Renal hemodynamics and prostaglandin E2 excretion in a nonhuman primate model of septic shock

The mechanisms responsible for renal insufficiency in septic shock (SS) have not been well characterized. We therefore investigated renal hemodynamics and the renal excretion of prostaglandin E2 (PGE2) in a nonhuman primate model of severe, low systemic vascular resistance (SVR) SS. In 18 cynomolgus monkeys, SS was induced by an infusion of 3 x 10(10) live Escherichia coli per kg; five saline-treated animals served as nonseptic controls. Systemic and renal hemodynamics, and urine PGE2 concentrations were determined over the 3 h after the induction of sepsis. The septic group demonstrated a significant (p less than .001) and sustained depression in both mean arterial pressure and SVR. Septic animals also had significantly lower effective renal plasma flow (ERPF) (p less than .01) and glomerular filtration rate (GFR) (p less than .01) compared to controls. Furthermore, the renal hemodynamic response to SS was biphasic, with significant increases in ERPF and GFR in the second hour postsepsis, followed by a pronounced decrease in the third postseptic hour. The septic group also demonstrated an increase in the renal excretion of PGE2 (p less than .001) that was temporally associated with the transient recovery in renal hemodynamics during the second postseptic hour. These sepsis-induced renal alterations may be important in the pathogenesis of renal insufficiency complicating clinical SS.     

Disturbed relationship between urinary prostaglandin E2 excretion, plasma arginine vasopressin and renal water excretion after oral water loading in early hepatic cirrhosis

An oral water load of 20 ml kg-1 body weight was given to 11 patients with early hepatic cirrhosis and to 16 healthy control subjects. Urinary output (V), free water clearance (CH2O), urinary excretion of prostaglandin E2 (PGE2) and F2 alpha (PGF2 alpha), and plasma concentration of arginine vasopressin (AVP) were determined before and during the first 4 h after loading. During basal conditions, PGE2 excretion was the same in patients (75 pg min-1, median, range 15-569) and controls (78 pg min-1, range 22-262), but during the first hour after water loading, PGE2 increased to a significantly higher level in cirrhotic patients (423 pg min-1, median) than in control subjects (162 pg min-1) (P less than 0.05). No difference in PGF2 alpha excretion was found between the two groups. Urinary output and CH2O were significantly lower after water loading in patients than in controls. Arginine vasopressin before water loading did not differ between patients and control subjects, but after loading it was unchanged in the patients, whereas a significant reduction (1.9 to 1.4 pmol l-1, P less than 0.01) was found in the control subjects. In controls, but not in patients, PGE2 was significantly positively correlated to V and CH2O, and negatively correlated to AVP after water loading. Thus, renal PGE2 excretion is increased and CH2O is decreased after water loading in patients with early hepatic cirrhosis, and a disturbed relationship seems to exist between PGE2 on the one hand, and AVP and renal water excretion, on the other, in these patients after water loading.(ABSTRACT TRUNCATED AT 250 WORDS)     

Renal tubular site of action of felodipine

The renal tubular site of action of felodipine was localized using renal clearance and recollection micropuncture techniques in the anesthetized rat. In initial renal clearance experiments, felodipine (2.75 nM/kg/min i.v. X 60 min) had no effect on mean arterial pressure or glomerular filtration but significantly increased urinary flow rate, sodium and potassium excretion. In subsequent recollection micropuncture experiments, felodipine decreased mean arterial pressure but did not affect renal blood flow or renal vascular resistance or glomerular filtration rate; absolute and fractional urinary excretion of sodium and water, but not potassium, were increased. Proximal tubular and loop of Henle sodium, potassium and water reabsorption were not affected but distal tubular and collecting duct sodium and water (not potassium) reabsorption were decreased by felodipine. Felodipine is a vasodilator antihypertensive agent which, in doses which decrease mean arterial pressure in normotensive rats, increases urinary flow rate and sodium excretion by inhibiting distal tubular and collecting duct sodium and water reabsorption; potassium reabsorption or excretion is not affected. As a vasodilator antihypertensive agent, felodipine possesses beneficial natriuretic rather than detrimental sodium retaining properties.     

