QTDT), respectively, while controlling for covariables. The participants were 39.7 years old and included 235 women (49.9%). The blood pressure measured at the subjects homes averaged 126/80 mmHg. Mean values were 71 µmol/l for serum creatinine, 111 ml min^–1 1.73 m^–2 for calculated creatinine clearance, and 236 µmol/l for serum uric acid. With adjustment for covariables, GEE analyses of single genes demonstrated that serum uric acid, but not serum creatinine, was positively associated with the ACE D allele. Serum uric acid concentrations were 15.8 µmol/l (95% confidence interval 3.3–28.2) and 25.7 µmol/l (11.1–40.2) higher in DD homozygotes than in ID and II subjects, respectively. Further GEE analyses of the three genes combined showed that the association between serum uric acid and the ACE polymorphism was confined to carriers of the -adducin Gly and/or aldosterone synthase C alleles. Sensitivity analyses in parents and offspring separately as well as QTDT analyses were confirmatory. Among 114 informative offspring carrying the -adducin Gly allele serum uric acid was significantly and positively associated with the transmission of the ACE D allele (=20.7 µmol/l). In conclusion, the present study extends our previous findings on the combined effects of the three candidate genes and supports the concept that these genetic polymorphisms jointly influence renal function.     

Renal metabolism of corticosteroid hormones

Summary IK and STF from male and female rats have been used to study in vitro the renal metabolism of B. in male rat tissue four lipid soluble metabolites (I–IV) have been found, I+II being more polar and III+IV being less polar than B. I and II have been identified as 11-dehydro-20-hydroxy-B and 20-hydroxy-B. The structure of III and IV remains to be determined. Renal tissue from female rats produced predominantly III indicating sexual variations of steroid metabolism in kidneys. — The literature has been reviewed which documents that the kidneys in addition to B metabolize A, cortisol, progesterone and other corticosteroids.

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Abbreviations A Aldosterone - B Corticosterone - Alb Albumin - CS Corticosteroids - MCS/GCS Mineralo-/gluco-CS - IK Isolated (perfused) kidney - STF Suspended tubular fragments Supported by Deutsche Forschungsgemeinschaft Hi 97/16     

Increased chloride permeability of amphibian epithelia treated with aldosterone

The transepithelial flux of chloride was increased by aldosterone treatment of amphibian skin and bladder and this was reflected by increased shunt conductance. The hormonal effect depended on the presence of chloride on the epithelial side of the preparation. These changes in tissue conductance and chloride permeability appear to be a direct effect of aldosterone as they did not occur when sodium transport was stimulated with vasopressin or hypotonicity.Chloride efflux was reduced in magnitude by indacrinone and DIDS, as well as after removal of chloride from the solution on the epithelial side of the preparations. These results suggest that, rather than merely diffusing along (a) paracellular pathway(s), chloride flows through (a) cellular structure(s), notably mitochondria-rich cells. These cells can therefore be considered as targets for aldosterone.Presented in part before the Belgian Physiological Society (Beauwens et al. 1985)