Release and effect of prostaglandin E2 in cocultures of lymphocytes and human tubular cells

Prostaglandin E2 reduced the expression of HLA-ABC as well as HLA-DR antigens in cultured human tubular cells, when cells were stimulated by gamma-interferon. The PGE2 release was low in tubular cell cultures, but highly increased by coculture of tubular cells and allogeneic lymphocytes, compared to cultures of unstimulated lymphocytes, or to cocultures with autologous lymphocytes. Cocultures between non-adherent mononuclear cells and tubular cells produced low amounts of PGE2, whereas cocultures of adherent monocytes and tubular cells produced equal as much PGE2 as cultures made with stimulated peripheral blood leucocytes. The adherent cells were dominated by macrophages. The proliferative response of lymphocytes in cocultures with tubular cells was low, and was increased by indomethacin. The results indicated, that presence of monocytes adherent to the tubular cells in cocultures, down-regulate the proliferative response of allogeneic lymphocytes to the tubular cells, which may in part attribute to an inhibitory effect of PGE2.     

Effect of Sar1-Ileu8-angiotensin on renal prostaglandin E2 biosynthesis and excretion

To test the hypothesis that renal prostaglandin (PG) biosynthesis is regulated by angiotensin (AII), rabbits were given prolonged treatment with the AII analogue, Sar1-Ileu8AII (200 micrograms/kg/4 hr, subcutaneously), for 2 days during a low, normal, and high sodium intake. Sodium restriction augmented plasma renin activity (PRA), which was associated with a rise in basal renal PGE2 synthesis and urinary excretion, whereas sodium supplementation attenuated PRA with a decrease in renal PGE2 synthesis and urinary excretion. Sar1-Ileu8AII administration, with either a low, normal, or high salt intake, suppressed PRA. Sar1-Ileu8AII injection with a low sodium intake also suppressed renal PGE2 synthesis and excretion that was associated with a fall in blood pressure, suggesting an antagonistic action of this agent on vascular beds and renal PGE2 synthesis. On the other hand, with a high sodium intake Sar1-Ileu8-AII increased renal PGE2 synthesis and excretion as well as blood pressure, revealing an agonistic action of this compound under these conditions. The results suggest that exogenous AII analogue may act as an antagonist or agonist depending on sodium intake and endogenous AII levels, renal PGE2 synthesis is dependent on AII levels, either endogenously produced or exogenously administered (as an AII agonist), and the action of AII analogue on vascular beds and renal PGE2 synthesis does not appear to parallel its action on renin-AII feedback regulation at the juxtaglomerular cell especially under conditions of high sodium intake.     

Renal excretion of prostaglandin E2 and plasma renin activity in type I diabetes mellitus: relationship to normoglycemia achieved with artificial pancreas

To determine the effect of normoglycemia on renal prostaglandin synthesis and renin-angiotensin system activity, prostaglandin E2 (PGE2) urinary excretion, plasma renin activity (PRA), and glomerular filtration rate (GFR) were studied in seven patients with insulin-dependent diabetes mellitus (IDDM) without complications, both in basal conditions and after a 20-h treatment with an artificial pancreas. Normoglycemia induced a significant reduction in PGE2 excretion (88 +/- 23 vs. 55 +/- 25 ng/12 h, P less than .05) and GFR (138 +/- 34 vs. 105 +/- 20 ml X min-1 X 1.73 m-2, P less than .05) and a nonsignificant increment of PRA (0.52 +/- 0.48 vs. 0.83 +/- 0.92 ng X ml-1 X h-1). The results enhance the hypothesis that renal prostaglandins play a role in the renal functional alterations observed in IDDM during hyperglycemia.     

Urinary prostaglandin F2 alpha excretion is not pH-dependent in the conscious rat: implications for the urinary prostaglandin E2/prostaglandin F2 alpha ratio

1. The influence of urine pH on the urinary excretion of prostaglandin (PG) F2 alpha and the PGE2/PGF2 alpha ratio has been examined in the conscious rat. 2. The basal urinary PGF2 alpha excretion rate of 3.9 pmol/h (n = 23) did not vary with urine pH. In marked contrast, PGE2 excretion increased as the urine became more alkaline. The PGE2/PGF2 alpha ratio therefore progressively increased from 1.5 to 22 as the pH of the urine changed from pH 5.8 to pH 7.8. 3. The independence of PGF2 alpha excretion from urine pH: (a) excludes cyclo-oxygenase as a potential site of action for the pH-dependence of urinary PGE2 excretion; (b) suggests that the urinary PGE2/PGF2 alpha ratio measured in alkaline urine may be a more accurate reflection of the kidneys, ability to synthesize these two prostaglandins in vivo; (c) suggests that control of urine pH is required before the urinary PGE2/PGF2 alpha ratio can be employed as an index of PGE2 9-ketoreductase (EC 1.1.1.189) activity in vivo.     

Urinary pH as a determinant of prostaglandin E2 excretion by the conscious rat

The urinary excretion of prostaglandin E2 (PGE2) was measured in conscious rats under conditions which produced either acid or alkaline urine, but a similar change in fluid and solute excretion. Oral isotonic saline increased both urine flow and sodium excretion but did not alter urinary PGE2 output (which remained constant at 80 pmol/3 h per rat) or urine pH (6.2). When the urine was made alkaline (pH 7.8) by oral sodium bicarbonate or carbonate, urinary PGE2 was approximately 3-fold greater (P less than 0.001) than the control (pH 6.2). The urine flow and sodium output were also increased. When the urine was made acidic (pH 5.7) by oral ammonium chloride, urinary PGE2 excretion was reduced (P less than 0.01) to approximately half the control output. The urine flow and sodium output increased. Within a group of 12 rats receiving oral isotonic saline a positive linear correlation coefficient (P less than 0.002) was established between urine pH and PGE2 excretion. The results indicate that urine pH may be a determinant of PGE2 excretion in unrestrained, conscious rats. It seems likely that this effect of pH is mediated by a change in the passive reabsorption of PGE2 in the distal nephron, although alternative explanations such as altered tubular secretion or synthesis cannot be categorically excluded.     

Renal and endocrine regulation of water and electrolyte balance

The kidneys have primary responsibility for regulating the body's water and solute balance. Of the 180 L per day that are filtered at the glomerulus, about 98 to 99 per cent is reabsorbed throughout the course of the renal tubule. The kidney can produce a concentrated urine or a dilute urine, depending on the needs of the body. Several hormones, notably aldosterone, ADH, PTH, and calcitonin, as well as vitamin D, are important in the regulation of water and solutes. This article has not discussed other important renal functions as noted in the introduction.     

Is the urinary excretion of prostaglandin E in man dependent on urine pH?

The relationship between urine pH, modified by the oral administration of either ammonium chloride or sodium bicarbonate, and the urinary excretion of prostaglandin E (PGE) was studied in healthy female subjects. The urinary concentration of PGE, normally constant in man, was significantly higher (P less than 0.02) in alkaline than in acid urine. pH-dependent metabolism and flow-dependent excretion were identified as two factors liable to obscure the demonstration of the pH-dependency of the urinary excretion rate of PGE in man.     

Effect of triamterene on urinary excretion of immunoreactive prostaglandin E in essential hypertension

The effect of triamterene on urinary excretion of prostaglandin E was studied, and the results were compared with those obtained with spironolactone. Urinary excretion of immunoreactive prostaglandin E was measured radioimmunologically. Triamterene was administered in a dose of 100 mg/day for 8 days to 7 patients with essential hypertension. Following the administration of triamterene, urinary prostaglandin E tended to increase. However, the increment was not significant. The lack of significant increase in urinary prostaglandin E excretion during the administration of triamterene contrasted with our previous finding with spironolactone, in which a significant increase in prostaglandin E excretion was observed on the first day of spironolactone administration. Urinary Na excretion and urinary Na/K ratio were significantly increased and urine volume also tended to increase following the administration of triamterene. Plasma renin activity and plasma aldosterone concentration were increased in all cases. However, there was no significant correlation between these parameters and urinary prostaglandin E. These results suggest that the effect of triamterene on renal prostaglandin E synthesis is different from that of spironolactone and that the change in urinary prostaglandin E after the administration of triamterene is not the reflection of the change in the renin-angiotensin-aldosterone system.